bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Fluid Supplementation and Modality on Peritoneal Permeability Characteristics in a Rat Peritoneal Dialysis Model
Authors: Zweers Machteld M. , Splint Laura J. , Krediet Raymond T. , Struijk Dirk G. 
Published: February 2020

Objective Hemoconcentration may influence peritoneal permeability parameters in anesthetized animals without fluid supplementation. Therefore, the aim of this study was to investigate the effects of fluid supplementation on peritoneal permeability in an acute peritoneal dialysis model in anesthetized rats. Design To study the effect of fluid supplementation on peritoneal permeability characteristics, 24 anesthetized male Wistar rats were investigated in 3 groups during a 4-hour standardized peritoneal permeability analysis with a 3.86% glucose dialysis solution (SPARa). The groups included a control group with no fluid supplementation (None, n = 8), a group with continuous subcutaneous infusion of 0.9% NaCl 3 mL/hr (SC, n = 9), and a group with continuous intravenous infusion of 0.9% NaCl 3 mL/hr (IV, n = 7). Inflow, sampling, and outflow of the dialysate during the SPARa occurred via a cannula inserted intraperitoneally in the lower left quadrant of the abdomen. Blood was drawn at the end of the dwell. Baseline blood samples were obtained from six separate untreated rats. Results Plasma osmolality was significantly lower in the IV group (334 ± 1.4 mOsm/kg) compared to the None group (348 ± 0.7 mOsm/kg, p < 0.01), and not different from the SC group (335 ± 6.4 mOsm/kg), but higher than baseline (314 ± 5.3 mOsm/kg, p < 0.001). Urine production during the dwell was not different among the groups: None 10.6 ± 5.3 mL; SC 8.0 ± 6.0 mL; and IV 10.5 ± 5.6 mL. Transcapillary ultrafiltration after 4 hours was significantly higher in the IV group ( p < 0.05) compared to the other two groups. Net ultrafiltration and effective lymphatic absorption were similar in all groups. Mass transfer area coefficient of urea (MTACurea) was significantly greater in the IV group (155 ± 23.2 μL/minute, p < 0.003), but not different between the None (118 ± 16.2 μL/min) and SC (123 ± 25.9 μL/min) groups. Correcting these for the baseline plasma concentration resulted in higher values, but the IV data remained greater than the SC and None groups ( p < 0.01). The glucose absorption, albumin, and IgG clearances and the sieving of sodium were alike in all groups. Conclusion It can be concluded that IV fluid supplementation is more effective in preventing dehydration than SC supplementation, and it enhanced some peritoneal permeability characteristics in anesthetized rats during a 4-hour investigation. It is therefore important to standardize fluid supplementation in experiments with anesthetized animals.
Hyaluronan Preserves Peritoneal Membrane Transport Properties
Authors: Guo Qun-Ying , Peng Wen-Xing , Cheng Hui-Hong , Ye Ren-Gao , Lindholm Bengt , Wang Tao 
Published: February 2020

Background We have shown that intraperitoneal (IP) addition of hyaluronan (HA) in a single dwell study in rat could increase peritoneal fluid removal by decreasing the peritoneal fluid absorption rate. In this study, we investigated the impact of repeated use of HA on peritoneal membrane transport characteristics. Methods Twelve male Sprague–Dawley rats received a once-daily IP injection of 25 mL 4.25% glucose dialysis solution without (HP group, n = 6) or with 0.025% HA (HA group, n = 6) for 1 week. Forty-eight hours after the last injection, a 4 hour dwell using 25 mL 4.25% glucose dialysis solution with IP volume marker and frequent dialysate and blood samplings was performed in each rat as well as in rats that did not receive any injection (control group, n = 8). Results Although the IP volumes were significantly lower in the HP and HA groups compared to the control group, IP volume in the HA group was significantly higher than in the HP group. Net ultrafiltration at 4 hours was 5.6 ± 1.3 mL, 10.2 ± 1.8 mL, and 13.2 ± 0.6 mL for the H P, HA, and control group, respectively. The peritoneal fluid absorption rate decreased by 45% in the HA group compared to the HP group. There was no significant difference in peritoneal fluid absorption rate between the HA and the control group. No difference was found in the direct lymphatic absorption rate between the HP and HA groups [0.010 ± 0.003 mL/minute in the HP group and 0.011 ± 0.004 mL/min in the HA group] although they were both higher than that of the control group (0.004 ± 0.001 mL/min). The solute transport rates were in general significantly higher in the HP group compared to the HA and control groups, and there was no significant difference between the latter two groups, except that protein transport rate was significantly lower in the HA group compared to the control group. Conclusions The present study suggests that ( 1 ) repeated exposure to hypertonic glucose-based dialysis solution results in increased peritoneal solute transport rates, as well as increased peritoneal fluid absorption rates; and ( 2 ) these changes, reflecting a highly permeable peritoneal membrane, were ameliorated by repeated IP addition of hyaluronan. The similar changes in the direct lymphatic absorption rate in rats that received daily IP injection of dialysis solution suggest that direct peritoneal lymphatic absorption was not influenced by hyaluronan.
Acute Effects of Peritoneal Dialysis on Hemodynamics
Authors: Boon Diederik , Bos Willem Jan W. , Van Montfrans Gert A. , Krediet Raymond T. 
Published: February 2020

Objectives To investigate the acute hemodynamic effects of peritoneal dialysis (PD) using the noninvasive Portapres technique [TNO Biomedical Instrumentation (TNO BMI); Amsterdam, The Netherlands]. Design and Methods Blood pressure was measured in 21 consecutive patients on continuous ambulatory PD during a standard peritoneal permeability analysis (SPA). Blood pressure, stroke volume, cardiac output, and total peripheral resistance were recorded and calculated using continuous finger pressure recordings with Portapres and Modelflow software (TNO BMI). The SPA consists of four phases: ( 1 ) drainage of night dwell dialysate, ( 2 ) instillation of a rinsing solution (1.36% glucose), ( 3 ) drainage of rinsing solution, and ( 4 ) instillation of the test solution (3.86% glucose to which dextran 70 has been added). Results Both systolic blood pressure (SBP) (7 ± 9 mmHg, p < 0.005) and diastolic blood pressure (DBP) (5 ± 6 mmHg, p < 0.01) increased during phase 2. Systolic BP and DBP increased further during phase 4 (SBP 8 ± 14 mmHg, p < 0.05; DBP 6 ± 8 mmHg, p < 0.005). These BP increases were caused by a rise in total peripheral resistance of 10% ± 18% ( p < 0.05) during phase 1, and 15% ± 21% ( p < 0.005) during phase 2. Conclusions Instillation and dwell of a dialysis solution during PD causes a rise in blood pressure. This is caused by an increase in total peripheral resistance. Factors influencing total peripheral resistance could be a direct mechanical effect of dialysate on mesenteric resistance vessels or a temperature-related effect.
Dissociation between Clearances of Small and Middle Molecules in Incremental Peritoneal Dialysis
Authors: Kim Dae Joong , Do Jung Ho , Huh Wooseong , Kim Yoon Goo , Oh Ha-Young 
Published: February 2020

Objective To evaluate the peritoneal clearance of middle molecules in comparison with the peritoneal clearance of small molecules in incremental peritoneal dialysis (PD). Study Design Peritoneal clearances of creatinine and b2-microgloblulin (B2M) were compared in 57 continuous ambulatory PD patients on full dose of 4 exchanges, and 54 incremental PD patients with 2 or 3 exchanges over 24 hours. Clearances were also compared when there were changes in the PD regimen, such as in the number of exchanges and the duration of the dwell time. Setting Tertiary-care university hospital. Results Peritoneal creatinine clearance increased almost linearly with the increase in the number of exchanges. In contrast, peritoneal clearance of B2M was 9.1 ± 3.6 L/week, 8.8 ± 4.4 L/week, and 7.9 ± 2.5 L/week with 2, 3, and 4 exchanges, respectively, per day, amounts that were not different from each other. Peritoneal clearance of B2M did not change when there was an increase in the number of dialysate exchanges from 2 to 3 and from 3 to 4 over a period of 24 hours; whereas the peritoneal clearance of creatinine increased. Peritoneal clearance of B2M almost doubled, from 5.4 ± 2.7 L/week with 2 exchanges over 12 hours per day, to 9.5 ± 4.4 L/week with the same 2 exchanges over 24 hours. The creatinine clearance did not change. Conclusion In contrast to peritoneal clearance of small molecules, such as creatinine, which was dependent on the number of dialysate exchanges, peritoneal clearance of middle molecules, such as B2M, depended mainly on the total dwell hours of PD and not on the number of exchanges of peritoneal dialysate in incremental PD. This might be another advantage of incremental PD, since peritoneal clearance of middle molecules in incremental PD over 24 hours can be comparable to that in full dose PD.
Effect of Preventing Staphylococcus Aureus Carriage on Rates of Peritoneal Catheter-Related Staphylococcal Infections. Literature Synthesis
Authors: Ritzau Jennifer , Hoffman Richard M. , Tzamaloukas Antonios H. 
Published: February 2020

Objective To determine whether specific preventive measures reduce the rate of peritoneal catheter-related infections and peritoneal catheter loss due to Staphylococcus aureus. Design Structured literature synthesis. Methods Relevant studies were identified by medline search, from personal files, and from the reference lists of retrieved articles. We analyzed English-language studies on treatment targeted at S. aureus, with at least 10 subjects and at least 3 months of follow-up, and data on staphylococcal peritoneal dialysis catheter infections. We excluded noncontrolled studies. Two investigators abstracted data using a structured form. Results W e evaluated six studies with concurrent controls and eight studies with historical controls. In one randomized, placebo-controlled, blinded study, periodic nasal mupirocin ointment reduced the rate of staphylococcal exit-site infection from 0.42 to 0.12 episodes/patient-year ( p = 0.006), but had no effect on the rates of staphylococcal tunnel infection, peritonitis, or catheter loss. In one randomized study without placebo control, periodic oral rifampin reduced the rate of staphylococcal exit-site infection from 0.65 to 0.22 epi/pt-yr ( p = 0.011), but had no effect on the rate of staphylococcal peritonitis. In another nonblinded, randomized, controlled study, the use of either rifampin or mupirocin was associated with low rates of staphylococcal catheter infections and catheter loss. In one study with historical controls, the rate of staphylococcal exit-site infection and peritonitis was lower after oral rifampin prophylaxis. In seven other studies comparing nasal or exit-site mupirocin to historical controls, the rate of staphylococcal exit-site infection decreased from 0.17 to 0.05 epi/pt-yr, the rate of staphylococcal peritonitis decreased from 0.18 to 0.06 epi/pt-yr, and the rate of catheter loss decreased from 0.09 to 0.05 epi/pt-yr during the mupirocin period. Conclusion The literature provides strong evidence that staphylococcal carriage prophylaxis using either oral rifampin or mupirocin ointment in the nares or exit site reduces significantly the rate of exit-site infection due to Staphylococcus aureus. Weaker evidence based on studies with historical controls suggests that rifampin or mupirocin prophylaxis also reduces the rate of staphylococcal peritonitis and peritoneal catheter loss. Studies with a stronger level of evidence are needed to verify this last point.
Ketoconazole Pharmacokinetics in Continuous Ambulatory Peritoneal Dialysis
Authors: McGuire Nancy M. , Port Friedrich K. , Kauffman Carol A. 
Published: February 2020

Ketoconazole, a new oral drug, has minimal toxicity and a broad spectrum of antifungal activity. To determine its usefulness in fungal peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD), we carried out nine pharmacokinetic studies in five patients on CAPD. Serum levels of ketoconazole in CAPD patients were lower than in normal controls, and some patients did not appear to absorb the drug. We did not detect ketoconazole in the peritoneal fluid of any patient, even in the presence of peritoneal inflammation. One should not use this agent in the treatment of fungal peritonitis at daily doses of 400 mg or less because such a dose achieves only poor peritoneal fluid concentrations. Continuous ambulatory peritoneal dialysis (CAPD) has become an attractive alternative to hemodialysis for many patients with chronic renal failure. However, a major drawback with this technique is peritonitis (1). Although most of these infections are due to staphylococci (I), fungal peritonitis appears to be increasing as experience with CAPD grows (2,3). The treatment of such peritonitis is hampered by the poor penetration of amphotericin B into the peritoneal fluid (2), chemical peritonitis when amphotericin B is instilled directly into the cavity (3), and the limited spectrum of activity of flucytosine -a drug which readily penetrates into the peritoneal fluid (4). Ketoconazole is less toxic than amphotericin B and easier to administer and it has a much broader antifungal spectrum than flucytosine. The value of ketoconazole in fungal peritonitis remains to be established, and we have only limited data concerning its penetration into the peritonal cavity (2, 5). In this study we assessed the serum and peritoneal-fluid levels of ketoconazole in patients on CAPD.
Peritonitis among CAPD Patients: Host, Agent and/or Environment?
Authors: Stegman Mary Ruth , Berger Ann M. 
Published: February 2020

At the Omaha Veteran's Administration Medical Center, Omaha, Nebraska, USA the authors used the classic epidemiological model based on the interaction between host, agent and environment, and a historical-prospective design to study the risk factors for peritonitis among all continuous ambulatory peritoneal dialysis (CAPD) patients. Data were abstracted from the medical records of the patients and from questionnaires completed by the nurses who had cared for the entire population since the inception of CAPD at this hospital. Using the Cox proportional hazard regression model, they analyzed variables considered to be associated with the host, agent and environment. This survival analysis demonstrated that, when other host, agent and environmental factors are controlled, age (younger patients), low patient motivation and minimal social support are significant risk factors for peritonitis. The literature suggests that the study of and the attempts to control peritonitis among continuous ambulatory peritoneal dialysis (CAPD) patients has not considered the host, agent and environment as a unit, but rather have centered on one element at a time. Most investigators focus upon the host as the contributing factor (1–4) and view the infectious agent as ubiquitous (5, 6). Others consider as primary the social and/or psychological environment of the host (7–9). None have undertaken an investigation which has studied all three aspects of the infectious disease model so that risk can be estimated while controlling for confounding factors.
Computerized Tomographic Scanning with Intraperitoneal Contrast Enhancement in a CAPD Patient with Localized EDEMA
Authors: Schultz Stanton G. , Harmon Thomas M. , Nachtnebel Kenneth L. 
Published: February 2020

In a patient on continuous ambulatory peritoneal dialysis with localized abdominal and genital edema, the site of extraperitoneal dialysate leakage was determined by computerized tomographic scanning with intraperitoneal contrast enhancement. No adverse effects were encountered. The source of fluid leakage should be sought in CAPD patients with localized (i.e. genital) edema, because often they may have an undetected hernia or other peritoneal defect. Removal of the peritoneal dialysis catheter would not solve such a problem. In such cases, intraperitoneal contrast-enhanced CT scanning may represent an effective technique for identifying the site of dialysate leakage. Abdominal and inguinal hernias are well-recognized complications of con tinuous ambulatory peritoneal dialysis (CAPD). Dialysate may escape from the peritoneal space through such hernias; also the development of genital edema in a CAPD patient may indicate the presence of an inguinal hernia, which otherwise may be impossible to detect clinically (I). In CAPD patients who have had multiple abdominal operations, there may be numerous possible sites of hemia development and dialysate leakage, so that it may prove difficult to identify and repair the defect. We describe a patient in whom contrast-enhanced computerized tomographic scanning was used to identify the site of extraperitoneal dialysate leakage.
Fungal Eosinophilic Peritonitis Due to AL Ternaria in a Patient on Continuous Ambulatory Peritoneal Dialysis
Authors: Horisberger Jean-Daniel , Bille Jacques , Wauters Jean-Pierre 
Published: February 2020

We describe an unusual episode of fungal peritonitis, caused by an Alternaria species and associated with a persistent eosinophilia in peritoneal fluid and blood. Peritoneal and systemic eosinophilia, persisting long after catheter insertion and, associated with the signs of peritonitis, should arouse suspicion of a fungus infection. About 5% of episodes of peritonitis in patients on CAPD are due to yeast, mainly of the Candida species (I). On rare occasions, cases have been re ported of peritoneal infections in CAPD patients caused by various filamentous fungi (2 7). Peritoneal fluid eosinophilia in CAPD patients, a self-limited, benign condition, is a well described entity and usually occurs soon after catheter implantation (8–10). We present an episode of a fungal peritonitis, associated with a late, longstanding eosinophilia of peritoneal fluid and peripheral blood. The responsible organism was a dematiceous filamentous fungus identified as Alternaria alternata.
An Unusual Cause of Massive Intraperitoneal Bleeding in CAPD
Authors: Zaki Joseph Shohat , Yussim Shapira Alexander , Boner Geoffrey 
Published: February 2020

A 73-year-old man, who had been on CAPD for two years, presented with massive intraperitoneal hemorrhage. On laparotomy the peritoneal catheter was situated in a large pouch that was lined by fibrous tissue. The hemorrhage arose from erosion of the pouch wall -an unusual cause of intraperitoneal bleeding in the CAPD patient. Massive intraperitoneal bleeding is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). Mild to moderate bleeding, which is more common in CAPD, usually is related to disintegration of small blood vessels. In most patients the bleeding is self-limited. This paper describes an unusual cause of massive bleeding in a CAPD patient.
Cancer in Patients on CAPD
Authors: Digenis George E. , Pierratos Andreas , Ayiomamitis Anthony , Dombros Nickolas , Sombolos Kostas , Oreopoulos Dimitrios G. 
Published: February 2020

Many workers have reported a high incidence of cancer in persons with uremia or on hemodialysis but there is no agreement on this point. Because the incidence of neoplasms in patients on CAPD is unknown, we reviewed the medical records of the 328 patients treated with CAPD at the TWH from 1977 to 1985. Of these, nine developed cancers, of whom three had been treated with immunosuppressive agents previously. Whether or not these three patients are included, we found no significant difference in cancer incidence between the CAPD and the control population (p = 0.12 and 0.51 respectively). In conclusion, this review found no evidence that our CAPD patients had an increased incidence of cancer. Although an increased incidence of cancer has been reported in patients with chronic renal failure, before or while on hemodialysis, there is no agreement on the issue. The reported incidence of tumors in different studies ranged widely between 0.84 and 9.5% (I, 2). Even though an increasing number of patients have been treated on CAPD, the literature contains no information regarding the incidence of cancer in this population. The present study was undertaken to provide an answer to this question.
Usefulness of Dialysate Fibrin Degradation Products and Lactic Dehydrogenase Isoenzyme Patterns in Assessing the Clinical Course of Peritonitis
Authors: Suzuki Kazuyuki , Ishizaki Makoto , Hotta Osamu , Horigome Ikuo , Sudo Katsuhiko , Kurosawa Kousei , Taguma Yoshio 
Published: February 2020

Objective To establish the usefulness of fibrin degradation products (FDP) and lactic dehydrogenase isoenzyme patterns (LDH isoenzyme) in assessing the clinical course of peritonitis. Design A retrospective study of patients with peritonitis who were divided into three groups according to their clinical course. Setting Single dialysis unit of a general hospital. Interventions Patients were treated by intraperitoneal and oral antibiotics. Patients Twenty-six patients with 34 episodes of peritonitis were studied. Group 1 consisted of 21 patients with 26 recoveries from peritonitis; Group 2 consisted of 5 patients with 5 relapsing episodes of peritonitis, and Group 3 consisted of 3 patients with 3 persistent episodes of peritonitis. Main Outcome Measures Concentrations of WBCs, FDP, LDH isoenzyme and microbiological culture of the dialysate were determined. Results In most of Group 1, WBCs, FDP, and LDH isoenzyme returned to normal within 2 weeks. In 4 patients of Group 1, who had complications (diverticulitis, cholecystitis, cystitis, and tunnel infection), WBCs, FDP, and LDH isoenzyme returned to normal gradually within 3 weeks. In Group 2, WBCs returned to normal, but FDP remained relatively high and LDH isoenzyme did not normalize. In Group 3, WBCs, FDP and LDH isoenzyme did not normalize. Conclusions Failure of normalization of FDP and LDH isoenzyme suggests an incomplete recovery from peritonitis. FDP and LDH isoenzyme are useful in assessing the course of peritonitis.
The Effect of Changes in Dialysate Volume on Glucose and Urea Equilibration
Authors: Kohaut Edward C. , Waldo F. Bryson , Benfield Mark R. 
Published: February 2020

Objectives To determine the effect of changing dialysate volume on urea and glucoseequilibration curves and to determine, if dialysate volume is prescribed on the basis of body surface area, whether equilibration curves will be consistent in patients of different sizes and ages. Design A prospective study wherein children with acute or chronic renal failure had peritoneal equilibration studies done with dwell volumes of 30 mL/kg, 40 mL/kg, and 1200 mL/m2. Patient Population Twenty-two children: 7 under 3 years of age; 8 between 3 and 10 years of age; 7 older than 10 years of age. Statistics Student's t-test. Results Urea and glucose equilibrated rapidly at dwell volumes of 30 mL/kg, slower at dwell volumes of 40 mL/kg, and slowest at dwell volumes of 1200 mL/m2. Equilibration curves were similar in children of different ages when dialysate volumes of 1200 mL/m2 were infused. Conclusion Dialysate volumes of 1200 mL/m2 should be used when equilibration studies are being done to compare individuals of different ages and sizes.