bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Peritoneal Dialysis Solutions on Rifampin Action against Staphylococcus Epidermidis in the Fluid and Biofilm Phases of Growth
Authors: Richards Geoffrey K. , Gagnon Raymonde F. , Obst Gregory , Kostiner Geoffrey B. 
Published: February 2020

Continuous ambulatory peritoneal dialysis (CAPD) catheter-assoclated infections can be resistant to conservative therapeutic measures despite the apparent susceptibility of the infecting bacterial strains to antibiotics. This chronicity of Infection has been ascribed to the development of bacteria on the surfaces of catheter material within a protective polysaccharide shield or matrix. CAPD catheters are unique In being exposed to nonphysiological environments of dialysis fluids of varying physical properties and constitution. We determined that the rate of growth of s. epidermldis In the fluid phase In laboratory media or fresh dialysis solution was significantly Influenced by pH. An acid milieu (pH 5) Impaired growth compared to a neutral milieu (pH 7). Spent dialysis fluid, however, which had an approximately neutral pH, also Impaired bacterial growth, the assumption being that this results from properties of spent fluid unrelated to pH. Using rifampin as the test antibiotic, we noted that Its action on S. epidermldis was unaffected by pH or by the differing milieu of fresh and spent fluid. Bacterial growth was arrested regardless of the milieu. We further examined the potential of dialysis fluids to modify the Interaction between rifampin and the matrix-enclosed bacteria of standardized S. epidermidis blofilms. We determined that the pH of the dialysis solution was a critical factor Influencing the outcome of exposure of the biofilm to rifampin. An acid pH enhanced antibiotic activity, whereas a neutral pH was associated with antibiotic antagonism. These findings have Implications in the management of S. epidermldis catheter-associated infections using rifampin. Administration of the antibiotic In fresh peritoneal dialysis solution (pH 5.6) Is Judged more likely to be associated with a successful outcome.
Insulin Therapy in Uremic Diabetic Patients on Continuous Ambulatory Peritoneal Diaysis; Comparison of Intraperitoneal and Subcutaneous Administration
Authors: Scarpioni Lino , Ballocchi Sergio , Castelli Aurelio , Scarpioni Roberto 
Published: February 2020

Objective To compare, in diabetic uremic patients on continuous ambulatory peritoneal dialysis (CAPD), the effects of two patterns of insulin administration, four times daily subcutaneous (SC) injections and intraperitoneal (IP) route, on blood glucose, insulin, lactate, beta-hydroxybutyrate and glycerol levels. Patients and Methods We examined 6 uremic insulin-dependent diabetic patients on CAPD. The two insulin regimens, SC and IP, were tested successively in randomized sequence in each patient. At the end of each treatment period we determined the 24-our profiles of blood glucose, free insulin, lactate, beta-hydroxybutyrate, and glycerol. Results Mean blood glucose over 24 hours (SC 7.21 ±0.61 mmol/L, IP 7.49±0.93 mmol/L), Schlichtkrull's M value, an index of glycemic control and stability (SC 10±3, IP 10±5), and the blood intermediate metabolites beta-hydroxybutyrate, lactate, and glycerol were similar in both groups. Mean serum free insulin was significantly higher during subcutaneous treatment (SC 257. 4±127.2 pmol/L, IP 170.4±83.4 pmol/L, p < 0.001). Insulin requirements were 2.5 times greater for the intraperitoneal route (SC 51 ±4 U/24 hours, IP 130±43 U/24 hours). Conclusions In uremic diabetic patients on CAPD, good glycemic control may be achieved either with subcutaneous intensive insulin therapy or with intraperitoneal insulin administration. The latter method allows reduction of circulating free insulin levels, but requires a higher dose of insulin per day.
Cancer Antigen 1251S Locally Produced in the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis
Authors: Koomen Ger C.M. , Betjes Michiel G.H. , Zemel Oésirée , Krediet Raymond T. , Hoek Frans J. 
Published: February 2020

The local production of cancer antigen (CA) 125 in the peritoneal cavity of 14 continuous ambulatory peritoneal dialysis patients was studied. In addition, the relationship between the concentration of mesothelial cells and CA 125 in the peritoneal dialysate effluent was examined. The median results and ranges were as follows: plasma CA 125 14 U/mL (range 10 23), dialysate CA 125 18 U/mL (range 5.2 76), dialysate/plasma ratio 1. 9 (range 0.61 -5.4), and number of mesothelial cells 400/mL (range 10 5000). Peritoneal concentrations of mesothelial cellsand CA 125 were positively correlated (r = 0.50, p < 0.01). Using a monoclonal antibody, CA 125-positive cells were found in the cytospin preparations of the cells of dialysis effluents. All these CA 125 positive cells were also positive for cytokeratin used as a mesothelial cell marker. In vitro experiments using mesothelial cells in monolayers showed a linear increase in CA 125 concentration both in time and in relation to the number of mesothelial cells. From these experiments a production rate of 24 U/hour/1 06 cells could be calculated. It is therefore concluded that CA 125 is locally produced in the peritoneal cavity during CAPD and that the mesothelial cells are the major source of this CA 125.
In Vitro Study of the Effect of Osmotic Solutes on the Interactions between Cells from the Peritoneum and Peritoneal Cavity
Authors: Breborowicz Andrzej , Balaskas Elias , Oreopoulos George D. , Martis Leo , Serkes Kenneth , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To study how the presence of osmotic solutes in medium affects growth of the peritoneal mesothelial cells and fibroblasts and how osmotic solutes influence the production of factors regulating growth of these cells. Design The proliferation of mesothelial cells and fibroblasts was evaluated by measuring the incorporation of 3H-thymidine into the cells. Cells were exposed to osmotic solutes; the concentration of the latter in the medium was continuously lowered over the time of the experiment to simulate changes of their concentration in the dialysate. The synthesis of factors influencing the proliferation of the mesothelial cells or fibroblasts, by mesothelial cells or fibroblasts themselves, or by peritoneal leukocytes, was tested by the characteristics of the “conditioned” medium. The conditioned medium was produced by exposing standard medium to mesothelial or fibroblasts monolayer or to peritoneal leukocytes over 24 hours; following filtration it was applied to growing test cells for the study of growth factors. Results The effect of osmotic solutes on the growth of mesothelial cells is less inhibitory when their concentration is gradually lowered over the time of the study, compared to previous findings with a constant concentration. Peritoneal leukocytes produce growth factors for mesothelial cells and fibroblasts. Glucose and amino acids inhibit production of peritonealleukocyte-derived growth factors for mesothelial cells, while glycerol increases synthesis of such growth factors for fibroblasts. Mesothelial cells produce factors stimulating the proliferation of mesothelial cells and fibroblasts. In the presence of glycerol or amino acids synthesis of mesothelium derived growth factors for fibroblasts is augmented. Finally, fibroblasts produce factors that inhibit the proliferation of the mesothelial cells, and this effect is potentiated in the presence of amino acids. Conclusions Cytotoxicity of the osmotic solutes measured by the inhibition of growth of the mesothelial cells or their increased damage is significantly reduced during in vitro kinetic study when the concentration of these solutes is gradually lowered. Presence of osmotic solutes in the medium affects synthesis of growth factors derived from mesothelium, fibroblasts, or peritoneal leukocytes, which affect the proliferation of mesothelial cells or fibroblasts.
Anabolic Steroids in the Treatment of Malnourished Capd Patients: A Retrospective Study
Authors: Dombros Nicholas V. , Digenis George E. , Soliman Gamal , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To assess the effect of anabolic steroids on malnutrition of continuous ambulatory peritoneal dialysis (CAPD) patients. Design Retrospective analysis of medical records, charts, and computer-generated laboratory and medication data. Setting Peritoneal Dialysis Unit of The Toronto Hospital. Patients Thirteen patients with moderate to severe malnutrition who had received nandrolone decanoate (ND) intramuscularly (IM) for at least three months. Nine of these patients (group A), with a mean age of 59.4 years, received only ND (100 -200 mg IM monthly). Group B consisted of 4 patients (mean age 74.0 years) who, in addition to ND, received intraperitoneal (IP) amino acids. Results In group A, serum albumin, while declining before ND treatment (34.4±3.2 to 31.5±3.35, x±SEM, g/L at -2 and 0 months), showed a progressive and significant (p < 0.001) increase during treatment, sustained up to the third month (36.57±1.51). In group B, serum albumin did not increase significantly (30.25±2.62, 30.75±1.9, and 31.5±4.8, x±SEM, g/L at -2, 0, and +3 months, respectively. In group A, serum creatinine was increased significantly (p < 0.01) from 0 to +3 months (731±185 to 938±92.5 mmol/L). Blood urea, bicarbonate, and total protein levels did not change significantly. In group B, serum creatinine fluctuated considerably with an insignificant trend to rise. Blood urea showed a steady trend to increase without reaching statistical significance. In relation to time 0, bicarbonate levels (28.7±3.3) were decreased significantly (p < 0.05) (27±0.8, 24.6±1.5, and 25±1 mEq/L, at + 1, +2, and +3 months, respectively). Conclusions Nandrolone decanoate alone, in relatively low doses, exerted a definite anabolic effect in 9 malnourished CAPD patients. The lack of a similar effect in 4 patients, who in addition to ND received amino acids IP, could be explained by the low dose of ND, the concurrent acidosis, the severity of malnutrition, and the older age of this group.
Synthesis of Phospholipids by Human Peritoneal Mesothelial Cells
Authors: Beavis Janine , Harwood John L. , Coles Gerald A. , Williams John D. 
Published: February 2020

Objective To assess the capacity of cultured human peritoneal mesothelial cells to synthesize choline-containing phospholipids. The study compares the phospholipids secreted from cultured cells with those which we, and others, have identified in the dialysate of patients treated by continuous ambulatory peritoneal dialysis (CAPD). Patients CAPD effluent was collected from 8 patients who had been receiving CAPD treatment for at least 11 months and who had normal ultrafiltration. Cell Cultures Using human omental tissue, homogeneous cultures of mesothelial cells were established. Methods Synthesis of phospholipids by mesothelial cells was assessed following incubation with [methyl14C] choline chloride-a precursor capable of being in corporated into phosphatidylcholine (PtdCho) and sphingomyelin. Lipids from CAPD effluent, cultured cells, and cell medium were extracted in chloroform/methanol. Phospholipids were separated and identified by thin layer chromatography. Synthesis and secretion of PtdCho and other choline-containing lipids by the mesothelial cells were determined by β scintillation counting of the appropriate bands, while the fatty acid composition of the phospholipids was ascertained by gas liquid chromatography. Results Synthesis and secretion of PtdCho by mesothelial cells were observed during a 96-hour period. When maintained in medium replete with essential fatty acids, the fatty acid composition of the PtdCho synthesized by cultured mesothelial cells closely resembled that isolated from the peritoneal cavity. Conclusion The demonstration of phospholipid secretion from mesothelial cells, with a fatty acid composition similar to the phospholipids isolated from peritoneal dialysate, lends added support to the hypothesis that the mesothelial cells are the source of the peritoneal phospholipids. As such they offer a useful experimental system in which to study peritoneal phospholipid synthesis.
Volume of Distribution and Fractional Clearance of Urea in Amputees on Continuous Ambulatory Peritoneal Dialysis
Authors: Tzamaloukas Antonios H. , Saddler Mark S. , Murphy Gayle , Morgan Kelley , Goldman Richard S. , Murata Glen H. , Malhotra Deepak 
Published: February 2020

Objectives To demonstrate the effects of amputation on the estimates of urea volume of distribution (V) and KTN urea in continuous ambulatory peritoneal dialysis (CAPD) patients and to present a method for correcting the errors created by the uncorrected anthropometric formulas estimating V. Design (1) A mathematical analysis of the error and the correction proposed was performed. (2) Urea kinetic modeling with uncorrected and corrected estimates utilizing both the Watson and the Hume anthropometric formulas was performed in amputees on CAPD. Setting Subjects were recruited from four dialysis units in one city: one Veterans Affairs unit, one university-affiliated unit, and two community units. Patients Fourteen amputees on CAPD: 12 with unilateralleg amputation and 2 with bilateral leg amputation, at the same length of the leg, were studied. Interventions Urea kinetic studies were performed in 24-hour drained dialysate and urine specimens. Main Outcome Measures Uncorrected and corrected estimates of V and KTN urea were compared to each other and to the predictions of the mathematical model. Body weights corresponding to uncorrected and correct ed V estimates were compared to the actual body weights. Results (1) The mathematical model predicts that uncorrected estimates by the anthropometric formulas will falsely characterize unilateral amputees as leaner than they are and bilateral amputees as more obese than they are. (2) In unilateral amputees studied with the Watson formulas, uncorrected V was 0.546±0.023 L/kg and corrected V was 0.520±0.023 L/kg (p < 0.001). Corresponding weekly KTN urea values were 1.97±0.14 and 2.07±0.14, respectively (p < 0.001). Similar results were obtained with the Humeformulas. In bilateral leg amputees studied with the Watson formulas, uncorrected V was 0.479±0.022 L/kg and corrected V was 0.514±0.023 L/kg. Corresponding KT N estimates were 2.11 ±0.45 and 1.96±0. 14, respectively. The differences were even greater with the Hume formulas. Estimates of body weight calculated from corrected V values were equal to actual weight measurements, whereas those calculated from uncorrected V values were lower than actual body weight measurements in unilateral amputees, and much higher than actual body weight measurements in bilateral amputees. Conclusion Uncorrected anthropometric estimates falsely characterize unilateral amputees as leaner than they actually are and bilateral amputees, amputated at the same leg length, as more obese than they actually are. Uncorrected KTN estimates are, therefore, falsely low in unilateral amputees, and falsely high in bilateral amputees. The proposed correction of the anthropometric formulas provides estimates agreeing closely with dietary estimates of body composition. Further studies are needed to define the accuracy of the corrected formulas.
Anabolic Steroids and Malnutrition in Chronic Renal Failure
Authors: Soliman Gamal , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To determine whether anabolic steroids are useful in the management of the malnutrition of chronic renal failure. Data Source Original research studies and book chapters about anabolic steroids and their use in uremia and various illnesses associated with malnutrition. We included studies that describe the benefits of anabotic steroids in the treatment of anemia and sexual dysfunction of chronic renal failure. Forty-two such studies were published between 1942 and 1992. Results Anabolic steroids improve the nutritional status and sexual dysfunction of uremic men. In addition, anabolic steroids have a recognized place in the treatment of the anemia of chronic renal failure. Conclusions Based on the findings of noncontrolled studies, one may conclude that anabolic steroids exert a beneficial effect in the malnutrition of renal failure. We believe that their efficacy should be established by controlled studies.
Bicarbona Te-Based Dialysis Solution Preserves Granulocyte Functions
Authors: Dobos Gustav J. , Böhler Joachim , Kuhlmann Jens , Elsner Jörn , Andre Martin , Passlick-Deetjen Jutta , Schollmeyer Peter J. 
Published: February 2020

Objective Intraperitoneal phagocytes play an important role in local defense in preventing continuous ambulatory peritoneal dialysis (CAPD) peritonitis. This study therefore investigates the effect of the conventional lactate-based dialysis solution-pH 5.2 (LBDS-pH 5.2) and a bicarbonate-based dialysis solution (BBDS) on various cell functions. Design We studied C5a-induced actin polymerization (AP) as a measure of the cytoskeletal alteration, phagocytosis of zymosan particles, and chemotaxis in neutrophils incubated in either LBDS-pH 5.2, LBDS-pH 7.4, or BBDS-pH 7.4, comparing the data with cells treated with phosphate-buffered saline-pH 7.4 (PBS-pH 7.4) as a control. Subjects Polymorphonuclear neutrophils (PMNs) were isolated from the blood of healthy donors and incubated with dialysis solution prior to the experiment. Results C5a-induced AP was dramatically inhibited in PMNs incubated in LBDS-pH 5.2, paralleled by a complete inhibition of phagocytosis and C5a-induced chemotaxis. In comparison, BBDS improved AP to values above the control and also nearly normalized phagocytosis. Chemotaxis markedly improved in cells treated with the low glucose-containing BBDS (Bic 20), but was still inhibited in PMNs incubated in the BBDS containing high glucose concentrations (Bic 30). Conclusion In comparison with conventional lactate-based dialysis solution-pH 5.2, bicarbonate-based dialysis solution at low osmolality better preserves neutrophil functions that involve the cytoskeleton.
Hormonal, Blood Pressure, and Peritoneal Transport Response to Short -Term Ace Inhibition
Authors: Ripley Elizabeth B.D. , Gehr Todd W.B. , Kish Charles W. , Sica Domenic A. 
Published: February 2020

Objectives To evaluate the hormonal, blood pressure, and peritoneal transport effects of intraperitoneal enalaprilat and oral enalapril. Design A nonrandomized, nonblinded, prospective clinical trial was performed. Setting The study was conducted at the Clinical Research Unit at the Medical College of Virginia, a tertiary care center. Patients Six continuous ambulatory peritoneal dialysis (CAPD) patients with hypertension were enrolled in the study. All 6 patients received intraperitoneal enalaprilat. Five of the patients also received oral enalapril. Interventions Hormonal, clinical, and transport parameters were investigated in patients given intraperitoneal enalaprilat and oral enalapril. Standardized 2-L exchanges were performed during a control period, following 2.5 mg intraperitoneal enalaprilat and after a week of oral enalapril. Inulin, blood urea nitrogen (BUN) and creatinine clearances, and glucose absorption were determined during these exchanges. Results After intraperitoneal enalaprilat, both systolic and diastolic blood pressure significantly declined, reaching maximal decreases of -21.7±14.2% at 95±92 minutes, and of -23.3±15.4% at 105±105 minutes, respectively. Plasma angiotensin converting enzyme (ACE) activity was suppressed below detectable limits at four hours following intraperitoneal enalaprilat, and remained suppressed throughout all sampling time points following oral enalapril treatment. There was no significant change in drain volumes, glucose absorption, or BUN, creatinine, or inulin clearances, whether enalaprilat was administered intraperitoneally or enalapril orally. Conclusion This study demonstrates that intraperitoneal administration of enalaprilat is a rapidly effective route of administration of this ACE inhibitor. There were no changes in peritoneal transport characteristics demonstrated.
The Concept of Adequacy in Peritoneal Dialysis
Authors: Ronco Claudio , Conz Piero , Agostini Francesco , Bosch Juan P. , Lew Susy A. , La Greca Giuseppe 
Published: February 2020

The aim of renal replacement therapy is to obtain blood purification from metabolic waste products sufficient to achieve patient rehabilitation, the control of dry body weight, and the correction of acid base and electrolyte imbalances (1–3). Among these, the correction of the hormonal imbalances as a result of renal disease would also be required (4). However, this is difficult to achieve, and the majority of substitute therapies such as hemodialysis and peritoneal dialysis focus on blood purification and fluid and electrolyte homeostasis. For this reason the search for the optimal dialytic therapy has been limited to the possibility of achieving a treatment that could at least be adequate in terms of blood purification and patient rehabilitation. Therefore, dialysis adequacy has been selected as a term to indicate successful renal replacement therapy, one that could overcome most of the uremic symptoms and allow the patient to reach a sufficient degree of rehabilitation, even though the treatment is far from the complete and optimal substitution of the lost kidney function in its whole. In recent years the concept of dialysis adequacy has been studied by several authors, and a continuous evolution of this concept has been observed. From the original description of the square-meter-hour hypothesis of Babb and Scribner in 1971 (5), a series of new studies led to the clinical application of various indices devoted to describing the level of efficiency achieved by dialysis treatment (6,7). Finally, after the American National Cooperative Dialysis Study was analyzed, and the KTN index was selected as a marker for dialysis adequacy, the majority of authors now rely on this index and are proposing various formulas for its calculation (8–11).
Predicted and Measured Daily Creatinine Production in CAPD: Identifying Noncompliance
Authors: Nolph Karl D. , Twardowski Zbylut J. , Khanna Ramesh , Moore Harold L. , Prowant Barbara F. 
Published: February 2020

Objective To evaluate the ratio of measured creatinine (Cr) production to predicted creatinine production as an index of noncompliance in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A cross-sectional analysis. Patients One hundred and twenty-one patients on CAPD. Measurements We have calculated Cr production from measured Cr outputs in 24-hour collections of urine and dialysate. Predicted Cr productions were calculated from standard tables. Weekly KTN urea and weekly Cr clearances were determined from the same 24-hour urine and dialysate collections. Lean body mass (LBM) was calculated from the Cr production. Serum albumin concentration was measured. Results The ratio of measured/predicted Cr production correlated positively and significantly with weekly KTN urea, the protein equivalent of nitrogen appearance (PNA), weekly Cr clearance, and LBM. There was a decline in serum albumin concentration at ratios greater than 1.24, supporting the opinions of previous authors who have suggested that ratios greater than 1.24 are highly suggestive of noncompliance with the dialysis prescription. Defining noncompliance as a ratio greater than 1.24 implied that at least 5% of the female and 17% of the male patients were noncompliant. Conclusions Declining serum albumin concentrations at higher ratios of measured/predicted Cr production support the opinion that this is an index of noncompliance. However, not all noncompliant patients necessarily have a ratio greater than 1.24. Weekly KTN urea, weekly Ccr and LBM are all artifactually increased by “washout effects” if all exchanges are done only or mainly on the collection day.