bluuebunny/crossref_metadata_2025_split huggingface dataset:
Measurement of Continuous Ambulatory Peritoneal Dialysis Prescription Adherence Using a Novel Approach
Authors: Sevick Mary Ann , Levine Douglas W. , Burkart John M. , Rocco Michael V. , Keith Jennifer , Cohen Stuart J. 
Published: February 2020

Objective The purpose of the study was to test a novel approach to monitoring the adherence of continuous ambulatory peritoneal dialysis (CAPD) patients to their dialysis prescription. Design A descriptive observational study was done in which exchange behaviors were monitored over a 2-week period of time. Setting Patients were recruited from an outpatient dialysis center. Participants A convenience sample of patients undergoing CAPD at Piedmont Dialysis Center in Winston–Salem, North Carolina was recruited for the study. Of 31 CAPD patients, 20 (64.5%) agreed to participate. Measures Adherence of CAPD patients to their dialysis prescription was monitored using daily logs and an electronic monitoring device (the Medication Event Monitoring System, or MEMS; APREX, Menlo Park, California, U.S.A.). Patients recorded in their logs their exchange activities during the 2-week observation period. Concurrently, patients were instructed to deposit the pull tab from their dialysate bag into a MEMS bottle immediately after performing each exchange. The MEMS bottle was closed with a cap containing a computer chip that recorded the date and time each time the bottle was opened. Results One individual's MEMS device malfunctioned and thus the data presented in this report are based upon the remaining 19 patients. A significant discrepancy was found between log data and MEMS data, with MEMS data indicating a greater number and percentage of missed exchanges. MEMS data indicated that some patients concentrated their exchange activities during the day, with shortened dwell times between exchanges. Three indices were developed for this study: a measure of the average time spent in noncompliance, and indices of consistency in the timing of exchanges within and between days. Patients who were defined as consistent had lower scores on the noncompliance index compared to patients defined as inconsistent ( p = 0.015). Conclusions This study describes a methodology that may be useful in assessing adherence to the peritoneal dialysis regimen. Of particular significance is the ability to assess the timing of exchanges over the course of a day. Clinical implications are limited due to issues of data reliability and validity, the short-term nature of the study, the small sample, and the fact that clinical outcomes were not considered in this methodology study. Additional research is needed to further develop this data-collection approach.
Comparison of Peritoneal Fluid Culture Results from Adults and Children Undergoing Capd
Authors: Yinnon Amos M. , Gabay Dorit , Raveh David , Schlesinger Yechiel , Slotki Itzchak , Attias Denise , Rudensky Bernard 
Published: February 2020

Background Peritonitis is a common complication in patients with end-stage renal disease treated by continuous ambulatory peritoneal dialysis (CAPD). Empirical treatment is based on the organisms that are most frequently isolated and their susceptibilities. Objective To analyze and then compare peritoneal fluid culture results from adult and pediatric patients on CAPD, with respect to micro-organisms and antimicrobial susceptibilities. Design Three-year retrospective review of peritoneal fluid cultures from adults and children on CAPD. Results We isolated 481 organisms from 378 peritoneal fluid specimens, collected from 135 patients (45 children, 90 adults). There were 191 episodes of peritonitis in children (mean 4.2 ± 3.5, range 1 – 15) compared to 187 in adults (2.1 ± 1.9, range 1 – 10) ( p < 0.001). Two or more episodes occurred in 30 of 45 children (67%) compared to 33 of 90 adults (37%) ( p < 0.001). The number of different organisms/patient as well as the total number of isolates/patient were significantly greater in children (respectively, 2.8 ± 2.3, range 1 – 12; and 5.3 ± 5.2, range 1 – 27) than in adults (2.0 ± 1.3, range 1 – 6; and 2.7 ± 2.4, range 1 – 10) ( p < 0.005). After Staphylococcus epidermidis, S. aureus was the most frequently isolated organism, occurring in 18% of episodes in adults and 12% of episodes in children ( p < 0.01). Twenty-two of 33 fungal isolates (67%) in children were Candida parapsilosis compared to 3 of 24 (12%) in adults ( p < 0.001). Subanalysis of multiple episodes revealed that Pseudomonas and Candida occurred significantly more often in children ( p < 0.01), whereas S. aureus occurred more often in adults ( p < 0.001). In polymicrobial episodes S. epidermidis occurred more often in adults ( p < 0.05). Significant differences in susceptibilities to ampicillin, ceftriaxone, chloramphenicol, and gentamicin were found between children and adults ( p < 0.05 – 0.001). Conclusions CAPD-associated peritonitis occurs significantly more often in children than adults. Significant differences in microbial etiology and susceptibilities were found between pediatric and adult patients. Each dialysis unit should periodically analyze peritoneal fluid culture results from its CAPD patients. These data can then be used for optimization of empirical antimicrobial therapy of peritonitis.
Pharmacokinetics of Intermittent Intraperitoneal Cefazolin in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Manley Harold J. , Bailie George R. , Asher Rupesh D. , Eisele George , Frye Reginald F. 
Published: February 2020

Objective To investigate the pharmacokinetic parameters of intermittent intraperitoneal (IP) cefazolin, and recommend a cefazolin dosing regimen in continuous ambulatory peritoneal dialysis (CAPD) patients. Design Prospective nonrandomized open study. Setting CAPD outpatient clinic in Albany, New York. Patients Seven volunteer CAPD patients without peritonitis. Three of the patients were nonanuric while 4 were anuric. Interventions Cefazolin (15 mg/kg total body weight) was given to each patient during the first peritoneal exchange. Blood and dialysate samples were collected at times 0, 0.5, 1, 2, 3, 6 (end of the first antibiotic-containing dwell), 24, and 48 hours after the administration of IP cefazolin. Urine samples were collected in nonanuric patients over the study period. Results The mean ± SD amount of cefazolin dose absorbed from the dialysate after the 6-hour dwell was 69.7% ± 8.0% of the administered dose. The cefazolin absorption rate constant from dialysate to serum was 0.21 ± 0.1 /hr (absorption half-life 3.5 ± 0.8 hr). The mean serum concentrations reached at 24 and 48 hours were 52.4 ± 3.7 mg/L and 30.3 ± 5.9 mg/L, respectively. The mean dialysate cefazolin concentrations reached at 24 and 48 hours were 15.1 ± 3.4 mg/L and 7.9 ± 1.4 mg/L, respectively. The cefazolin serum elimination rate constant was 0.02 ± 0.01 /hr (elimination half-life 31.5 ± 8.8 hr). The total cefazolin body clearance was 3.4 ± 0.6 mL/min. In the 3 nonanuric patients the mean renal clearance of cefazolin was 0.6 ± 0.4 mL/min. The peritoneal clearance of cefazolin was 1.0 ± 0.3 mL/min. The systemic volume of distribution of cefazolin was 0.2 ± 0.05 L/kg. No statistical difference was detected in pharmacokinetic parameters between anuric and nonanuric patients, although this may be due to the small number of patients in each group. Conclusion A single daily dose of cefazolin dosed at 15 mg/kg actual body weight in CAPD patients is effective in achieving serum concentration levels greater than the minimum inhibitory concentration for sensitive organisms over 48 hours, and dialysate concentration levels over 24 hours. Caution is warranted in extrapolation of dosing recommendations to patients who maintain a significant degree of residual renal function.
Intraperitoneal Hyaluronan Production in Stable Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Yamagata Kunihiro , Tomida Chie , Koyama Akio 
Published: February 2020

Objective Several cytokines and proteins are excreted intraperitoneally during the course of peritonitis and stable states in continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate hyaluronan (HYA) is also regarded as a marker of peritoneal healing during bacterial peritonitis. We examined here, intraperitoneal HYA production in stable CAPD patients and compared the results to those of the peritoneal equilibration test (PET), the length of time on dialysis, and other marker proteins. Design We determined the concentration of HYA and other marker proteins in the 4-hour-dwell dialysate at 1-year intervals. Setting CAPD unit in Hitachi General Hospital. Patients The subjects were 46 stable CAPD patients who underwent 104 PETs. Results A correlation was found between the length of time on dialysis and the amount of HYA excretion in the 4-hr-dwell dialysate ( r = 0.403, p < 0.001). A positive but weak correlation was found between the dialysate-to-plasma ratio of the creatinine concentration and dialysate HYA excretion ( r = 0.229, p < 0.05). Seven patients were over the 90th percentile in both the concentration of HYA (>349.2 ng/mL) and the amount of HYA (>743.6 μg/4-hr dwell). Five patients exceeded 1000 μg of HYA excretion in the 4-hr-dwell dialysate, 4 of whom showed an abrupt increase of HYA excretion to more than 1000 μg/4-hr dwell, and discontinued CAPD within 6 months due to ultrafiltration failure. Two of these 4 patients were diagnosed with sclerosing encapsulating peritonitis at autopsy. Conclusion Intraperitoneal HYA production increased with both higher permeable membrane and the length of time on CAPD. Monitoring of HYA in the peritoneal dialysate may be useful as a marker to assess functional and morphological changes in the peritoneum in long-term CAPD patients.
The Effect of Insulin Delivery Route on Lipoproteins in Type I Diabetic Patients on CAPD
Authors: Nevalainen Pasi I. , Lahtela Jorma T. , Mustonen Jukka , Taskinen Marja-Riitta , Pasternack Amos 
Published: February 2020

Objective To evaluate the influence of subcutaneous and intraperitoneal (IP) insulin on plasma lipoproteins in type I diabetic (IDDM) patients with end-stage renal failure (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD). Design A before–after trial. Setting University hospital outpatient care. Participants Eleven IDDM patients with stabilized peritoneal dialysis, age 42.9 ± 2.9 (SEM) years and duration of diabetes 31.4 ± 3.4 years. Intervention Two treatment periods during stabilized CAPD. All patients were first treated with subcutaneous and then with IP insulin. The studies were performed after a median time of 3 months on each treatment. Main Outcome Measures Plasma lipids; apoproteins (Apo) A-I, A-II, and B; high-density lipoprotein (HDL) subfractions; glycemic status; and uremic status. Results After changing from subcutaneous insulin to IP insulin, plasma HDL cholesterol decreased (from 1.29 ± 0.13 mmol/L to 0.96 ± 0.06 mmol/L, p < 0.05), and the low density to high density lipoprotein (LDL/HDL) cholesterol ratio increased ( p < 0.05). The HDL cholesterol decreased in both HDL2 and HDL3 fractions, but significantly so only in HDL3 ( p < 0.01). ApoA-I ( p < 0.05) decreased while the ApoB/ApoA-I ratio ( p < 0.01) and the ApoA-I/HDL-cholesterol ratio ( p < 0.01) increased during IP insulin therapy. Intraperitoneal insulin resulted in significantly better glycemic control than subcutaneous insulin ( p < 0.01). Conclusions In diabetic patients on CAPD therapy, IP insulin, although inducing better glycemic control than subcutaneous insulin, was associated with lowered plasma HDL cholesterol and ApoA-I levels. The atherogenic potential is probably less than expected as the relative particle size of HDL remained unchanged.
Sclerosing Peritonitis and Systemic Lupus Erythematosus: A Report of Two Cases
Authors: Odama Uninibile O. , Shih David J. , Korbet Stephen M. 
Published: February 2020

Objective To heighten the awareness of a possible association of sclerosing peritonitis in patients with systemic lupus erythematosus (SLE). Methods and Results Over the course of 17 years (from January 1981 to December 1997), 371 patients were treated with continuous ambulatory peritoneal dialysis (CAPD) at Rush–Presbyterian–St Lukes Medical Center. The patients were followed on CAPD for an average of 25 ± 21 (SD) months with a median of 19 months (range 0.2 – 115 months). During this time only 2 (0.5%) patients were diagnosed with sclerosing peritonitis, and both had SLE with ongoing evidence of active disease while on CAPD. With a total of 26 SLE patients being treated with CAPD during the observation period, the prevalence of sclerosing peritonitis can be said to be as high as 8% in this patient population. Conclusion These cases suggest that autoimmune diseases, such as SLE, that are well known to cause immune-mediated serositis may represent an additional factor predisposing to the development of sclerosing peritonitis in patients treated with CAPD.
High Glucose Solution and Spent Dialysate Stimulate the Synthesis of Transforming Growth Factor-β1 of Human Peritoneal Mesothelial Cells: Effect of Cytokine Costimulation
Authors: Kang Duk-Hee , Hong Young-Sook , Lim Hyun Joung , Choi Jin-Hee , Han Dae-Suk , Yoon Kyun-Il 
Published: February 2020

Objective To investigate the effect of high glucose and spent peritoneal dialysate on the transforming growth factor-β1 (TGFβ1) synthesis of cultured human peritoneal mesothelial cells (HPMCs) and to examine the effect of costimulation with high glucose or spent dialysate, and cytokines, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNFα) on TGFβ1 synthesis of HPMCs. Design HPMCs were exposed to different concentrations of glucose (30, 60, and 90 mmol/L) or spent peritoneal dialysate for 48 hours in the absence or presence of IL-1β (1 ng/mL) and TNFα (1 ng/mL). TGFβ1 mRNA expression was assessed by Northern blot analysis and TGFβ1 protein release by Western blot analysis and enzymelinked immunosorbent assay (ELISA). Results Exposure of HPMCs to high glucose conditions (30, 60, and 90 mmol/L of D-glucose) induced 2.3-, 3.6-, and 4.0-fold increases in TGFβ1 mRNA expression of HPMC with enhanced TGFβ1 protein synthesis and secretion into the media, whereas there were no significant changes in TGFβ1 synthesis with equimolar concentrations of D-mannitol. Incubation with spent dialysate also significantly increased TGFβ1 mRNA expression and protein secretion compared to control media ( p < 0.05). Stimulation with IL-1β (1 ng/mL) or TNFα (1 ng/mL) resulted in a significant increase in TGFβ1 mRNA expression after 48 hours: 2.7 and 2.1 times the control level, respectively. However, TNFα-induced increase in TGFβ1 mRNA expression was not translated into TGFβ1 protein secretion, while IL-1β stimulation induced a significant increase in TGFβ1 protein secretion as well as TGFβ1 mRNA expression. Combined stimulation by high glucose or spent dialysate, together with IL-1β or TNFα, showed a greater increase in TGFβ1 mRNA expression and protein secretion compared to stimulation by high glucose or spent dialysate alone. Conclusion Our results clearly show that high glucose solution and spent dialysate themselves might be sufficient to stimulate the production of TGFβ1 by peritoneal mesothelial cells. In peritoneal dialysis patients, this state of chronic induction of TGFβ1 is further exacerbated in the presence of peritonitis because of the stimulatory effect of proinflammatory cytokines, resulting in augmented TGFβ1 synthesis, thus promoting peritoneal fibrosis.
Calcium Use Increases Risk of Calciphylaxis: A Case-Control Study
Authors: Zacharias James M. , Fontaine Bunny , Fine Adrian 
Published: February 2020

Objective To investigate the risk factors for the development of calciphylaxis in renal failure, a poorly understood and often fatal condition characterized by calcium deposition in tissues. Design Retrospective case-control study. Setting University hospital peritoneal dialysis center. Patients Eight continuous ambulatory peritoneal dialysis (CAPD) patients with calciphylaxis were identified in a 3-year period. We matched up to five controls for dialysis modality and length of time on dialysis with each case. Statistics Multivariate conditional logistic regression analysis for matched case-controls. Main Outcome Measures Laboratory data and demographics were collected as well as cumulative calcium and vitamin D ingestion over the year prior to disease onset. Results All the patients were female, versus only 38% (14/37) of controls ( p < 0.0001). While not statistically significant, a majority of the patients were diabetic [62.5% (5/8) vs 32% (12/37)]. Peak and average levels of serum calcium, phosphate, calcium x phosphate product, parathyroid hormone (PTH), albumin, iron, total iron-binding capacity (TIBC), and ferritin were not significantly different in cases compared with controls. The use of calcitriol alone or with calcium carbonate was not found to be a significant risk factor for the development of calciphylaxis. In a multivariate analysis, iron intake seemed to be protective, contrary to previous reports, while the use of calcium carbonate was associated with a strong trend to increased risk of calciphylaxis development (odds ratio = 1.029/g and 1.011/g calcium ingested per month, at 1 and 2 – 3 months prior to calciphylaxis development; p = 0.0556 and 0.0565, respectively). Conclusion These data, although limited by the small numbers of index cases, suggest that calcium ingestion is a risk factor for calciphylaxis. The increased use of calcium salts as a phosphate binder in recent years might explain the apparent increased incidence of calciphylaxis in our and other centers. The preponderance of female diabetics among cases reported elsewhere was confirmed in our study.
A Comparative Analysis on the Incidence of Peritonitis and Exit-Site Infection in Capd and Automated Peritoneal Dialysis
Authors: Rodríguez–Carmona Ana , Fontán Miguel Pérez , Falcón Teresa García , Rivera Constantino Fernández , Valdés Francisco 
Published: February 2020

Objective To compare the incidence of peritonitis and exit-site infection in an ample group of patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis in a single center during a 10-year period. Design Nonrandomized, prospective study. Setting Public, tertiary care hospital providing peritoneal dialysis care to a population of (approximately) 750 000 people. Patients We studied 213 patients on CAPD and 115 on automated peritoneal dialysis (APD) starting therapy between January 1989 and August 1998, with a minimum follow-up of 3 months. Main Outcome Measures Using a multivariate approach, we compared the incidence, clinical course, and outcome of peritonitis and exit-site infections in both groups, controlling for other risk factors for the complications studied. Results The incidence of peritonitis was higher in CAPD than in APD (adjusted difference 0.20 episodes/ patient/year, 95% confidence interval 0.08 – 0.32). There was a trend for CAPD patients to present earlier with peritonitis than APD patients, yet the incidence of and survival to the first exit-site infection were similar in both groups. The etiologic spectrum of infections displayed minor differences between groups. Automated PD patients were more frequently hospitalized for peritonitis, but otherwise, the complications and outcome of peritonitis and exit-site infections did not differ significantly between patients on CAPD and those on APD. Conclusions Automated PD is associated with a lower incidence of peritonitis than is CAPD, while exit-site infection is similarly incident under both modes of therapy. The etiologic spectrum, complications, and outcome of peritonitis and exit-site infection do not differ markedly between CAPD and APD. Prevention of peritonitis should be included among the generic advantages of APD over CAPD.
Peritoneal Loss of Growth Hormone in Children on Automated Peritoneal Dialysis
Authors: Haffner Dieter , Hofstetter Christina , Mehls Otto , Schaefer Franz 
Published: February 2020

Objective To provide quantitative data regarding the daily dialytic loss of growth hormone (GH) in children on peritoneal dialysis (PD). Design Prospective study involving 24-hour dialysate collections on 3 consecutive days in patients with and without recombinant human GH (rhGH) treatment. Setting Single-center outpatient PD program. Patients Twenty-six children undergoing automated PD (APD): 6 with and 20 without daily rhGH. Main Outcome Measures Daily peritoneal losses of GH, α1-, β2-microglobulin, transferrin, and albumin. Results The mean (±SEM) daily dialytic GH loss was 2.18 ± 0.62 μg/1.73 m2 per day in rhGH-treated patients and 0.42 ± 0.28 μg/1.73 m2 per day in untreated patients, ( p < 0.05). The intraindividual coefficient of variation of daily GH loss was 65%. The peritoneal loss of GH was positively correlated with that of β2-microglobulin ( r = 0.77, p < 0.001) and α1-microglobulin ( r = 0.51, p < 0.01). The variability in β2-microglobulin and α1-microglobulin elimination, together with the use of rhGH, explained 66% of the total variability of daily GH excretion. In patients without rhGH therapy, the daily peritoneal GH loss was approximately 0.05% of the estimated daily endogenous production rate based on previous estimates in children with end-stage renal failure. In patients on rhGH therapy, less than 0.1% of the injected rhGH dose was eliminated by dialysis. Conclusion Peritoneal losses of GH in children on APD account only for a minute fraction of endogenous metabolic clearance, and do not explain the variability of the rhGH treatment response. The assessment of dialytic GH elimination may be used to estimate time-integrated mean plasma GH concentrations, and to monitor rhGH treatment compliance.
Measurement of Fluid Shift in Capd Patients Using Segmental Bioelectrical Impedance Analysis
Authors: Song Joon Ho , Lee Seoung Woo , Kim Gyeong A. , Kim Moon-Jae 
Published: February 2020

Objective To determine, using segmental bioelectrical impedance analysis (BIA), the characteristics of fluid shift of each body segment in continuous ambulatory peritoneal dialysis (CAPD) patients during and after peritoneal dialysis (PD) solution exchange. Design Observational study with repeated measurements of bioelectrical impedance, which is inversely related to tissue fluid content. Patients Thirteen clinically stable CAPD patients. Methods Bioelectrical impedance was measured at frequencies of 5, 50, 250, and 500 kHz in each body segment four times: (1) before and (2) after drainage of dialysate, and (3) at 1 hour and (4) at 2 hours after exchange of new 1.5% dextrose PD solution. Results Impedance of both arms was significantly increased at 1 hour post exchange at all frequencies. In the trunk, impedance at all frequencies increased significantly after drainage, decreased significantly at 1 hour post exchange, and then increased again for the next hour without significance. Impedance of both legs showed a decreasing tendency at all frequencies during and after exchange. Net calculated water volume changes between the time before drainage and 2 hours post exchange were –0.5 L in the trunk, –0.25 L in both arms, +0.47 L in both legs, –0.28 L in total. The change in body weight between the time before drainage and 2 hours post exchange was –0.21 kg, on average, and significantly correlated with total net calculated water volume change ( p = 0.009). Conclusions Each body segment of the CAPD patient has its own characteristic pattern of fluid shift in response to PD solution exchange or dwell. Segmental BIA may be a useful tool for understanding the physiological changes in fluid shift in CAPD patients.