bluuebunny/crossref_metadata_2025_split huggingface dataset:
Blood Pressure Control and Left Ventricular Hypertrophy in Long-Term Capd and Hemodialysis Patients: A Cross-Sectional Study
Authors: Günal Ali Ihsan , Ilkay Erdogan , Kirciman Ercan , Karaca Ilgin , Dogukan Ayhan , Celiker Huseyin 
Published: February 2020

Background It is still not clear whether hypertension and left ventricular hypertrophy (LVH) are more common in continuous ambulatory peritoneal dialysis (CAPD) than in hemodialysis (HD) patients. Methods To examine this subject, the indices of cardiac performance were compared between 50 HD and 34 CAPD patients. Patients were further divided into two subgroups [long-term (L) CAPD and L-HD] according to dialysis modality and duration of dialysis (more than 60 months’ duration). Results The blood pressure and cardiothoracic index of CAPD patients did not differ from HD patients. On average, the left atrial index was 2 mm/m2 higher in HD patients than in CAPD patients. Left ventricular chamber sizes, wall thickness, and left ventricular mass index (LVMI) in patients on CAPD were similar to those of HD patients. Isovolumic relaxation time (IVRT) of CAPD patients was insignificantly less than that of HD patients (101 ± 22 and 115 ± 27 msec respectively). There was no significant difference between the two subgroups (L-HD and L-CAPD) in blood pressure, left atrial diameter, left ventricular chamber size, wall thickness, LVMI, ejection fraction, or IVRT. Conclusion If normovolemia and normotension are obtained by strict volume control without using antihypertensive drugs, the effects of the two modalities of chronic dialysis treatment (HD and CAPD) on cardiac structure and function are not different from each other.
Comparison of the Charlson Comorbidity Index and the Davies Score as a Predictor of Outcomes in PD Patients
Authors: Fried Linda , Bernardini Judith , Piraino Beth 
Published: February 2020

Background Comorbidity is a strong predictor and confounds many studies of outcomes. Previous studies have shown that the Charlson Comorbidity Index (CCI) and the Davies score predict mortality in peritoneal dialysis (PD) patients. However, there are few data on the comparison of comorbidity scores. Objective To compare the CCI (combines comorbidity and age) and Davies score (comorbidity score without age) to see if one score was superior to the other in predicting outcomes. Design Prospective database study. Setting Seven dialysis centers in Western Pennsylvania. Participants 415 incident PD patients, starting PD from 1/1/90 to 2/1/00. Measurements The CCI and Davies score calculated at the start of PD; serum albumin levels and demographics at the start of PD; total hospitalizations and mortality, collected prospectively. Results The correlation between CCI and Davies was 0.80, p < 0.0001. The CCI was inversely correlated with serum albumin (–0.31, p < 0.0001). Davies was significantly correlated with age (0.32, p < 0.0001) and inversely correlated with albumin (–0.27, p < 0.0001). The CCI alone was a stronger predictor than Davies alone (score by best subsets regression 49.6 vs 42.0, p = 0.0058). The CCI and Davies with age appeared to be equivalent models of survival (49.61 vs 49.64). The best predictive models were CCI and initial albumin, or Davies, age, and initial albumin. Both CCI and Davies were predictors of hospitalization rates, but the model with the Davies score was better (Akaike information criterion 799.2 vs 850.2). The best predictive model was Davies, albumin, age, and race. Conclusions Both comorbidity scores were significant predictors of outcomes, with CCI the stronger predictor for mortality, but the Davies was a stronger predictor of hospitalizations. One or both should be done at the start of dialysis to predict outcome.
What Can We Do to Preserve the Peritoneum?
Authors: Krediet Raymond T. , Zweers Machteld M. , Van Westrhenen Roos , Ho-dac-Pannekeet Marja M. , Struijk Dirk G. 
Published: February 2020

Background Long-term peritoneal dialysis may lead to peritoneal membrane failure. Loss of ultrafiltration is the most important clinical abnormality. Loss of ultrafiltration is associated with an increased number of peritoneal blood vessels, with fibrotic alterations, and with loss of mesothelium. Continuous exposure to bioincompatible dialysis solutions is likely to be important in the pathogenesis of these alterations. Methods This article reviews the toxicity of various constituents of dialysate, current assessments of interventions, and the results of interventions aimed at preserving the peritoneum. Results Glucose, possibly in combination with lactate, and glucose degradation products (GDPs) are likely to be the most toxic constituents of dialysate. Diabetiform peritoneal neoangiogenesis is likely to be mediated by vascular endothelial growth factor (VEGF). Release of VEGF might be influenced by glucose-induced cellular pseudohypoxia, which is likely to be increased by exposure to lactate. Glucose and GDPs are both toxic to peritoneal cells. Glucose degradation products induce the formation of advanced glycosylation end-products at a much faster rate than does glucose itself, but the relative importance of GDPs and glucose in clinical PD has not been clarified. The effects of interventions should first be assessed in long-term animal models, followed by clinical studies on peritoneal transport and on effluent markers that may reflect the status of the peritoneum. Possible interventions aim at reducing peritoneal exposure to glucose, GDPs, and lactate. Techniques include peritoneal resting, replacing some glucose-based exchanges with amino acid–based and icodextrin-based dialysate, using bicarbonate as a buffer, and administering solutions that have a low GDP content. Exposure to various dialysis solutions with a reduced GDP content has resulted in an increase in the effluent concentration of the mesothelial cell marker CA125, irrespective of the buffer used. Experimental studies in a long-term peritoneal exposure model in rats showed that the combination of a reduction in the concentration of lactate and replacement of lactate with pyruvate resulted in a reduction of the number of peritoneal blood vessels. Results of drug therapy have been studied in various animal models. Their use in patients is still experimental. Conclusions Strategies to preserve the peritoneum aim at reducing membrane exposure to bioincompatible solutions. Currently available dialysis fluids that are more biocompatible are likely to have some beneficial effects. Further research on the development of dialysis solutions that use combinations of osmotic agents and alternative buffers is necessary.
Does Amino Acid–Based Peritoneal Dialysate Change Homocysteine Metabolism in Continuous Ambulatory Peritoneal Dialysis Patients?
Authors: Chang Jer-Ming , Chen Hung-Chun , Hwang Shang-Jyh , Tsai Jer-Chia , Lai Yung-Hsiung 
Published: February 2020

Objective We examined whether amino acid–based peritoneal dialysate that contains 85 mg/dL L-methionine affects homocysteine (Hcy) metabolism. Design The study enrolled 17 adult CAPD patients (11 men, 6 women) who had been receiving CAPD for at least 6 months and who had low serum albumin levels (<3.7 g/dL). Diet was not specifically changed. All of the study patients received daily 4-exchange CAPD treatment, and they used Nutrineal (Baxter Healthcare, Deerfield, IL, U.S.A.) as one of their daily exchanges (first or second exchange). Blood samples were collected every 2 weeks, and Hcy was measured. Results After use of Nutrineal, serum albumin was unchanged, but blood urea nitrogen (BUN) and total protein were increased. Before the study began, 1 patient had a very high Hcy level (256 μmol/L); his data were excluded from the analysis. In the remaining 16 patients, baseline Hcy was 24.4 ± 7.0 μmol/L. Levels of Hcy progressively increased with the use of Nutrineal: 28.1 ± 6.2 μmol/L in week 2, 28.4 ± 7.1 μmol/L in week 4, 29.1 ± 7.6 μmol/L in week 6, 29.3 ± 9.0 μmol/L in week 8, 27.5±9.7 μmol/L in week 10, and 30.3 ± 8.2 μmol/L in week 12. Conclusions Nutrineal might help to replenish daily protein loss, but it also increased formation of Hcy and, therefore, the potential risk of cardiovascular illness. Further studies will be needed to examine the effect of folic acid and vitamin B12 supplementation in the rescue of that Hcy increase, and also a possible correlation with methylenetetrahydrofolate reductase gene polymorphism.
Nutritional Requirements and Actual Dietary Intake of Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Chow Vincent C. , Yong Rose M. , Li Alice L. , Lee Chi-wai , Ho Eva H. , Chan Ching-kit , Lo Stanley H. , Mo Stephen K. , Wong Kin-shing 
Published: February 2020

Objective Nutritional status is related to morbidity and mortality in the continuous ambulatory peritoneal dialysis (CAPD) population. In the present study, we compared the dietary intake of CAPD patients with their requirements for calorie and protein nutrition and with the recommended intakes of potassium and phosphate. Design Patients were recruited from the CAPD clinic. Desirable body weight was derived from the height of the individual patients and the desirable body mass index (BMI) for adult Asians. The calorie requirement was calculated by multiplying desirable body weight by 30 kcal. The protein requirement was calculated by multiplying desirable body weight by 1.2 – 1.5, according to serum albumin level. The K requirement was set at 3500 mg daily, and the PO4 requirement, at 1000 mg daily. The actual dietary intake of individual patients was estimated from dietary history by a computer software program. Results The study included 57 patients who had been on CAPD for 22.1 ± 23.5 months. Of the 57 patients, 8 patients (14.0%) were below the desirable BMI range, 20 (35.1%) were within the range, and 29 (50.9%) were above the range. By subjective global assessment (SGA), 45 patients (78.9%) were mildly-to-moderately malnourished, and 12 (21.1%) well nourished. Serum albumin was 32.1 ± 4.7 g/L. Patients met 98% ± 35.7% (range: 33% – 224%) of their nutritional requirement for calories and 92.1% ± 37.7% (range: 22% – 202%) of their nutritional requirement for protein. Only 23 patients (40.4%) reached the target for calorie intake, and only 22 (38.6%) reached the target for protein intake. Excess K intake was seen in 1 patient (1.8%), and excess PO4 intake, in 6 patients (10.5%). Actual dietary intake was not related to BMI or SGA score. Conclusion Most CAPD patients had inadequate calorie and protein intakes. Calorie and protein intakes were not related to BMI and SGA scores. Compliance with recommended K and PO4 intakes was good.
Nutritional Assessment of Continuous Ambulatory Peritoneal Dialysis Patients by Bioelectrical Impedance
Authors: Chow Vincent C. , Lee Chi-wai , Ho Eva H. , Chan Ching-kit , Yong Rose M. , Li Alice L. , Lo Stanley H. , Mo Stephen K. , Wong Kin-shing 
Published: February 2020

Objective The Dialysis Outcomes Quality Initiative (DOQI) guidelines suggest that anthropometric measurements are useful in assessment of nutrition. However, the technique is operator-dependent and time consuming. To estimate fat-free mass and fat mass, bioelectrical impedance analysis (BIA) measures the impedance of an electrical current passing through the body. Our aim in the present study was to validate the use of BIA in continuous ambulatory peritoneal dialysis (CAPD) patients. Design We recruited patients from the CAPD clinic. The biceps, triceps, subscapular, and suprailiac skinfold thickness were measured by Harpenden skinfold calipers (British Indicators, Burgess Hill, West Sussex, U.K.). Using a linear regression equation (Durin and Womersley) and the Siri equation, we calculated percentage body fat composition from the anthropometric measurements. For BIA assessment, fat composition was measured using the Body Composition Analyzer (TBF-300GS: Tanita Corporation of America, Arlington Heights, IL, U.S.A.). Results We recruited a total of 60 patients who had been on CAPD for 21.8 ± 23 months. The percentage of body fat in the study group as estimated by anthropometry was 27.5% ± 8.6% (range: 5.78% – 40.4%). By BIA, the percentage of body fat was 17.6% ± 8.9% (range: 2.4% – 42.3%). The results by the two methods were highly correlated ( r = 0.712, p < 0.001). By paired t-test, the mean difference in body fat composition using the two different methods was 9.9% ± 6.6% ( p < 0.001). Conclusions Measurement of body fat composition in CAPD patients by BIA and by anthropometry were highly correlated. The body fat composition measured by BIA was lower than that measured by anthropometry. The BIA method is simple and noninvasive. It may play a role in monitoring trend of body composition in CAPD patients in an outpatient setting.
Hypoproteinemia in Patients with Diabetes Undergoing Continuous Ambulatory Peritoneal Dialysis is Attributable to High Permeability of Peritoneal Membrane
Authors:   for the Japan PDC Study Group, Nakamoto Hidetomo , Suzuki Hiromichi 
Published: February 2020

Background The present study used the newly developed personal dialysis capacity (PDC) peritoneal function test to investigate differences in individual peritoneal membrane transport function and nutritional status in non diabetic (non DM) and diabetic (DM) patients on continuous ambulatory peritoneal dialysis (CAPD). Patients and Methods To clarify the differences in peritoneal function that determine plasma protein levels, we carried out PDC tests in non DM and DM patients. Between May 1995 and May 1999, in multicenter study in Japan, we carried out 232 PDC tests on 232 non DM patients and 47 PDC tests on 47 DM patients who had been on CAPD for 1 – 210 months. Results Plasma levels of total protein and albumin in DM patients were significantly lower than those in non DM patients (total protein: 6.5 ± 0.1 g/dL non DM vs. 5.9 ± 0.1 g/dL DM, p < 0.0001; albumin: 3.5 ± 0.1 g/dL non DM vs. 2.9 ± 0.1 g/dL DM, p < 0.0001). The mean membrane area in the DM group was significantly larger than that in the non DM group (21943 ± 608 cm/1.73 m2 non DM vs. 26 304 ± 1699 cm/1.73 m2 DM, p = 0.0076). The mean plasma loss through the large pores in the DM group was significantly greater than that in the non DM group (0.095 ± 0.004 mL/min/1.73 m2 non DM vs. 0.119 ± 0.008 mL/min/1.73 m2 DM, p = 0.0113). Protein loss into dialysate in DM patients was significantly greater than that in non DM patients. We observed a significant correlation between total protein or albumin and plasma loss from dialysis solution in non DM and DM patients on CAPD. Conclusions The study demonstrated that peritoneal function, including peritoneal membrane transport and peritoneal permeability to protein was significantly higher in DM patients than in non DM patients. Hypoproteinemia in DM patients might be associated with high permeability of peritoneal membrane in CAPD.
Improving Outcome in Geriatric Peritoneal Dialysis Patients
Authors: Hiramatsu Makoto 
Published: February 2020

Objective Few data are available about elderly patients on peritoneal dialysis (PD). In the present study, we reviewed our experience with patients aged 70 years or more at the start of peritoneal dialysis (PD). Design This retrospective study was conducted at a single center in Japan. Patients and Methods Of 222 patients managed using PD at our hospital between 1991 and 2001 (including 219 cases of PD first), 150 patients were aged under 70 years and 72 patients were 70 years of age or older. For the two groups of patients, we determined clinical data, erythropoietin and PD prescriptions, reasons for selecting PD (elderly patients only), urine and ultrafiltration volumes, comprehensive functional assessment, quality of life (QOL), comorbidity, technique survival rate, and causes of death. Results Serum creatinine, serum β2-microglobulin, total dose of erythropoietin (EPO) needed to maintain hematocrit at 30%, number of continuous ambulatory peritoneal dialysis (CAPD) exchanges, and total volume of dialysis solution prescribed were significantly lower in the elderly patients as compared with patients aged under 70 years. The main reasons for starting PD in elderly patients at our hospital were advanced age (57%), patient's choice (25%), and cardiovascular complications (9%). Residual renal function was well maintained in CAPD patients aged 70 years or more as compared with patients aged under 70 years. Ultrafiltration volume was lower in the elderly CAPD patients. Scores on the Revised Hasegawa Dementia Scale, the Physical Self-Maintenance Scale, and the Instrumental Activities of Daily Living scale were significantly higher in CAPD patients than in hemodialysis patients. Subjective assessment using a linear analog scale showed a high QOL score in the elderly patients for overall feelings of well-being, mood, and anxiety. At the time of dialysis introduction, the major existing disorders in patients over 80 years of age were mostly cardiovascular disorders such as heart failure, myocardial infarction, serious arrhythmia, and cerebrovascular disease. The median technique survival in patients aged 70 years or more was 31.5 months. The main causes of death in elderly PD patients were heart failure (35.7%), peritonitis (14.3%), and cerebrovascular disease (11.9%). Conclusion Peritoneal dialysis should be considered the treatment method of choice when introducing dialysis in elderly patients.
Effect of a Home Exercise Program Based on Tai Chi in Patients with End-Stage Renal Disease
Authors: Ling Kin-wa , Wong Flora S.Y. , Chan Wing-ki , Chan Shuk-yin , Chan Eric P. Y. , Cheng Yuk-lun , Yu Wai-yin 
Published: February 2020

Objective Previous reports have documented the benefits of exercise on the well-being of renal patients. However, fewer than 50% of our end-stage renal disease (ESRD) patients engage in regular exercise. To promote exercise, we implemented a home-based exercise program. The aim of the program was to reduce barriers to exercise by helping patients to exercise at their convenience and without the need to travel. The effect of the program was evaluated 3 months after implementation. Patients and Methods Each study participant received a videotape that demonstrated 30 minutes of low-capacity aerobic exercise. Participants were advised to exercise by following the demonstration on the videotape. Encouragement was given over the telephone. Self-reports on practice were recorded in a log book that was also provided. The effect of the program was evaluated by comparing outcomes data before, and 3 months after, implementation of the program. Outcomes assessment included functional mobility (timed “Up & Go” test), muscle flexibility (“Sit & Reach” test), physical capacity (“Six-Minute Walk”), and quality of life [Kidney Disease Quality of Life Short Form (KDQOL-SF)]. Results The program began with 72 participants. Over time, 39 dropped out. The remaining 33 participants included 11 men and 22 women with a mean age of 52.8 ± 9.8 years. They exercised 3 – 7 times weekly. Significant improvements were observed in the timed “Up & Go” ( p = 0.003) and “Sit & Reach” ( p < 0.001) tests. Improvements in the “Six-Minute Walk” ( p = 0.130) and in KDQOL-SF scores for emotional well-being ( p = 0.456), pain ( p = 0.100), burden of kidney disease ( p = 0.061), and general health ( p = 0.085) were statistically insignificant. Conclusions Physically, patients with ESRD benefit from home-based low-capacity aerobic exercise. A home-based program provides an alternative to outdoor and group exercise. In view of a high drop-out rate, intensive promotion and encouragement should be considered to achieve a positive outcome.
A Prospective Randomized Study on Three Different Peritoneal Dialysis Catheters
Authors: Lo Wai-Kei , Lui Sing-Leung , Li Fu-Keung , Choy Bo-Ying , Lam Man-Fai , Tse Kai-Chung , Yip Terence P.S. , Ng Flora S.K. , Lam Suk-Ching , Chu Wai-Ling , Cheng Suk-Wai 
Published: February 2020

Objective We compared outcomes for catheters with different configurations: conventional straight, swan-neck straight tip, and swan-neck curled tip. Design The study was conducted as a prospective randomized controlled trial in the continuous ambulatory peritoneal dialysis (CAPD) unit of a university center. Patients and Methods We randomized 93 new regular CAPD patients without prior peritoneal dialysis (PD) catheter insertion to receive a conventional straight, double-cuffed catheter (CS), a swan-neck straight catheter (SNC), or a swan-neck curled tip catheter (SNC) in 2:1:1 ratio. Results The exit-site infection (ESI) rate was slightly lower with swan-neck catheters as compared with straight catheters, but the difference was not statistically significant. The peritonitis rate and overall catheter survival were similar. In Staphylococcus aureus nasal non carriers as compared with carriers, ESI-free catheter survival was significantly better with swan-neck catheters ( p = 0.0302 and p = 0.82 respectively). As compared with SC catheters, SNC catheters had a significantly higher migration rate ( p = 0.022). Conclusions Swan-neck catheters were associated with a slightly better ESI rate, but SNC catheters are not routinely recommended because of a high migration rate. The SNS catheter is therefore recommended as the first-line catheter of choice, particularly in populations with a low rate of S. aureus nasal carriage.
Medico-Social Problems in Bruneian Dialysis Patients
Authors: Dwarakanathan Ranganathan , Yaakob Hjz Zarah , Hadi Hasanani , Asing Anthony 
Published: February 2020

Objective Our objective in the present study was to identify the medico-social problems in dialysis patients at the Department of Renal Medicine, RIPAS Hospital, Brunei Darussalam. Patients and Methods We retrospectively analyzed the social problems encountered by the patients in our dialysis program during the period January 2001 to June 2002. During that period, 285 patients were on hemodialysis (HD), and 65 patients were on continuous ambulatory peritoneal dialysis (CAPD). We made 302 referrals to the medical social unit. Results Of the 302 cases referred to the medical social unit, 35 (11.59%) were referred for welfare assistance from government or service clubs. Home assessments were conducted on 85 occasions (28.15%) during the study period. The HD section referred 18 (5.96%) patients to the medical social unit for assistance with employment- or work-related problems. The medical social unit also helped patients to settle medical bills (2 cases), acquire prosthetic equipment (9 cases), and obtain approval for housekeeping services applications (6 cases). Our medical social workers (MSWs) solved all 18 employment-related problems referred in HD cases. No cases were referred to the MSWs from the CAPD section for similar problems. It seems that employment-related problems are fewer in CAPD patients than in HD patients. However, long-term studies are required to confirm our findings. Conclusion The MSWs helped to improve the quality of life in patients undergoing dialysis in Brunei.