bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome following Staphylococcal Peritonitis
Authors: Peacock Sharon J. , Howe Paul A. , Day Nicholas P.J. , Crook Derrick W.M. , Winearls Christopher G. , Berendt Anthony R. 
Published: February 2020

Objective Staphylococcus spp predominate as the causative pathogen of continuous ambulatory peritoneal dialysis (CAPD)-related peritonitis. This study evaluated the difference in morbidity and mortality between peritonitis caused by S. aureus and coagulase-negative staphylococci (CoNS). Design Prospective observational study. Setting A single regional dialysis unit in a teaching hospital. Patients Thirty-seven patients had S. aureus peritonitis and 65 patients had CoNS peritonitis between July 1990 and November 1995. Main Outcome Measures Using the first recorded episode of peritonitis, survival analysis was performed for time to ( 1 ) death, ( 2 ) removal of peritoneal dialysis catheter, and ( 3 ) change to hemodialysis. Abdominal complications were recorded for the first and subsequent episodes. Results No difference in time to death was demonstrated for the two groups ( p = 0.79), although two deaths that occurred during therapy for peritonitis were attributable to S. aureus infection. In addition, 5 patients developed serious abdominal complications related to an episode of S. aureus peritonitis. Patients with S. aureus peritonitis had a shorter time to both peritoneal dialysis catheter removal ( p = 0.004) and change to hemodialysis ( p = 0.014). The change in mode of dialysis was independent of catheter loss. Conclusion This study highlights the serious nature of S. aureus peritonitis and confirms the need for effective preventive measures against infection by this pathogen.
The Longitudinal Effect of a Single Peritonitis Episode on Peritoneal Membrane Transport in CAPD Patients
Authors: Ates Kenan , Koç Rafet , Nergizoglu Gökhan , Ertürk Sehsuvar , Keven Kenan , Sen Arzu , Karatan Oktay 
Published: February 2020

Objective To evaluate the longitudinal effect of a single peritonitis episode on peritoneal membrane transport. Design A prospective longitudinal study. Setting Department of nephrology in a university hospital. Patients Eighteen continuous ambulatory peritoneal dialysis patients with peritonitis. Methods Peritoneal transport for low, middle, and high molecular weight (MW) solutes was evaluated by peritoneal equilibration test (PET). The first PET was performed on the day following the diagnosis of peritonitis. The test was repeated at weeks 1, 2, 4, 12, and 24 and the results were compared to baseline PET data obtained before peritonitis. In addition, dialysate CA125 concentration and leukocyte count were measured. Results During peritonitis there were significant increases in dialysate-to-plasma (D/P) ratios for all low, middle, and high MW solutes except potassium, and decreases in D4/D0 glucose ratio and ultrafiltration (UF) volume. Over the subsequent 2 weeks, solute transport gradually decreased to the baseline values then remained unchanged during follow-up. Although net UF volume demonstrated a similar course during the study, it did not completely return to the baseline value. No decrease in D/P sodium ratio was found at 60 minutes during the PET performed 24 weeks after peritonitis. The percent change in solute transport during peritonitis compared to baseline value was significantly correlated with a solute's MW ( r = 0.776, p = 0.014). The slope of the regression line for D/P ratios versus MW, in double logarithmic scale, before peritonitis (-0.73 ± 0.09) was steeper than the slope during peritonitis (-0.59 ± 0.08). Conclusions These findings indicate that a single peritonitis episode does not permanently affect peritoneal solute transport. However, the loss of net UF that accompanies peritonitis is not completely recovered, probably due to impairment of transcellular water transport. The transport changes associated with peritonitis may be due to the combined effect of increased effective peritoneal surface area and intrinsic permeability. Our findings suggest that the latter mechanism seems to be more important.
Phenotypic Alterations of Recruited Eosinophils in Peritoneal Fluid Eosinophilia
Authors: Hellman Cecilia , Lundahl Joachim , Hylander Britta , Halldén Gunilla 
Published: February 2020

Objective To characterize eosinophils and soluble factors in effluent from continuous ambulatory peritoneal dialysis (CAPD) patients and connect these findings to related conditions with eosinophilic accumulation. Patients Three newly started CAPD patients, two with peritoneal fluid eosinophilia (PFE) and one with bacteria-induced peritonitis. One patient with PFE was followed up for 10 visits during a 7-month period. Methods Leukocytes were analyzed in dialysate and peripheral blood from the patients, by flow cytometry, and soluble mediators by ELISA or CAP technique. Results We found an increased number of neutrophils in the effluent from the patient with bacteria-induced peritonitis; accumulation of eosinophils in combination with negative cultures was noted in the patients with PFE. Increased levels of interleukin (IL)-5 and eosinophil cationic protein, but equal levels of eotaxin, were found in effluent from the PFE patients compared to the patient with neutrophilia. Peritoneal fluid eosinophils were activated by means of EG2, CD11b, CD9, and CD69 expression. Compared to blood eosinophils, the cytokine receptors for IL-5 and granulocyte-macrophage colony-stimulating factor, but not IL-3, were down regulated. Conclusion The finding of activated eosinophils in combination with IL-5 and eotaxin in PFE indicates existing similarities between PFE and conditions found during recruitment of eosinophils in allergic inflammatory responses.
A Survey of CAPD Peritonitis Management and Outcomes in North and South Thames NHS Regions (U.K.): Support for the ISPD Guidelines
Authors: Kent James R. , Almond Michael K. 
Published: February 2020

Objective This survey examined the current management of continuous ambulatory peritoneal dialysis (CAPD) peritonitis and the effectiveness of the various antibiotic protocols in use. Design The information required was elicited via a postal questionnaire. Setting The questionnaire was posted to each renal dialysis unit offering CAPD throughout the North and South Thames National Health Service regions. Patients All patients using CAPD at each responding unit were eligible for inclusion. Main Outcome Measures Each unit provided details of their CAPD peritonitis episodes for 1997. Each unit's empirical treatment regimen for CAPD peritonitis was sought in addition to response rates. Also requested were numbers for peritonitis episodes, recurrences, and negative cultures, plus the peritonitis rate per patient-month. Results Thirteen units returned the questionnaire (87% of the survey population). Nine of the 13 units were using vancomycin regimens, with the remainder using cephalosporin regimens. The results were compared to the audit standards of the British Renal Association. Seventy percent of units reached the 80% mark for response rate; similar results were achieved with both the vancomycin and cephalosporin regimens. Ninety-two percent achieved the suggested peritonitis rate of 1 episode every 18 patient-months; 30% achieved the culture-negative rate of 10%. The average recurrence rate was 19%. Conclusion The units contacted achieved most of the standards suggested by the British Renal Association; however, wide variations did exist. Recent guidelines have suggested avoiding vancomycin-based regimens in order to reduce the incidence of vancomycin resistance. The suggested regimen of a cephalosporin with an aminoglycoside seems to represent a suitable alternative.
High Prevalence of Hyperparathyroidism among Peritoneal Dialysis Patients: A Review of 176 Patients
Authors: Billa Viswanath , Zhong Aimin , Bargman Joanne , Vas Stephen , Wong Pui Y. , Oreopoulos Dimitrios G. 
Published: February 2020

Objectives Parathyroid dysfunction continues to produce significant morbidity in dialysis patients. Since the introduction of low calcium dialysate for peritoneal dialysis (PD), no large studies have been done to determine the prevalence of parathyroid dysfunction in these patients. This study was done to assess the prevalence of parathyroid disease in the PD population and to determine the risk factors associated with this dysfunction. Design We analyzed data on 176 patients who received PD at a single center between August 1998 and February 1999. Clinical data, laboratory variables related to parathyroid function, and data pertaining to dialysis treatment and weekly drug dosing were obtained for each patient on two different occasions, approximately 3 months apart. Variables predictive of the development of parathyroid dysfunction were calculated by univariate and multivariate logistic regression analysis. Results Two-thirds of the patients surveyed had an abnormal intact parathyroid hormone (iPTH) level: 47% had an iPTH level more than three times normal, the mean was 54.6 ± 35.4 pmol/L; 23% had an iPTH value below the upper limit of normal, here the mean was 3.6 ± 1.8 pmol/L. Diabetic patients had lower iPTH levels (22.2 ± 28.4 pmol/L) than nondiabetics (33.9 ± 34.8 pmol/L) ( p = 0.02). On multivariate regression analysis, we found that age, duration of dialysis, Kt/V, serum bicarbonate, and serum ionized calcium levels did not significantly affect parathyroid function. Hyperphosphatemia was the only factor that was associated with the development of secondary hyperparathyroidism in this study population ( p = 0.029). Conclusion There is a high prevalence of hyperparathyroidism in the current PD population. Phosphate control is suboptimal and hyperphosphatemia is an independent risk factor for the development of hyperparathyroidism.
Residual Renal Function in a Large Cohort of Peritoneal Dialysis Patients: Change over Time, Impact on Mortality and Nutrition
Authors: Shemin Douglas , Bostom Andrew G. , Lambert Cynthia , Hill Connie , Kitsen Jenny , Kliger Alan S. 
Published: February 2020

Objective Residual renal function contributes importantly to total solute clearance in peritoneal dialysis (PD) patients. This study was designed to examine the progression of residual renal function over time and its impact on nutrition and mortality in PD patients in the six New England states (ME, NH, VT, CT, MA, RI) comprising End Stage Renal Disease (ESRD) Network 1. Design As part of the ESRD Clinical Indicators Project, data on 990 PD patients in Network 1 were abstracted from data supplied by dialysis units in the fourth quarter of 1997. This included demographic information; dose of PD in L/day; weekly renal, dialysis, and total Kt/V urea; weekly renal, dialysis, and total creatinine clearance (CCr); serum albumin level; and mortality and transplantation information. Data collection was repeated in the second and fourth quarters of 1998 and in the second quarter of 1999. Patients 990 PD patients in Network 1. Outcome Measures The change in total and renal solute clearances over time, the relationship between renal clearance and mortality, and the relationship between renal clearance and nutritional status, as represented by serum albumin. Results Over the 2-year period, mean weekly renal Kt/V urea and weekly renal CCr dropped significantly. To examine the effect of residual renal function on mortality, patients were divided into high and low (above and below the median) weekly renal Kt/V urea and weekly renal CCr groups. Patients above the median levels of both weekly renal Kt/V urea and weekly renal CCr had a significantly decreased risk of dying during the observation period, after controlling for age, gender, serum albumin level, and diabetic status [OR for high vs low renal Kt/V urea 0.54 (CI 0.34 – 0.84), OR for high vs low renal CCr 0.61 (CI 0.40 – 0.94)]. The mean weekly renal Kt/V urea was significantly and directly correlated with the mean serum albumin level by Spearman rank correlation ( R = 0.133, p < 0.001), as was the mean weekly renal CCr ( R = 0.115, p < 0.001). Conclusions Residual renal function is an important contributor to total solute clearance in PD patients. Even at low levels it is linked to decreased mortality and better nutritional status.
Left Ventricular Hypertrophy and Clinical Outcome in CAPD Patients
Authors: Silaruks Songkwan , Sirivongs Dhavee , Chunlertrith Darunee 
Published: February 2020

Objective To determine the clinical outcome of left ventricular hypertrophy (LVH) (left ventricular wall diastole thickness ≥ 1.2 cm) detected by echocardiography in non-diabetic, continuous ambulatory peritoneal dialysis (CAPD) patients without dilated cardiomyopathy. Design A prospective, descriptive study was conducted between 1 July 1995 and 31 January 1998. Patients were followed up for 24 months. Setting Peritoneal dialysis unit in a medical school hospital. Patients and Methods Baseline and yearly echocardiograms were carried out on 66 patients receiving CAPD. Cardiac death was assessed. LVH was correlated with outcome. Results Of 66 nondiabetic CAPD patients without dilated cardiomyopathy, 20 had a normal echocardiogram (LV wall thickness < 1.2 cm), 21 had mild hypertrophy, and 25 severe hypertrophy (LV wall thickness > 1.4 cm in diastole). In the first two groups, 21% were admitted with congestive heart failure (CHF) after starting dialysis. The 1-year cumulative survival was 85% among those with mild hypertrophy and 91% in the normal group. In the group with severe hypertrophy, 57% were admitted at least once with CHF, and the 1-year cumulative survival was 56%. Eighty-two percent of those who died in the severe group, which accounted for the significantly worse survival ( p = 0.003), died from cardiac or cerebrovascular causes, compared with none of those with a normal echocardiogram. Conclusions Severe LVH was found in a third of our CAPD patients and was associated with a significantly high cardiovascular morbidity and mortality.
Comparison between DOQI and Canadian Guidelines for Peritoneal Dialysis
Authors: Blake Peter G. 
Published: February 2020

The recently published Canadian Society of Nephrology (CSN) Guidelines for Peritoneal Dialysis Adequacy differ in a number of ways from the United States National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) guidelines on the same topic. The three main differences are ( 1 ) the CSN targets are the same for continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), whereas the DOQI targets are higher for APD; ( 2 ) the CSN guidelines have a lower creatinine clearance (CCr) target of 50 L/wk for low and low-average transporters compared to 60 L/wk for high and high-average transporters, but no such distinction is made by DOQI; and ( 3 ) the CSN has set lower limit targets as well as preferred targets for Kt/V and CCr. Other differences are that the CSN recommendations do not give Kt/V the same primacy over CCr that DOQI does. Also, the CSN recommendations give greater emphasis to the risks associated with high transport status. This review looks at the reasons for these differences and demonstrates that some are due to information that has become available since the publication of the DOQI guidelines. However, it is emphasized that, when recommendations are predominantly opinion- rather than evidence-based, geographic and economic factors may also account for differences.
Production and Regulation of Matrix Metalloproteinases and Their Inhibitors by Human Peritoneal Mesothelial Cells
Authors: Martin John , Yung Susan , Robson Rachel L. , Steadman Robert , Davies Malcolm 
Published: February 2020

Objective Human peritoneal mesothelial cells (HPMC) are likely to be involved in maintenance of the peritoneal membrane. We determined whether these cells were able to synthesize the matrix degrading enzymes, matrix metalloproteinases (MMPs), likely to be responsible for the breakdown of this membrane, and whether this secretion could be modulated by cytokines involved in the inflammatory response. Design MMP activity in conditioned medium of growth-arrested HPMC was measured by zymography. Cultures were incubated in the presence and absence of the cytokines transforming growth factor-beta (TGFβ) and interleukin (IL)-1β in order to determine the effects of these cytokines on this process. The mRNA for these MMPs, together with that of their specific inhibitors, tissue inhibitors of metalloproteinases (TIMPs), was also examined by reverse transcriptase polymerase chain reaction (RT-PCR). Results HPMC were shown to constitutively secrete the metalloproteinases MMP-2 and MMP-3 in vitro. In response to the proinflammatory cytokine IL-1β, the protein and mRNA for MMP-9 was induced, while secretion of MMP-2 was unaltered. Similarly, the mRNA for MMP-3 was also increased relative to actin following the addition of IL-1β. TGFβ was shown to slightly induce the secretion of MMP-2 together with the mRNA for TIMP I, TIMP II, and, to a greater extent, TIMP III. Used peritoneal dialysate was also shown to induce MMP-9 secretion, and this effect was blocked by the co-incubation of IL-1 receptor antagonist. The secretion of enzyme activity was shown to be from the apical surface of the cells. Conclusion HPMC have the ability to control the accumulation of extracellular matrix by secreting the matrix degrading molecules MMP-2, MMP-3, and MMP-9. In addition, the secretion of these enzymes, together with that of their inhibitors (TIMPs) is regulated by the cytokines IL-1β and TGFβ. This process is likely to be important in both the normal maintenance of the integrity of the peritoneal membrane and in the changes that occur following prolonged peritoneal dialysis.
Advanced Glycosylation End-Products in Diabetic Rats on Peritoneal Dialysis Using Various Solutions
Authors: Lee Jeong H. , Reddy Dheerendra K. , Saran Rajiv , Moore Harold L. , Twardowski Zbylut J. , Nolph Karl D. , Khanna Ramesh 
Published: February 2020

Objective To evaluate and compare the effects of glucose-based solutions to those of icodextrin with respect to peritoneal transport characteristics and advanced glycosylation end-product (AGE) formation in the peritoneal membrane in a diabetic rat model of peritoneal dialysis (PD). Design Thirty-three male Sprague–Dawley rats weighing between 275 – 300 g were divided into five groups: group C ( n = 6), control rats implanted with a catheter but not dialyzed; group D ( n = 5), diabetic rats implanted with a catheter but not dialyzed; group G ( n = 7), diabetic rats implanted with a catheter and dialyzed with standard 2.5% glucose solution for daytime exchanges and 4.25% glucose solution for overnight exchanges; group H ( n = 8), diabetic rats implanted with a catheter and dialyzed with standard 2.5% glucose solution for daytime exchanges and 7.5% icodextrin solution for overnight exchanges; group I ( n = 7), diabetic rats implanted with a catheter and dialyzed with 7.5% icodextrin solution for all exchanges. Dialysis exchanges (25 mL per exchange) were performed three times daily for a period of 12 weeks. Tissue sections were stained using a monoclonal anti-AGE antibody. One-hour peritoneal equilibration tests (PET) were performed every 4 weeks for comparison of transport characteristics. Results The level of immunostaining was lowest in group C and highest in group G. Significant differences in immunostaining were seen between group C and group G ( p < 0.001), group C and group H ( p = 0.001), and group C and group I ( p < 0.05). Significant differences were also found between group G and group D ( p < 0.05), and between group G and group I ( p < 0.05). Over time, the ratio of glucose concentration after 1 hour to glucose concentration at instillation (D/D0) decreased and the dialysate-to-plasma ratio (D/P) of urea increased. Significant differences in D/D0 glucose and D/P urea were found between group C and group H (D/D0: 0.40 ± 0.01 vs 0.35 ± 0.01, p < 0.05; D/P urea: 0.87 ± 0.03 vs 0.97 ± 0.02, p < 0.05). Conclusions These results suggest that AGE formation is lower with the use of peritoneal dialysis solution containing icodextrin than with glucose-based solution. We conclude that use of icodextrin may help to slow the deterioration of the peritoneal membrane, prolonging its use for dialysis.
Iron Absorption after Single Pharmacological Oral Iron Loading Test in Patients on Chronic Peritoneal Dialysis and in Healthy Volunteers
Authors: Bastani Bahar , Islam Shah , Boroujerdi Nasser 
Published: February 2020

Objective Oral iron is poorly absorbed in chronic dialysis patients. We tested the hypothesis that a superpharmacologic dose of iron sulfate (260 mg elemental iron) administered on an empty stomach results in significant iron absorption in these patients. Design A prospective open controlled trial. Setting Outpatient department of a university hospital. Patients Nine stable chronic peritoneal dialysis (PD) patients and seven normal control subjects. Method All subjects ingested a single dose of 4 tablets of iron sulfate (260 mg elemental iron total) in the morning while fasting. Outcome Measures Serum iron concentrations at baseline, and at 2 and 4 hours after the oral dose were compared between the two groups. Results The control group showed a significant rise in mean [± standard error (SE)] serum iron concentration, from a baseline value of 76.5 ± 7 μg/dL to 191 ± 10.5 μg/dL at 2 hours and to 190 ± 24 μg/dL at 4 hours. This result represents a percentage rise of 164% ± 32% at 2 hours and 152% ± 28.5% at 4 hours. In the PD patients, a significant rise in serum iron concentration was also seen, from a baseline value of 64 ± 8 μg/dL to 130 ± 3 μg/dL at 2 hours and 111 ± 18 μg/dL at 4 hours. This result represents a percentage rise of 105% ± 29% at 2 hours and 77% ± 23.5% at 4 hours. However, the absolute change in serum iron concentration in PD patients at 2 and 4 hours was approximately equal to 50% of the change in control subjects at those time points. None of the PD patients experienced gastrointestinal side effects; 4 control subjects experienced mild side effects. Conclusion Despite impaired oral iron absorption in chronic dialysis patients, a large pharmacologic dose given orally can result in significant iron absorption and may prove to be a more efficient means of oral iron supplementation therapy in these patients.