bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Malfunction Rate with Self-Locating Catheters
Authors: Minguela Ignacio , Lanuza Manuel , De Gauna Ramón Ruiz , Rodado Raquél , Alegría Soledad , Andreu Alberto J. , González María J. , Rodríguez Benigno , Vítores Jose M. , Castellanos Teresa , Martínez Concepción , Aurrekoetxea Begoña , Chena Alejandro 
Published: February 2020

Objective We analyzed malfunction rates (obstruction, omental wrapping, displacement) and catheter survival for self-locating catheters as compared with other Tenckhoff catheter designs. Patients and Methods We conducted our survey at two centers, prospectively studying all self-locating catheters implanted from May 1997 to October 2000 and used for peritoneal dialysis (PD). Tenckhoff catheters of other designs used previously in our units were used as the control group. We analyzed removal causes and catheter survival. Results We studied 173 catheters (105 self-locating catheters, 53 straight catheters, and 15 coiled catheters) implanted in 139 patients (43% of them women) with a mean age of 53 ± 14 years. The analysis of catheter removal showed that 3 of 105 self-locating catheters, 3 of 15 coiled catheters, and 17 of 53 straight catheters were removed owing to malfunction (c 2: p = 0.0000). Kaplan–Meier curves showed that the bulk of removals for malfunction occurred within the first 3 months after PD start. The group of self-locating catheters showed better survival (log-rank: p = 0.0009). Other causes for catheter removal included peritonitis ( n = 22), exit-site infection alone ( n = 4), and end of PD treatment ( n = 66). No significant differences were seen in the annual peritonitis rate (straight-tip: 0.955 ± 2.315 episodes annually; coiled-tip: 0.651 ± 0.864 episodes annually; self-locating: 0.720 ± 1.417 episodes annually; t-test: p > 0.400). No gut or bladder perforations were observed. Conclusion In our survey, self-locating catheters were associated with better survival and fewer removals for malfunction than were Tenckhoff catheters of other designs.
Building the Evidence in Peritoneal Dialysis: Use of Randomized Controlled Trials, and Observational and Registry Data
Authors: Moist Louise M. 
Published: February 2020

Renal replacement therapy (RRT) has achieved widespread acceptance without being subjected to the rigors of randomized controlled clinical trials (RCCTs). The RCCT remains the “gold standard” of evidenced-based medicine, but ethical, logistic, and financial limitations mean that not all questions are amenable to a RCCT. Renal registries collect, aggregate, analyze, and interpret data on the occurrence and outcome of renal failure in a defined population. Observational data can be used only to show associations, not causality. Nevertheless, most clinical practice guidelines in nephrology are derived from observational data. The nephrology community needs to join forces to decide the questions that deserve the time, energy, and resources of an RCCT. Prospective observational data can be enhanced by collaboration, standardized definitions, development of a risk-adjustment tool, and consensus among the key players, including professional associations, government, industry, and hospitals. The challenge is to provide evidence-based practice guidelines for the delivery of care to the end-stage renal patient.
Peritoneal Dialysis in the Patient with a Failing Renal Allograft
Authors: Davies Simon J. 
Published: February 2020

Background Patients returning to dialysis treatment after a period with a functioning allograft represent a special case in the integrated care model of renal replacement therapy. They are known to nephrologists— and thus are ideal candidates for a timely commencement of dialysis—but they have had time to accrue additional cardiovascular risk. Furthermore, they have been exposed to prolonged immunosuppression. Purpose The present study aimed to establish the clinical outcomes of patients returning to peritoneal dialysis (PD) with failing allografts [survival, technique survival, longitudinal residual renal function (Kt/VR), peritoneal membrane function (solute transport), and plasma albumin] and to compare those outcomes with outcomes in new, contemporary patients. Setting The study was conducted in a single center where prospective collection of data now known to be important in determining outcome on peritoneal dialysis (age, comorbidity, albumin, Kt/VR, and solute transport) has been performed since 1989. Methods All patients commencing PD between 1989 and 2001 after failure of an allograft that had functioned for more than 6 months were identified. Outcomes in that group were compared to outcomes in all new PD patients and in all dialysis patients with failed grafts who were returning to hemodialysis (HD) in the same period. Results The study identified 45 patients with failed allografts: 28 were commencing PD treatment, and 17 were commencing HD treatment. Those patients were significantly younger than the 469 new patients commencing PD [FailedTx→ PD 41.2 years, FailedTx→ HD 38.9 years, NewPD 54.7 years; analysis of variance (ANOVA): p < 0.001]. We saw no significant difference in the survival of failed transplant patients commencing PD as compared with those commencing HD (log rank: p = 0.11). Kaplan–Meier plots of patient survival were better for failed transplant patients as compared with all new PD patients. When corrected using Cox regression, the survival advantage was seen to be due to age and comorbidity at start of PD. Pure technique failure (excluding death) was not different between the groups. Compared with all new PD patients, patients with failed allografts had similar longitudinal plasma albumin and a tendency toward an earlier increase in solute transport, but a more rapid loss of Kt/VR, ( p < 0.05 at 6 – 48 months). Conclusions Peritoneal dialysis would appear to be a good option for patients with failing allografts. Co-morbidity is the predominant determinant of survival. That finding underlines the need for attention to factors that might prevent accrual of cardiovascular risk during the post-transplantation period. The earlier loss of Kt/VR in those patients might be prevented by developing strategies of continued immunosuppression after commencement of dialysis, although infection risk is an important issue.
The Cost Barrier to Peritoneal Dialysis in the Developing World—An Asian Perspective
Authors: Li Philip K.T. , Chow Kai Ming 
Published: February 2020

Countries in Asia vary significantly in culture and socioeconomic status. Dialysis costs and reimbursement structures are significant factors in decisions about the rates and modalities of renal replacement therapy. From our survey of Asian nephrologists conducted in 2001, a number of observations can be made. In many developing countries, the annual cost of continuous ambulatory peritoneal dialysis (CAPD) is greater than the per-capita gross national income (GNI). The median cost of a 2-L bag of peritoneal dialysis (PD) fluid is around US$5. The absolute cost of PD fluid among countries with significant differences in per-capita GNI actually varies very little. Thus, most renal failure patients can be expected to have problems accessing PD therapy in developing countries in Asia. In countries with unequal reimbursement policies for PD versus hemodialysis, a lack of incentive to prescribe PD also exists. Automated PD is nearly non existent in many developing countries in Asia. Some possible ways to reduce the cost barriers to PD in those countries include • individual governments providing more public funding for treating dialysis patients; • dialysate-producing companies reducing the cost of their products; • physicians using appropriately smaller exchange volumes (3 x 2 L) in some Asian patients with smaller body sizes and with residual renal function; and • reducing the complication rate for PD (for example, peritonitis) thereby reducing the costs required for treatment and hospitalization.
How Can We Standardize Peritoneal Thickness Measurements in Experimental Studies in Rats?
Authors: Duman Soner , Sen Sait , Günal Ali I. , Asci Gülay , Akcicek Fehmi , Basci Ali 
Published: February 2020

Objective The various methods of measuring peritoneal thickness in experimental studies in rats have yielded conflicting results. Also, no standard method exists to assess histologic findings in peritoneal morphology. We therefore undertook the present study to create a reproducible and standard method for assessing rat peritoneal histology in experimental studies. Methods Parietal peritoneal samples from 61 Wistar albino rats were used in the study. Excepting the skin, the whole abdominal wall from each rat was cut two-dimensionally (longitudinally and horizontally), fixed in formalin, and processed routinely for light microscopy. Slides were divided into two groups according to the direction of the inner abdominal muscle fibers in the sections. Longitudinal and horizontal sections of abdominal muscle were evaluated. For every section, one histopathology image was captured from a light microscope to an IBM-compatible computer. Peritoneal thickness (mean of the maximum and the minimum) and submesothelial area (SMA) were drawn on the image. A computer program then automatically performed measurements. Two different measurement methods were compared, based on the same sections. Results The mean peritoneal thickness was 91 ± 8 μm in the longitudinal sections and 75 ± 7 μm in the horizontal sections ( p < 0.05). Measurements of the SMA were found to be 47,762 ± 4,374 μm2 for the longitudinal sections and 40,389 ± 3,631 μm2 for the horizontal sections ( p < 0.05). In both types of sections, a positive correlation (96% for longitudinal and 90% for horizontal) was found between the SMA and the peritoneal thickness ( p < 0.01). The SMA measurements correlated significantly with functional properties [ratio of the dialysate concentration of glucose initially and after a 1-hour dwell (D1/D0 glucose), ultrafiltration, and protein loss; p < 0.01]. Conclusion Peritoneal thickness can be measured as a mean of the minimum and maximum values. That measurement strongly correlates with submesothelial area. Both types of sections can be used, but the horizontal and longitudinal sections show systematic differences. All samples in a study should be taken using the same section pattern, either longitudinal or horizontal.
New Animal Models for Encapsulating Peritoneal Sclerosis—Role of Acidic Solution
Authors: Nakamoto Hidetomo , Imai Hiroe , Ishida Yuji , Yamanouchi Yasuhiro , Inoue Tsutomu , Okada Hirokazu , Suzuki Hiromichi 
Published: February 2020

Objective Encapsulating peritoneal sclerosis (EPS), in which all or part of the intestine is enveloped in a fibrous ball resembling a cocoon, is a serious complication of peritoneal dialysis (PD). The aim of the present study was to investigate whether pH-neutral or acidic dialysis solutions induce peritoneal fibrosis. Design We divided 18 male Wistar–Kyoto (WKY) rats into three groups and dialyzed them with various solutions as follows: group I, 10 mL acidic dialysis solution (pH 3.8, containing 1.35% glucose), n = 6; group II, 10 mL pH 5.0 dialysis solution, n = 6; and group III, 10 mL neutral dialysis solution (pH 7.0), n = 6. Peritoneal catheters were inserted, and dialysis solution was injected every day for 40 days. At the end of the experiment, a peritoneal equilibration test (PET) was performed. Expression of mRNA of aquaporins 1 and 4 (AQP-1 and AQP-4) in the peritoneum were studied by semiquantitative reverse-transcriptase polymerase chain reaction (RT-PCR). Results In rats treated with pH 3.8 dialysis solution, necropsy findings revealed features identical to those of EPS. The typical appearance was of granulation tissue or fibrotic tissue (or both) covering multiple surfaces. Multiple adhesions were present. In microscopic examinations, peritoneal fibrosis and loss of mesothelium were found. In rats treated with pH 7.0 dialysis solution, no signs of EPS were seen. In rats treated with pH 5.0 dialysis solution, milder changes (subserosal thickening and partial adhesion of the peritonea) were observed. The mRNA of AQP-1 and AQP-4 were expressed in the peritonea of the rats. The expression of the AQPs was significantly suppressed in rats treated with pH 3.8 dialysis solution. Conclusions In rats, long-term intraperitoneal injection of acidic dialysis solution produced features typical of EPS in humans. Newly developed neutral dialysis solutions protected the against the development of EPS during peritoneal dialysis in rats.
Non Anticoagulant Effects of Heparin: Implications for Animal Models of Peritoneal Dialysis
Authors: De Vriese An S. , Mortier Siska , Lameire Norbert H. 
Published: February 2020

Heparin is a glycosaminoglycan with well-known anticoagulant activity. That property is used in animal models of peritoneal dialysis to maintain catheter patency and to prevent the development of peritoneal adhesions. However, heparin has a host of biologic actions beyond its role as an anticoagulant. Heparin modulates the activity of various inflammatory cells, affects the synthesis of extracellular matrix, has antiproliferative effects on several cell types, and influences neoangiogenesis. By virtue of those actions, intraperitoneally administered heparin may interfere with peritoneal membrane homeostasis. The potential side effects of heparin use in animal models of peritoneal dialysis should be recognized to permit correct interpretation of experimental studies conducted in those models.
The Effect of Icodextrin-Based Solutions on Peritoneal Transport in Rats Undergoing Chronic Peritoneal Dialysis
Authors: Pawlaczyk Krzysztof , Garcia–Lopez Elvia , Kuzlan–Pawlaczyk Malgorzata , Heimbürger Olof , Bergström Jonas , Breborowicz Andrzej , Lindholm Bengt 
Published: February 2020

Background We evaluated the effect of icodextrin on peritoneal permeability and inflammation in an experimental chronic peritoneal dialysis (PD) model with repeated dwell studies (DSs) in non uremic rats. Methods Male Wistar rats with implanted peritoneal catheters were infused twice daily for 3 weeks with 20 mL Dianeal 3.86% (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.) ( n = 11) or icodextrin 7.5% ( n = 12). After 10 days (DS1) and 21 days (DS2), a 4-hour DS using 30 mL icodextrin solution was performed in conscious animals. Radioiodinated serum albumin (RISA) was used as a macromolecular volume marker. Blood samples were drawn before the start of the dwell and at its end. Results We observed a steady increase in intraperitoneal volume (IPV) versus dwell time (0 – 240 minutes) during DS1 and DS2 in both groups. No significant differences in peritoneal permeability to solutes were observed between the groups. However, in both groups, IPV volume was significantly higher during DS2 after the 4-hour dwell time [IPV icodextrin: 34.4 ± 1.4 mL (DS1), 35.4 ± 1.1 mL (DS2), p < 0.002; IPV Dianeal: 34.2 ± 0.9 mL (DS1), 35.2 ± 0.7 mL (DS2), p < 0.01]. Conclusion Changes of peritoneal permeability seen during in vivo experimental models of chronic peritoneal dialysis in rats with repeated dwell studies are comparable to results obtained in humans on continuous ambulatory peritoneal dialysis (CAPD).
Colonization-Resistant Antimicrobial-Coated Peritoneal Dialysis Catheters: Evaluation in a Newly Developed Rat Model of Persistent Pseudomonas Aeruginosa Peritonitis
Authors: Finelli Anthony , Burrows Lori L. , DiCosmo Frank A. , DiTizio Valerio , Sinnadurai Selva , Oreopoulos Dimitrios G. , Khoury Antoine E. 
Published: February 2020

Objective Development of a rat model of persistent peritonitis and evaluation of the ability of liposomal ciprofloxacin hydrogel-coated silicone to resist colonization. Design A newly developed model of persistent Pseudomonas aeruginosa peritonitis to compare the ability of liposomal ciprofloxacin hydrogel (LCH)-coated silicone versus plain silicone for resistance to bacterial colonization. Animals Male Sprague–Dawley rats. Results Inoculating the peritoneum of rats with 1 mL 0.5% agar containing 106 colony-forming units (cfu)/mL P. aeruginosa in the presence of a plain silicone coupon resulted in persistent peritonitis for at least 7 days. Plain silicone coupons in all 40 rats were colonized (median 2.54 × 103 cfu/cm2; range 5.0 × 101 – 1.0 × 106 cfu/cm2) and peritoneal washings were consistently culture-positive. In contrast, the LCH coupons removed after 7 days from the 40 test rats were sterile, as were the peritoneal washings, and there was no evidence of peritonitis. Blood cultures were negative in both groups. Conclusions Liposomal ciprofloxacin hydrogel-coated silicone resists colonization in this rat model of persistent P. aeruginosa peritonitis.
Comparison of Hemodialysis and Peritoneal Dialysis — a Cost–Utility Analysis
Authors: Sennfält Karin , Magnusson Martin , Carlsson Per 
Published: February 2020

Objective Our aim was to compare both health-related quality of life and costs for hemodialysis (HD) and peritoneal dialysis (PD) in a defined population. Design Decision-tree modeling to estimate total costs and effects for two treatment strategies, HD and PD, among patients with chronic kidney failure, for 5 years following the start of treatment. Courses of events and health-care consumption were mapped in a retrospective matched-record study. Data on health status were obtained from a matched population by a quality-of-life questionnaire (EuroQol). The study has a societal perspective. Setting All dialysis departments in the southeastern health-care region of Sweden. Patients 136 patients with kidney failure, comprising 68 matched pairs, were included in a retrospective record study; 81 patients with kidney failure, comprising 27 matched triplets, were included in a prospective questionnaire study. Main Outcome Measures Cost per life year and cost per quality-adjusted life year. Results The cost per quality-adjusted life year for PD was lower in all analyzed age groups. There was a 12% difference in the age group 21 – 40 years, a 31% difference in the age group 41 – 60 years, and an 11% difference in the age group 61+ years. Peritoneal dialysis and HD resulted in similar frequencies of transplantation (50% and 41%, respectively) and expected survival (3.58 years and 3.56 years, respectively) during the first 5 years after the initiation of treatment. Conclusion The cost–utility ratio is most favorable for PD as the primary method of treatment for patients eligible for both PD and HD.
The Effect of Technique Failure on Outcome in Black Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Kim George C. , Vonesh Edward F. , Korbet Stephen M. 
Published: February 2020

Background We previously reported that, while black patients have a better patient survival than white patients on peritoneal dialysis (PD), they also have a significantly higher technique failure rate (39% vs 8%, p < 0.0001). The purpose of this study was to determine the effect of technique failure/transfer to hemodialysis (HD) on patient survival in black PD patients. Methods We retrospectively evaluated 137 incident black patients entering our PD program from January 1987 to December 1997. During the course of follow-up, 82 (60%) patients remained on PD (PD group) while 55 (40%) patients were permanently transferred to HD (PD–HD group). The primary outcome measured was patient survival. Results Average age was 49 ± 15 years, 42% were male, and 40% had diabetes mellitus. At baseline, serum creatinine was 10.8 ± 5.4 mg/dL, serum albumin 3.4 ± 0.7 g/dL, body mass index 27.3 ± 6.5 kg/m2, peritoneal transport status was high in 18% and high-average in 61%, and residual glomerular filtration rate was 3.4 ± 3.5 mL/minute. There were no significant differences in clinical features, nutritional status, peritoneal transport, residual renal function, or dialysis adequacy at baseline between the PD group and PD–HD group. While a greater proportion of patients transferring to HD had cardiac disease (53% vs 32%, p < 0.05), there were no other significant differences in 15 comorbid conditions assessed at baseline. The primary reason for transfer was peritonitis (64%) and the overall peritonitis rate in the PD–HD group was significantly higher than in the PD group (2.21 vs 1.17 episodes/patient-year, p < 0.0001). Overall follow-up was 34 ± 25 months for PD group and 44 ± 26 months for PD–HD group ( p < 0.01), with a mean time on PD prior to transfer to HD of 22 ± 18 months. During the course of follow-up, there were no significant differences between the two groups in the number of patients transplanted or deaths. Patient survival at 1, 2, and 5 years was 91%, 80%, and 57% for PD group and 96%, 92%, and 55% for PD–HD group [ p = not significant (NS)]. A risk-adjusted time-dependent Cox regression analysis resulted in an adjusted relative risk of death that was not significantly different for those who transferred from PD to HD versus those who remained on PD (relative risk 1.49; 95% confidence interval 0.77–2.89; p = NS). Conclusions In black patients on PD, transfer to HD is not associated with any significant difference in patient survival compared to patients remaining on PD. While a high rate of peritonitis predisposes to technique failure, we found no features at baseline predictive of patients at greatest risk to fail PD. Since technique failure does not portend a poorer prognosis, PD remains a viable option for black patients entering an end-stage renal disease program.
A Population-Specific Formula Predicting Creatinine Excretion in Continuous Peritoneal Dialysis
Authors: Tzamaloukas Antonios H. , Murata Glen H. 
Published: February 2020

Objective The Cockroft–Gault formula was shown to systematically overestimate the decline in creatinine excretion with age in continuous peritoneal dialysis (CPD) patients and is, therefore, not suitable for studying creatinine excretion. The purpose of the present study was to develop and test a population-specific formula predicting average creatinine excretion in CPD. Methods Creatinine excretion in urine plus dialysate was measured in 925 CPD patients. Forty patients were excluded because of evidence of noncompliance. The remaining 885 subjects were randomly grouped into a derivation group ( n = 432) and a validation group ( n = 453). Stepwise multiple linear regression models were used to predict creatinine excretion in the derivation group. The candidate variables, chosen because they were previously shown to be predictors of creatinine excretion in CPD, included weight (W), age (A), gender (G), diabetes (D), and interaction terms between these four variables. Estimates of creatinine excretion from the best-fit regression formula (CrExcr1) and from the Cockroft–Gault formula (CrExcr2) were compared to creatinine excretion (CrExcr) in the validation group. Results The best-fit regression model in the derivation group included all four candidate variables (W, A, G, D), but no interaction terms. This model was as follows: CrExcr1 = 302.150 – 4.380A + 171.234G – 39.041D + 11.730W ( r 2 = 0.477, p < 0.001). In the validation set, CrExcr = –15.795 + 0.988CrExcr1 ( r2 = 0.447, p < 0.001), and CrExcr = –303.823 + 0.732CrExcr2 ( r2 = 0.340, p < 0.001). When the differences between measured and predicted creatinine excretion did not take into account the sign of each individual difference, CrExcr – CrExcr1 = 201 ± 156 mg/24 hours, and CrExcr – CrExcr2 = 235 ± 174 mg/24 hr ( p < 0.001) in the validation group. When the sign of the difference was taken into account, CrExcr – CrExcr1 = –28 ± 149 mg/24 hr, and CrExcr – CrExcr2 = 63 ± 295 mg/24 hr ( p < 0.001). Conclusions A population-specific formula predicting creatinine excretion in CPD was derived. This formula has greater accuracy than the Cockroft–Gault formula and can be used in studies of creatinine excretion in CPD.