bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pharmacologic Modification of Transperitoneal Movement of Water
Authors: Grzegorzewska Alicja E. 
Published: February 2020

Investigations concerning the influence of pharmacologic agents on transperitoneal water movement are predominantly undertaken in the hope that their results can help in a restoration of net ultrafiltration (UF) volume toward normal in cases with declining UF during long-term dialysis treatment. Net UF volume represents the difference between net transcapillary UF and lymphatic absorption. The choice of a pharmacological agent for enhancing UF depends on the mechanisms responsible for net UF loss, which include: (a) early dissipation of the transperitoneal osmotic gradient; (b) decrease in the peritoneal surface area; (c) Iymphomonokine overproduction; (d) enhanced lymphatic absorption; (e) high residual volumes left in the peritoneal cavity; or (f) a combination of these factors. Leakage of dialysate to the abdominal wall sometimes occurring in peritoneally dialysed patients (1), according to a definition of net UF volume, cannot be regarded as a true UF loss.
Treatment of Pseudomonas Infections in Peritoneal Dialysis Patients
Authors: Taber Tim E. , Hegeman Theodore F. , York Susan M. , Kinney Raynel A. , Webb Douglas H. 
Published: February 2020

Pseudomonas species infections in the peritoneal dialysis population consist primarily of peritonitis or exit site infections. These organisms have traditionally proven difficult to eradicate, and the standard antibiotic regimen has carried the potential for nephrotoxicity. At our institution, all peritoneal dialysis patients with Pseudomonas exit site infections or peritonitis were treated with an antibiotic combination of intraperitoneal ceftazidime and oral ciprofloxacin. Treatment duration was dependent upon the site of infection. Recurrent exit site infections were treated with a repeated course of the antibiotics, and with surgical debridement and subsequent shaving of the external cuff of double-cuffed catheters. We saw a total of 11 Pseudomonas aeruginosa exit site infections in 7 patients (4 recurrent). Patients with recurrent infections were subsequently cured with the regimen as outlined above. Of 7 patients with Pseudomonas species peritonitis (aeruginosa, fluorescens, stutszeri, and maltophilia), 5 were cured with the initial antibiotic regimen. The 2 failures were both infected with Pseudomonas maltophilia, which is consistent with observed organism sensitivity data. The combination of ceftazidime and ciprofloxacin with the option for surgical debridement of the external cuff (in exit site infections) appears effective in the treatment of Pseudomonas species infections in the peritoneal dialysis population. Sensitivity data should be used to adjust the antibiotic regimen when appropriate.
Problems in Comparisons of Clearances Prescriptions in Hemodialysis and Continuous Ambulatory Peritoneal Dialysis
Authors: Nolph Karl D. , Keshaviah Prakash , Popovich Robert 
Published: February 2020

There is currently great interest in defining acceptable doses of dialysis therapy with different techniques. In hemodialysis (HD) and in continuous ambulatory peritoneal dialysis (CAPD), doses of weekly clearances of urea and/or creatinine required for achieving acceptable nutrition and quality of life need better definition (1–2). If control of the peak blood urea nitrogen concentration (BUN) is important in preventing uremic toxicity (the peak concentration hypothesis), then any intermittent therapy requires a greater dose of therapy to maintain the peak concentration below or at the steady state value of CAPD (assuming the same urea nitrogen generation rate and, hence, the same weekly net removal [mass transfer] of urea nitrogen) (2). The peak concentration hypothesis remains unproven, but it is certainly compatible with the apparent need for higher weekly clearances with intermittent therapies. Accordingly, it may be appropriate to increase the weekly KTN urea for intermittent PD therapies, such as nightly peritoneal dialysis, as compared to CAPD. For chronic hemodialysis, most centers strive for a weekly KTN urea value at or above 3.0 (2), whereas in CAPD the typical regimen yields a weekly KTN urea between 1.5 and 1.8. There was great interest in kinetic modeling of CAPD clearance prescriptions at the 10th Annual Conference on Peritoneal Dialysis in Dallas, Texas, in February of 1990 (1, 3–6). The focus was on defining adequate peritoneal dialysis and optimizing nutrition. The purpose of this editorial is not to review the pros and cons of modeling dialysis therapy to achieve defined doses of small solute clearances nor to support or refute the peak concentration hypothesis.
Effects of Chondroitin Sulphate on Fluid and Solute Transport during Peritoneal Dialysis in Rats
Authors: Breborowicz Andrzej , Radkowski Maciej , Knapowski Jan , Oreopoulos Dimitrios G. 
Published: February 2020

The effect of chondroitin sulphate (CS) on peritoneal fluid and solute transport was studied in rats undergoing peritoneal dialysis. In the presence of CS, net ultrafiltration increased, while absorption of glucose and horseradish peroxidase from the peritoneal cavity decreased. Albumin, used instead of CS, did not modify either fluid or solute transport. In in vitro experiments on isolated rabbit mesentery, CS decreased transmembrane water flow induced by hydrostatic pressure, and its effect was not fully reversed 60 minutes after “wash-out” of this glycosaminoglycan. We postulate that the polyanionic CS molecules are trapped in the peritoneal interstitium, thus decreasing its hydraulic conductivity and permeability, which in turn increases net fluid removal during peritoneal dialy sis because of its slower absorption from the peritoneal cavity.
Chemical Peritonitis following the Intraperitoneal Administration of Vancomycin
Authors: Freiman Joel P. , Graham David J. , Reed Theresa Greene , McGoodwin1 Ermona B. 
Published: February 2020

The Food and Drug Administration has received 51 reports of cases in the United States in which chemical peritonitis was associated with the intraperitoneal administration of sterile vancomycin hydrochloride, USP intravenous. The clinical presentation of the cases ranged from mild (cloudy dialysate alone) to more severe (severe abdominal pain and fever). The temporal circumstances suggest that intraperitoneal vancomycin may be associated with chemical peritonitis. A positive rechallenge was reported in 9 cases. The underlying mechanism responsible for this adverse reaction has not yet been identified. Several adverse reaction reports have been submitted to the Food and Drug Administration (FDA) concerning the development of chemical peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients following the intraperitoneal administration of sterile vancomycin hydrochloride, USP intravenous. The reactions reported ranged from mild (cloudy dialysate alone) to more severe (severe abdominal pain and fever). Although the majority of reactions were self-limited, some resulted in hospitalization and/or a prolongation of antibiotic therapy. Based upon these reaction reports, the FDA issued a Safety Alert Letter in May 1990 to all known dialysis centers in the United States (1). The purpose of this article is to provide additional clinical and laboratory data on the cases cited in the Safety Alert Letter.
Dialysis Efficiency in Continuous Ambulatory Peritoneal Dialysis Patients Treated with Erythropoietin
Authors: Taylor Joanne E. , MacTier R.A. , Henderson I.S. , Belch Jill J.F. , Stewart W.K. 
Published: February 2020

Objective To determine the effect of subcutaneous erythropoietin treatment on dialysis efficiency in continuous ambulatory peritoneal dialysis (CAPD) patients. .Design: Dialysis efficiency, platelet and white cell aggregation, and red cell deformability were measured monthly for six months in nine anaemic CAPD patients treated with erythropoietin, and on a single occasion in seven control CAPD patients with intrinsically high haemoglobin concentrations. Setting Renal dialysis unit. Patients Nine patients stable on CAPD for a minimum of six months and with haemoglobin concentrations less than 8.5 g/dl were treated with erythropoietin. Seven CAPD patients matched for age and renal function, with haemoglobins greater than 9.0 g/dl served as controls. Results Daily peritoneal clearances and net ultrafiltration volumes were unchanged when haematocrit increased from 25.0:1: 2.2% to 36.5:1: 3.5%. Spontaneous whole blood platelet aggregation was significantly increased from week twelve (pre-treatment aggregation 46:I: 23%; 12 weeks: 67:1: 19%, p<0.05; 16 weeks: 64:1: 19%, p<0.01; 20 weeks: 71:1: 16%, p<0.01; 24 weeks: 73:1: 10%, p<0.01). Conclusions The increase in haematocrit and platelet aggregation associated with erythropoietin treatment did not affect peritoneal clearances or ultrafiltration capacity.
Bicarbonate versus Lactate-Based Capd Fluids: A Biocompatibility Study in Rabbits
Authors: Schambye Hans T. , Flesner Per , Pedersen Regitze B. , Hardt-Madsen Michael , Chemnitz John , Christensen Hanne K. , Detmer Ann , Pedersen Fritz B. 
Published: February 2020

Previous in vitrobiocompatibility studies have shown bicarbonate-based continuous ambulatory peritoneal dialysis (CAPD) fluids to be superior to those based upon lactate/acetate. To evaluate these findings in vivo, 41 rabbits were subjected to CAPD for four weeks in a randomized prospective study using either Dianeal, a commercially available dialysis fluid containing lactate, or 87b, a bicarbonate-based CAPD fluid. Ten rabbits with CAPD catheters, which were flushed with a heparin solution every 36 hours, served as controls. None of the control rabbits showed clinical or histopathological signs of peritonitis, while 8 of 20 in the Dianeal group and 6 of 21 in the 87b group contracted peritonitis. Four rabbits in the Dianeal group had to be sacrificed early due to severe peritonitis. Post mortem examinations, including scanning and light microscopy, did not reveal any macroscopic or microscopic differences among the three groups of noninfected animals. No significant distinctions between the groups could be made for body temperature, weight gain, dialysate volume, dialysate differential leukocyte count, dialysate protein content, and food intake during the course of the study. In conclusion, the present animal model did not reveal any major difference in the biocompatibility between the lactate and the bicarbonate-based CAPD fluids.
Intraperitoneal Administration of Recombinant Human Erythropoietin
Authors: Frenken Leon A.M. , Struijk Dirk G. , Coppens Peter J.W. , Tiggeler Roland G.W.L. , Krediet Raymond T. , Koene Robert A.P. 
Published: February 2020

Objective To determine the efficacy and safety of intraperitoneal administration of recombinant human erythropoietin (rHuEPO) in continuous ambulatory peritoneal dialysis (CAPD) patients compared to subcutaneous rHuEPO. Design Prospective analysis of an open, nonrandomized investigation. Setting Outpatient CAPD clinics in two university hospitals. Patients Nine adult CAPD patients receiving rHuEPO intraperitoneally and 8 patients receiving rHuEPO sub-cutaneously. Intervention One hundred units of rHuEPO per kilogram of body weight were administered three times a week for 8 weeks or until the target hematocrit of 35% was reached. Thereafter, dosages of rHuEPO were adjusted for response. Intraperitoneal rHuEPO was administered in 1 L of dialysis solution during the night. Measurements Efficacy was assessed by measuring the increase in hemoglobin. Tolerance was assessed by monitoring side effects. Results In the first 8 weeks of treatment hemoglobin concentration increased from 64.5±12.9 glL to 98.3±16.1 g/L (p<0.0005) in the intra peritoneally treated group. In the subcutaneously treated group hemoglobin increased significantlyfaster (p<0.05) from 72.5±4.8 g/L to 119.2±11.3 g/L (p<0.0005) in the same period. Antihypertensive medication had to be increased or instituted in most of the patients in both groups. The incidence of peritonitis in the intraperitoneally treated group was not increased when compared to the pretreatment incidence. Conclusions Subcutaneously administered rHuEPO is superior to intraperitoneally administered rHuEPO with regard to the required dosages. However, the results of this study show that intraperitoneal administration of rHuEPO might be a convenient and safe alternative when subcutaneous administration is undesirable.
Initial Hypoalbuminemia and Hyperlipidemia Persist during Chronic Peritoneal Dialysis in Children
Authors: Scolnik Dennis , Balfe J. Williamson 
Published: February 2020

Objective To document serum lipid values in pediatric peritoneal dialysis (PD) patients, particularly the very young, and investigate relationships with serum albumin levels. Design Retrospective review of all PD patients seen in the first 11 years of the PD program at our institution. Patients and Methods Any pediatric PD patient was eligible for inclusion if at least four simultaneous measurements of serum lipids and albumin were recorded over a minimum of 90 days of PD. Results Thirty-nine continuous ambulatory peritoneal dialysis (CAPD) patients (9, aged <5 years) and 14 continuous cycling peritoneal dialysis (CCPD) patients (7, aged <5 years) were followed for 90–1200 days. Hypoalbuminemia, present In 43% of initial recordings, did not alter significantly during PD in any group; it was most marked in the CAPD <5 year (mean 30.7 g/L) and CCPD >5 year groups (mean 31.4 g/L). Average serum cholesterol levels were 27% higher, and triglyceride 122% higher, than the maximum accepted 18-year-old level and did not change significantly during PD. Similarly, 33% of high-density lipid recordings were below normal and remained unaltered during PD. Conclusions Our results confirm the high incidence of hypoalbuminemia, hypertriglyceridemia, and hypercholesterolemia and associated low levels of high density lipids, even in young PD patients, and demonstrate that these remain unchanged during PD. Such results have not previously been reported in PD patients as young as ours. Abnormal lipid profiles are a neglected cardiovascular risk factor in children with renal failure; therapeutic interventions should therefore be seriously considered.
Capd Therapy for Patients over 80 Years of Age
Authors: Gorban-Brennan Nancy , Kliger Alan S. , Finkelstein Fredric O. 
Published: February 2020

Objective The purpose of the study is to review our experience with patients over 80 years of age with end stage renal disease (ESRD) treated with continuous ambulatory peritoneal dialysis (CAPD). Design The records of all patients over 80 years of age treated in our unit with CAPD since 1979 were reviewed. Setting Outpatient CAPD facility. Patients Eighteen patients over 80 years of age were identified and studied. Main Outcome Measures The duration of CAPD therapy, duration of CAPD training, mortality rate, hospitalization rate, peritonitis rate, and family assessment were reviewed and analyzed. Results The mean ± SD duration of therapy was 20±17 months. Nine patients expired, 3 transferred to hemodialysis, 1 recovered renal function, and 5 remained on CAPD therapy. Peritonitis rates were 1.7 episodes/patient year. Of the organisms causing peritonitis, 56% were gram-positive bacteria. The average hospitalization rate was 13.9 days/patient year. The most frequent causes of hospitalization were peritonitis and cardiovascular disease. Conclusion CAPD therapy is a reasonable therapeutic option for patients with end-stage renal disease over 80 years of age.
Assessment of Dialysis Dose by Measured Clearance versus Extrapolated Data
Authors: Burkart John M. , Jordan Jean R. , Rocco Michael V. 
Published: February 2020

Objective To determine whether estimates of daily dialysis clearance of creatinine and urea, based on data from the 4-hour peritoneal equilibration test, correlate well with daily dialysis clearance measured by 24-hour dialysate collection in chronic ambulatory peritoneal dialysis patients. Design Prospective study in which each subject collected all dialysate from a 24-hour period and then immediately thereafter underwent a standard peritoneal equilibration test (PET). Daily clearances of creatinine and urea were calculated from 24-hour dialysate collections by standard methods and then were compared with several estimates of 24-hour clearance based on PET data. Setting Single peritoneal dialysis unit of a university teaching hospital. Patients Thirty-six stable patients on continuous ambulatory peritoneal dialysis (CAPD). Main Outcome The estimated values for daily dialysis clearance both overestimated and underestimated the measured 24-hour clearance. The correlation coefficient between the extrapolations and the actual 24-hour clearances ranged from 0.63–0.68. The range of discordance for daily creatinine clearance was from -2530 mL/dayto +2199 mL/day. For daily urea clearance, the range of discordance was from -21 03 mL/ day to +1940 mL/day. The peritoneal membrane transport characteristics of the individual patient did not predict whether the extrapolation overestimated orunder estimated the measured daily clearance. Conclusion Extrapolation of PET data is not a reliable method to estimate the dose of dialysis delivered to the patient. A 24-hour collection of dialysis is necessary for this determination.
In Vitro Study of the Mechanism of Potassium Transport into Human Mesothelial Cells. I: Effect of Hyperosmolality
Authors: Breborowicz Andrzej , Witowski Janusz , Knapowski Jan , Serkes Kenneth D. , Martis Leo , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To study the mechanism(s) of potassium transport into human mesothelial cells (HMC) exposed to osmotic solutes. Design Using potassium analog 86Rb, we evaluated its intracellular transport through three pathways: 1. blocked by ouabain; 2. blocked by furosemide but not by ouabain; 3. blocked by neither furosemide nor ouabain. Experiments were performed in a normotonic medium (control) or in a medium supplemented with osmotic solutes (glucose, glycerol, mannitol). Both the acute and chronic effects of osmotic solutes on potassium transport were studied. Results The acute exposure of mesothelial cells to osmotic solutes modifies the intracellular transport of potassium through all studied channels, and the effect is specific for every solute. In mesothelial cells exposed over 7 days to glucose (90 mM), the intracellular transport via ouabain and furosemide-blocked channels is decreased, whereas it is increased through the third pathway. Total intracellular accumulation of 86Rb (potassium) ions in mesothelial cells cultured in a medium supplemented with various concentrations of glucose is decreased, and this effect is proportional to the concentration of glucose in the medium. Conclusions The intracellular transport of potassium in mesothelial cells is regulated through at least three independent mechanisms. Acute or chronic exposure of mesothelial cells to a hypertonic medium affects the intracellular accumulation of potassium, an d this effect is specific for the various osmotic solutes.
The Serum Complement System in Children on Continuous Ambulatory Peritoneal Dialysis
Authors: Reddingius Roel E. , Schröder Cornelis H. , Daha Mohamed R. , Monnens Leo A.H. 
Published: February 2020

Objective During continuous ambulatory peritoneal dialysis (CAPD), the loss of complement factors via the dialysate may cause complement deficiencies. This hypothesis was tested in a group of children treated with CAPD. Design Classical (CH50) and alternative (AP50) complement activity and serum levels of factors C1 q, C3, C4, C3d, B, D, and P in CAPD patients were compared to normal controls and to children with preterminal renal failure. Setting Patients were seen in a university hospital; normal controls were seen in an outpatient clinic of a general hospital. Patients A group of 22 children on CAPD was compared to a normal control group of 44 children and to a group of 12 children with preterminal renal failure with a creatinine clearance below 25 mL/min/1.73 m2. Results CH50, AP50, C3, and B were not significantly different from the control group in both the CAPD and preterminal groups. Factors C1q (p=0.01) and C4, C3d, D, and P (p<0.001) were higher in the CAPD group in comparison to the normal control group. The factors D (p<0.001) and P (p=0.02) were also elevated in the preterminal group. For the measured factors there was no significant difference between the CAPD group and the preterminal group. Conclusions There is no deficiency of complement in children treated with CAPD. High levels of C3d and D can be explained by the reduction of their elimination by the kidney. The increased levels of the other factors are presumably due to increased synthesis in renal failure. This does not seem to be caused by CAPD.
Quantitation of Lymphatic Drainage of the Peritoneal Cavity in Sheep: Comparison of Direct Cannulation Techniques with Indirect Methods to Estimate L Ymph Flow
Authors: Tran Lisa , Rodela Helen , Hay John B. , Oreopoulos Dimitrios , Johnston Miles G. 
Published: February 2020

Objective It has been suggested that lymphatics may contribute to ultrafiltration failure in patients on continuous ambulatory peritoneal dialysis (CAPD) byabsorbing dialysate and ultrafiltrate from the peritoneal cavity. In most studies lymphatic drainage has been estimated from the disappearance of an instilled tracer from the peritoneal cavity or estimated from the appearance of an intraperitoneally administered tracer in the bloodstream. However, in sheep it is possible to cannulate several of the relevant lymphatics that drain the peritoneal cavity and assess lymph drainage parameters directly. The purpose of this study was to estimate lymph drainage from the peritoneal cavity in sheep using the disappearance of tracer from the cavity and the appearance of intraperitoneally instilled tracer in the bloodstream and to compare these results with those obtained from our previous studies using cannulation techniques. Design Experiments were performed in anesthetized and nonanesthetized animals. Volumes of 50 mL/kg of Dianeal 4.25% containing 25 μCi of 1251-albumin were infused into the peritoneal cavity. Results In anesthetized sheep the calculated peritoneal lymph drainage from monitoring the disappearance of tracer from the peritoneal cavity over 6 hours was 1.873±0.364 mL/kg/hour. Monitoring the appearance of tracer in the blood gave significantly lower peritoneal lymph flow rates of 1.094±0.241 mL/kg/hour. Directly measured lymph flow rates from our earlier publication were lower still and ranged from 0.156±0.028 -0.265±0.049 mL/hour/kg, depending on how we estimated the right lymph duct contribution to peritoneal drainage, since we could not cannulate this vessel. We repeated these experiments in conscious sheep. The value for lymph flow estimated from the disappearance of tracer from the peritoneal cavity was 2.398±0.617 mL/hour/kg and from the appearance of tracer in the blood, 1.424±0.113 mL/ hour/kg. The1ymph flow rates monitored from indwelling lymphatic catheters ranged from 1.021 ±0.186 -1.523±0.213 mL/hour/kg (again, depending on our estimates for the right lymph duct). Conclusions Lymph flow rates measured from indwelling lymphatic catheters provided the most conservative values for lymphatic drainage of the peritoneal cavity under dialysis conditions. Estimates of lymphatic drainage based on the appearance of tracer in the blood gave values that were on average higher. The method using the disappearance of tracer from the cavity to estimate lymph flows overestimated peritoneal lymph drainage. Fluid was lost from the peritoneal cavity, and the estimated proportion of liquid lost through lymphatic drainage depended on the technique used to measure lymph flow rates.