bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraperitoneal Urokinase and Oral Rifampicin for Persisting Asymptomatic Dialysate Infection following Acute Coagulase-Negative Staphylococcus Peritonitis
Authors: Demoulin Nathalie , Goffin Eric 
Published: February 2020

Background Coagulase-negative staphylococcus (CoNS) is responsible for cases of refractory and relapsing peritonitis in peritoneal dialysis (PD) patients, probably by biofilm formation on the catheter. The ISPD recommends catheter removal in such cases. Urokinase has been used to dissolve the biofilm lining the PD catheter, thus favoring antibiotic efficacy. Rifampicin has shown its efficacy in penetrating CoNS biofilm. Methods We defined persisting asymptomatic CoNS dialysate infection as a peritonitis episode with clinical improvement within 48 hours and dialysate clearing, but with persisting positive dialysate cultures. We retrospectively analyzed the outcome of such cases observed between 1/1998 and 12/2007. In all cases, intraperitoneal (IP) urokinase (100 000 units) and oral rifampicin (600 mg every day for 3 weeks) were added to intravenous vancomycin. Results 33 cases of CoNS peritonitis were recorded and 11 of them (33.3%) met the criteria of persisting asymptomatic CoNS dialysate infection. All were initially treated with intravenous vancomycin and oral ciprofloxacin, according to our protocol. Dialysate clearing, defined by a white blood cell count <100/μL, was noted at day 8 (range 4 – 17 days) on average, while dialysate cultures were still positive a mean of 6 (range 0 – 16) days later [ i.e., 13.9 (range 5 – 24) days after peritonitis onset]. IP urokinase instillation was performed an average of 18.9 (range 11 – 30) days after peritonitis onset. Treatment success, defined by peritonitis resolution with sterilization of the dialysate, without catheter removal and relapse peritonitis within 6 weeks of treatment completion, was observed in 7 of 11 (64%) cases. No side effects following IP urokinase instillation were noted. One case of rifampicin-induced toxidermia was recorded. Conclusion IP urokinase and oral rifampicin in addition to conventional antibiotics resulted in a catheter salvage rate of 64% in persisting asymptomatic dialysate infection following a CoNS peritonitis. Larger studies are needed to confirm these results. In CoNS peritonitis, dialysate cultures should be repeated, even after clearing of the dialysate, to avoid missing persisting asymptomatic infection.
Identification of Inflamed Atherosclerotic Plaque using 123I-Labeled Interleukin-2 Scintigraphy in High-Risk Peritoneal Dialysis Patients: A Pilot Study
Authors: Hubalewska–Dydejczyk Alicja , Stompór Tomasz , Kalembkiewicz Marta , Krzanowski Marcin , Mikolajczak Renata , Sowa–Staszczak Anna , Tabor–Ciepiela Barbara , Karczmarczyk Urszula , Kuśnierz–Cabala Beata , Sulowicz Wladyslaw 
Published: February 2020

Background Patients with end-stage renal disease (ESRD) suffer from markedly increased cardiovascular morbidity and mortality. Common carotid artery (CCA) intima-media thickness (IMT) assessment and CCA plaque identification using ultrasound are well-recognized tools for identification and monitoring of atherosclerosis. A new method for monitoring the inflammatory status of plaque, namely radiolabeled interleukin-2 (IL-2) scintigraphy, was proposed recently. The aim of this pilot study was to perform 123I-labeled-IL-2 carotid plaque scintigraphy in ESRD patients treated with peritoneal dialysis and to correlate obtained results with ultrasound assessment of CCA and selected inflammatory markers. Methods CCA-IMT was measured and CCA plaques were identified by ultrasound in 10 patients (5 women, 5 men; mean age 62.4 ± 10.4 years; median peritoneal dialysis duration 32.5 months, range 12 – 55 months) with advanced cardiovascular comorbidity. Following CCA ultrasound, 123I-labeled IL-2 carotid plaque scintigraphy was performed. Several biomarkers of inflammation and atherosclerosis were also measured in all patients. Results Mean target/non-target ratio for focal 123I-IL-2 uptake within the plaque was 3.15 ± 0.54, and mean IMT from the site of the scintigraphy analysis was 0.975 ± 0.337 mm. Highly significant correlation was found between CCA-IMT and a target/non-target ratio for focal 123I-IL-2 uptake in a corresponding artery ( R = 0.92, p = 0.01). However, no significant correlations were found between target/non-target ratio for focal 123I-IL-2 uptake and levels of measured biomarkers. Conclusions Our preliminary results suggest potential for identification of an inflamed (vulnerable) plaque using IL-2 scintigraphy in ESRD patients with cardiovascular comorbidities.
Continuous Peritoneal Dialysis Compared with Daily Hemodialysis in Patients with Acute Kidney Injury
Authors: Gabriel Daniela Ponce , Caramori Jacqueline Teixeira , Martin Luis Cuadrado , Barretti Pasqual , Balbi Andre Luis 
Published: February 2020

Background In some parts of the world, peritoneal dialysis is widely used for renal replacement therapy (RRT) in acute kidney injury (AKI), despite concerns about its inadequacy. It has been replaced in recent years by hemodialysis and, most recently, by continuous venovenous therapies. We performed a prospective study to determine the effect of continuous peritoneal dialysis (CPD), as compared with daily hemodialysis (dHD), on survival among patients with AKI. Methods A total of 120 patients with acute tubular necrosis (ATN) were assigned to receive CPD or dHD in a tertiary-care university hospital. The primary endpoint was hospital survival rate; renal function recovery and metabolic, acid–base, and fluid controls were secondary endpoints. Results Of the 120 patients, 60 were treated with CPD (G1) and 60 with dHD (G2). The two groups were similar at the start of RRT with respect to age (64.2 ± 19.8 years vs 62.5 ± 21.2 years), sex (men: 72% vs 66%), sepsis (42% vs 47%), shock (61% vs 63%), severity of AKI [Acute Tubular Necrosis Individual Severity Score (ATNISS): 0.68 ± 0.2 vs 0.66 ± 0.22; Acute Physiology and Chronic Health Evaluation (APACHE) II: 26.9 ± 8.9 vs 24.1 ± 8.2], pre-dialysis blood urea nitrogen [BUN (116.4 ± 33.6 mg/dL vs 112.6 ± 36.8 mg/dL)], and creatinine (5.85 ± 1.9 mg/dL vs 5.95 ± 1.4 mg/dL). In G1, weekly delivered Kt/V was 3.59 ± 0.61, and in G2, it was 4.76 ± 0.65 ( p < 0.01). The two groups were similar in metabolic and acid–base control (after 4 sessions, BUN < 55 mg/dL: 46 ± 18.7 mg/dL vs 52 ± 18.2 mg/dL; pH: 7.41 vs 7.38; bicarbonate: 22.8 ± 8.9 mEq/L vs 22.2 ± 7.1 mEq/L). Duration of therapy was longer in G2 (5.5 days vs 7.5 days; p = 0.02). Despite the delivery of different dialysis methods and doses, the survival rate did not differ between the groups (58% in G1 vs 52% in G2), and recovery of renal function was similar (28% vs 26%). Conclusion High doses of CPD provided appropriate metabolic and pH control, with a rate of survival and recovery of renal function similar to that seen with dHD. Therefore, CPD can be considered an alternative to other forms of RRT in AKI.
Impact of Stratification of Comorbidities on Nutrition Indices and Survival in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Prasad Narayan , Gupta Amit , Sinha Archana , Singh Anurag , Sharma Raj Kumar , Kaul Anupama 
Published: February 2020

Background Case-mix comorbidities and malnutrition influence outcome in continuous ambulatory peritoneal dialysis (CAPD) patients. In the present study, we analyzed the influence of stratified comorbidities on nutrition indices and survival in CAPD patients. Patients and Methods We categorized 373 CAPD patients (197 with and 176 without diabetes) into three risk groups: low—age under 70 years and no comorbid illness; medium—age 70 – 80 years, or any age with 1 comorbid illness, or age under 70 years with diabetes; high—age over 80 years, or any age with 2 comorbid illnesses. We then compared nutrition indices and malnutrition by subjective global assessment (SGA) between the three groups. Survival was compared using Kaplan–Meier survival analysis. Results Mean daily calorie and protein intakes in the low-risk group (21 ± 6.7 Kcal/kg, 0.85 ± 0.28 g/kg) were significantly higher than in the medium- (17.6 ± 5.2 Kcal/kg, 0.79 ± 0.25 g/kg) and high-risk (17.5 ± 6.1 Kcal/kg, 0.78 ± 0.26 g/kg) groups ( p = 0.001 and p = 0.04 respectively). Relative risk (RR) of malnutrition was less in the low-risk group (103/147, 70.06%) than in the medium-risk group [135/162, 83.3%; RR: 2.0; 95% confidence interval (CI): 2.1 to 3.4; p = 0.01] or the high-risk group (54/64, 84.4%; RR: 2.3; 95% CI: 2.1 to 4.9; p = 0.03). Mean survivals of patients in the low-, medium-, and high-risk groups were 51 patient–months (95% CI: 45.6 to 56.4 patient–months), 43.3 patient–months (95% CI: 37.8 to 48.7 patient–months), and 29.7 patient–months (95% CI: 23 to 36.4 patient–months) respectively (log-rank: 35.9 patient–months; p = 0.001). The 1-, 2-, 3-, 4-, and 5-year patient survivals in the low-, medium-, and high-risk groups were 96%, 87%, 79%, 65%, and 56%; 89%, 67%, 54%, 43%, and 34%; and 76%, 48%, 31%, 30%, and 30% respectively. Conclusions Intake of calories and protein was significantly lower in the medium-risk and high-risk groups than in the low-risk group. Survival was significantly better in low-risk patients than in medium- and high-risk patients.
Update on Fungal Peritonitis and its Treatment
Authors: Matuszkiewicz–Rowinska Joanna 
Published: February 2020

Fungal peritonitis (FP) is a rare but potentially fatal complication of chronic peritoneal dialysis (PD), associated with high morbidity and mortality ranging between 20% and 30%. If not leading to death, the inflammatory process usually causes irreversible damage to the peritoneal membrane with subsequent dropout from PD therapy. Fungal peritonitis accounts for 3% – 6% of all peritonitis episodes; however, in some areas, the numbers can be much higher. The most common cause of the disease is Candida, predominately C. albicans, C. parapsilosis, and—more recently— C. glabrata; other yeasts and filamentous fungi such as Aspergillus, Paecilomyces, Penicillium, and Zygomycetes are found, but much less frequently. The main factors associated with the development of FP include previous antibiotic therapy, particularly for bacterial peritonitis, when two important operative mechanisms coincide: fungal overgrowth in the gastrointestinal tract and declining peritoneal defense because of peritonitis. The management of FP poses a difficult challenge. Prompt initiation of therapy is critical, but no typical clinical picture has emerged, and the infecting organism can be difficult to isolate. The approach to the disease has changed considerably in recent years, and the 2005 guidelines from the International Society for Peritoneal Dialysis list FP as a strong indication for immediate catheter removal with temporary hemodialysis. The conventional antifungal regimens include fluconazole, amphotericin B, and flucytosine alone or in combination, optimally based on fungal sensitivities. The newer agents such as caspofungin and voriconazole have the potential to alter treatment strategies for FP, but further studies are required to clarify the precise role of these agents in this group of patients.
Does Immunosuppressive Treatment Ameliorate Morphology Changes in Encapsulating Peritoneal Sclerosis?
Authors: Bozkurt Devrim , Sipahi Savas , Cetin Pinar , Hur Ender , Özdemir Özden , Ertilav Muhittin , Sen Sait , Duman Soner 
Published: February 2020

Encapsulating peritoneal sclerosis (EPS) is a clinical syndrome associated with ileus symptoms and irreversible sclerosis of the peritoneal membrane. Inflammation, fibrosis, and neoangiogenesis are the main features of the pathophysiology. No evidence-based therapy is currently available for EPS. In recent years, anti-inflammatory and immunosuppressive (IS) treatment modalities have become more popular. The aim of the present study was to investigate the effects of various IS treatment strategies—glucocorticosteroid (GC), azathiopurine (AZT), and cyclosporin (CsA)—on regression of EPS. We divided 52 nonuremic Wistar albino rats into six groups: Control group—2 mL isotonic saline injected intraperitoneally (IP) daily for 3 weeks; CG group—2 mL/200 g 0.1% chlorhexidine gluconate (CG) and 15% ethanol dissolved in saline injected IP daily for 3 weeks; Resting group—CG (weeks 1 – 3), plus peritoneal rest (weeks 4 – 6); Corticosteroid (GC) group—CG (weeks 1 – 3), plus 10 mg/L prednisolone in drinking water (weeks 4 – 6); AZT group—CG (weeks 1 – 3), plus 100 mg/L azathioprine in drinking water (weeks 4 – 6); and CsA group—CG (weeks 1 – 3), plus cyclosporin 7.5 mg/kg by subcutaneous injection daily (weeks 4 – 6). At the end of the study, under ketamine HCl anesthesia, the rats were humanely killed by bleeding. Parietal peritoneal samples were then taken from same location (away from the injection site) and changes of parietal peritoneum morphology were examined by a single pathologist. The CG severely disturbed parameters of peritoneal morphology, increasing peritoneal thickness, inflammatory activity, vascularity, and fibrosis score as compared with the Control group ( p < 0.05). No benefit was observed for any parameter in the Resting group as compared withthose parameters in the CG group ( p < 0.05). We observed a lower fibrosis score and less peritoneal thickness in the GC group as compared with the Resting group ( p < 0.05). No beneficial effects of AZT on peritoneal morphology were observed as compared with the effects of peritoneal rest or corticosteroid therapy. Treatment with cyclosporin resulted in more fibrosis, vascularity, and inflammation than was seen with corticosteroid therapy ( p < 0.05). Immunosuppressive therapies, especially those that are corticosteroid-based, may have therapeutic value in the management of EPS. Patients treated with cyclosporin may have a risk for developing EPS.
The Peritoneal Handling of Digoxin during CAPD
Authors: Gloor Hans Jakob , Karl Harold Moore , Nolph D. 
Published: February 2020

We measured digoxin concentrations in serum and dialysate from five digitalized patients on continuous ambulatory peritoneal dialysis (CAPD). Mean peritoneal clearance of digoxin was 3.6 ± 0.4 ml/min (± SEM). Mean mass transfer was 8.6 ± 0.6 μg/min. Our patients lost from 3.7 to 13.3% of their daily oral digoxin intake in dialysate. The mean dialysate over serum (D/S) digoxin ratio was 0.59 and fell between D/S creatinine (0.81) and D/S inulin (0.34). Between patients the range of this ratio was wide (0.25 to 0.90). We also measured serial digoxin dialysate concentrations during a six hour “dwell” in one patient and determined a D/S equilibration curve. After six hours dialysate digoxin approached a plateau near 0.5. Digoxin removal per week from dialysate was two to three times greater during CAPD than that reported from IPD. Peritoneal losses of digo xin cannot be predicted for an individual patient. In four of eight digitalized patients, the cardiac drug could be discontinued suggesting a beneficial effect of long-term CAPD in controlling congestive heart failure.
Effect of the Perioex(R) Fil ter on Peritonitis Rates in a CAPO Population
Authors: Richard Stephen R. Ash , Emilie Horswell Jr , Heeter M. , Bloch R. 
Published: February 2020

A unidirectional filter for CAPD fluid was tested in a population of CAPD patients at one center, to determine its effectiveness in reducing peritonitis. Incidence of peritonitis was compared in four groups of patients: 1. High -risk patients who chose to use the filter. 2. Same patients, before filter use. 3. Overall population of the center before March, 1981 (introduction of filter for high-risk patients). 4. Overall population after filter introduction.
CAPO in toronto -An overview
Authors: Williams Clair C. 
Published: February 2020

During the last five years, 508 patients completed CAPD training. The mean age on entry was 50.4 years. Eighty-nine patients were diabetic. The overall incidence of peritonitis was one episode every 11.1 treatment months. The cumulative patient survival was 65% at four years, and corresponding technique success rate 35%. Cardiovascular causes accounted for 58.7% of deaths and peritonitis was the most common reason for CAPD failure. An analysis of outcomes by year of entry into the program suggests that survival and technique success improved in patients entered during 1981. Similarly there was a significant reduction in the incidence of peritonitis between 1978 and 1982. CAPD continues to be a successful and well-accepted dialysis modality.
A Review of Peritonitis Episodes that Caused Interruption of CAPD
Authors: Wu George 
Published: February 2020

In 49 of 508 ESRD patients, CAPD failed because of peritonitis, constituting the leading cause of such failure. These patients were divided into two groups (I and II) according to frequency of peritonitis. Group I patients (n = 25) had frequent, recurrent peritonitis (one episode every 2.6 months) whereas, among Group II patients, unusual or severe peritonitis (fecal, fungal and TB) was more common -in the latter the frequency of peritonitis was similar to that in the average population. Fecal peritonitis constituted 19% of all the episodes which led to interruption of CAPD; most of these cases seemed to be the result of diverticulitis. We believe that patients at particular risk of developing diverticulosis i.e., those older than 50 years and those with polycystic kidneys, should have a barium enema; if extensive diverticulosis is found, they should be considered to be at high risk for development of diverticulitis and fecal peritonitis. Even though the decreasing incidence of peritonitis leads to an overall decrease in peritonitis mortality and CAPD failure, once peritonitis develops, patients have the same risk of dying or failing now, as they had five years ago. For this reason we must undertake further studies in order to improve our management of these patients.
Risk Factors Associated with Time to First Infection and Time to Failure on CAPD
Authors: Corey Paul N. , Steele Cathy 
Published: February 2020

The Cox proportional hazards model was used to identify prognostic risk factors for time to first infection and time to failure among 183 patients on chronic ambulatory peritoneal dialysis (CAPD). This methodology permits continuous variables such as albumin and blood pressure to be used in the predictive equation avoiding arbitrary categorization. Initial serum creatinine and albumin were found to be related to the risk of first infection. Serum creatinine increases the risk whereas albumin is protective. Age and blood pressure are related to an increased risk of failure on CAPD whereas albumin is associated with a lower risk. The occurrence of the first infection almost doubles the risk of failure. Patients who have “high” albumin and “low” blood pressure have a 75th percentile for time to failure on CAPD which is more than 1000 days longer than those who have both “low” albumin and “high” blood pressure.
Hypotension on CAPD: An Approach to Treatment
Authors: Leenen Frans H.H. , Shah Perween , Boer Walther H. , Khanna Ramesh , Oreopoulos Dimitrios G. 
Published: February 2020

Development of orthostatic hypotension occasionally complicates treatment of end-stage renal failure by continuous ambulatory peritoneal dialysis (CAPD). The cause may be excessive sodium removal via the dialysate relative to the dietary sodium intake, leading to the gradual development of sodium depletion. Therefore, a group of five symptomatic, hypotensive CAPD patients was treated with oral salt-loading without allowing a concomitant increase in body weight. Supine blood pressure increased markedly after salt-loading (from 94/67 mmHg to 121/78 mmHg) and symptomatic orthostatic hypotension disappeared. The mechanisms leading to the improvement after salt-loading were studied in three of these patients. The beneficial effect of salt-loading was related to two mechanisms: 1) an increase in extracellular fluid volume and presumably blood volume; 2) an increase in sympathetic tone, as assessed by plasma norepinephrine levels and the pressor responsiveness to norepinephrine
Life After Capo
Authors: Williams Clair C. 
Published: February 2020

Of 508 patients trained for CAPD during the first five years, 115 (22.6%) were transferred to an alternative dialysis modality. Of these 87% were transferred to centre dialysis programs, equally divided between hemodialysis and intermittent peritoneal dialysis. Advanced age favoured transfer to intermittent peritoneal dialysis and failure due to peritonitis, transfer to hemodialysis. Three year survival after transfer from CAPD was 38%. The presence of diabetes and advanced age adversely affected survival after transfer. Dialysis modality and peritonitis as the cause of CAPD failure did not affect survival. Other treatment options are available to patients who fail CAPD. A relatively high drop-out is therefore acceptable and preferable to continuing CAPD in patients encountering complications which might ultimately influence their survival. Since its introduction in Toronto in 1977, continuous ambulatory peritoneal dialysis (CAPD) has achieved increasing prominence in the management of end-stage renal disease. Throughout its comparatively short history, one of the major criticisms of this technique has been the relatively high drop-out rate. This report provides a follow-up of patients transferred from CAPD to alternative dialysis modalities.
Quality of Life in End-Stage Renal Disease
Authors: Churchill David N. , Morgan Janet , Torrance George W. 
Published: February 2020

Survival in end-stage renal disease seems to depend more on age and associated diseases than on the form of treatment. Previously published comments on the quality of life experienced by patients treated by hemodialysis, peritoneal dialysis and transplantation were based on subjective estimates or on the use of unvalidated instruments. We have used a modified form of a “time trade-off” technique to estimate the patient's perception of the utility or worth of their ESRD health state. It was used successfully in 42 of 50 stable chronic hemodialysis patients. The correlation between paired observations six weeks apart (a test of temporal stability) was 0.80. Evidence for the validity of this instrument was obtained by comparing it with the physicians’ assessment of the patient's health state. Health was scored on a scale from 0 for death to 1 for perfect health. The mean values for hospital-based hemodialysis, CAPD and transplantation were 0.57, 0.57 and 0.80 respectively. For each form of treatment the distribution of scores was wide suggesting that factors other than form of treatment are important determinants of the per ceived quality of life for these patients.
Chyloperitoneum: A Rare Complication of Peritoneal Dialysis
Authors: Pomeranz Avishalom , Reichenberg Yona , Schurr Daniel , Drukker Alfred 
Published: February 2020

An eight-year old girl with extensive burns and aminoglycoside-induced acute renal failure was treated with peritoneal dialysis. She developed chyloperitoneum after medical insertion of a Tenckhoff catheter. Conservative dietary treatment with medium-chain triglycerides, supplemented by parenteral hyperalimentation and temporary cessation of the peritoneal dialysis allowed the chylous fistula to heal, without the need for surgical intervention. Leakage of milky chyle into the peritoneal cavity (chyloperitoneum or chylous ascites) is a rare clinical entity. Generally it is due to trauma or obstruction of the lymphatic system. It has been observed in adults with intra-abdominal malignancies and/or inflammations and in children with congenital malformations of the abdominal lymphatics (I). Chyloperitoneum also has been seen after abdominal trauma, including surgery (1–5); chyloperitoneum has been mentioned before as a complication of peritoneal dialysis but no details have been provided (1,6). This paper will report the occurrence and treatment of chyloperitoneum in an eight-year-old child undergoing peritoneal dialysis for acute renal failure.