bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acid-Base Balance with Different Capd Solutions
Authors: Feriani Mariano , Ronco Claudio , La Greca Giuseppe 
Published: February 2020

Our objective is to investigate transperitoneal buffer fluxes with solution containing lactate and bicarbonate, and to compare the final effect on body base balance of the two solutions. One hundred and four exchanges, using different dwell times, were performed in 52 stable continuous ambulatory peritoneal dialysis (CAPD) patients. Dialysate effluent lactate and bicarbonate and volumes were measured. Net dialytic base gain was calculated. Patients’ acid-base status and plasma lactate were determined. In lactate-buffered CAPD solution, lactate concentration in dialysate effluent inversely correlated with length of dwell time, but did not correlate with plasma lactate concentration and net ultrafiltration. Bicarbonate concentration in dialysate effluent correlated with plasma bicarbonate and dwell time but not with ultrafiltration. The arithmetic sum of the lactate gain and bicarbonate loss yielded the net dialytic base gain. Ultrafiltration was the most important factor affecting net dialytic base gain. A previous study demonstrated that in patients using a bicarbonate-buffered solution the net bicarbonate gain is a function of dwell time, ultrafiltration, and plasma bicarbonate. By combining the predicted data of the dialytic base gain with the calculated metabolic acid production, an approximate body base balance could be obtained with both lactate and bicarbonate-buffered CAPD solutions. The body base balance in CAPD patients is self-regulated by the feedback between plasma bicarbonate concentration and dialytic base gain. The level of plasma bicarbonate is determined by the dialytic base gain and the metabolic acid production. This can explain the large interpatient variability in acid-base correction. Bicarbonate-buffered CAPD solution is equal to lactate solution in correcting acid-base disorders of CAPD patients.
Compliance Study in Peritoneal Dialysis Using Pdadequest Software
Authors: Amici Gianpaolo , Viglino Giusto , Virga Giovambattista , Gandolfo Carmen , Da Rin Giorgio , Bocci Carlo , Cavalli Pier Luigi 
Published: February 2020

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.9±1.5 years and on PD for 28.6±4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24hour urine and dialysate were collected. Total weekly creatinine clearance (CrCI, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCI and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values. The control group was significantly different from the noncompliant group in the percentage of the CrCI and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCI and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.
Peritoneoscopic Placement of Swan Neck Peritoneal Dialysis Catheters
Authors: Copley J. Brian , Lindberg Jill S. , Back Sandra N. , Tapia Nina P. 
Published: February 2020

Peritoneoscopic placement of peritoneal dialysis catheters, although accomplished in only about 10% of dialysis centers, is a nonsurgical technique that fulfills requirements for safety and dependability. Over a 40-month period, 136 catheters were placed with the peritoneoscope, 135 of which were double-cuffed, Swan neck curled catheters, with a uniform radiopaque stripe. Patients were followed longitudinally for outcome. Catheters were placed in 44 diabetic patients, 1 human immunodeficiency virus (HIV)-positive patient, and 18 morbidly obese patients. No complications occurred as a direct result of placement. Catheters were used, on average, nine days after placement (many on days 1 to 4) usually with 1.5 to 2 L exchanges. With 1183 patient-months’ experience, complications were few: 28 patients experienced catheter-related infections, and there were five leaks that resolved with supine, low-volume dialysis for several days. Leakage did not correlate with time of usage after placement. Of ten outflow/mechanical problems that required catheter removal, nine involved catheter migration, probably due to lack of attention during placement to orientation of the radiopaque stripe. One was due to a preperitoneal placement early in this institution's experience with the peritoneoscope. Five of the migrated catheters were removed and then successfully replaced with the peritoneoscope at the same sitting. Four patients requested surgical removal and replacement. Sixteen catheters were removed because of catheter-related infections: five refractory Staphylococcus aureus, six Pseudomonas aeruginosa, two fungal, two Serratia species, and one Mycobacterium chelonei. Actuarial life table analysis showed that at the end of the 40-month follow-up, 62% of the catheters were expected to survive. Because more than 50% survived, median catheter survival could not be calculated. The adverse responses were removal because of infection or catheter migration. Peritoneal dialysis catheter implantation with the peritoneoscope represents a safe and dependable method for catheter placement. Literature review and comparison indicate that catheter-related complications are fewer and catheter longevity is better with peritoneoscopic placement than with surgical placement. Our experience with prompt postplacement utilization suggests the need for further evaluation of catheter break-in procedure with the peritoneoscope.
A Home Visit Program for Capd
Authors: Warmington Victoria 
Published: February 2020

In the U.K. in the last five years a reassessment of the central role of the hospital has taken place, with a fundamental shift in care for people with increased dependencies to community settings. For patients using peritoneal dialysis a need has been realized for a home-visiting service by specialist renal nurses who can manage and coordinate the program of care, thus reducing the strain on hospital resources. In addition, the provision of a community nurse to visit the patient at home means that ongoing education and training can be undertaken in a suitable learning environment. The home-visiting program creates an opportunity to develop an holistic care plan using strategies of general health promotion as well as practical nursing care. This paper highlights the experiences of a pioneering model of community continuous ambulatory peritoneal dialysis care in South London. Auditing of this unusually funded post has shown significant reductions in peritonitis, exit-site infections, and hospital admissions In this growing patient population.
Clinical Experience with a 39 Mmol/L Bicarbonate-Buffered Peritoneal Dialysis Solution
Authors: Feriani Mariano , Carobi Carmen , La Greca Giuseppe , Buoncristiani Umberto , Passlick-Deetjen Jutta 
Published: February 2020

Objective To investigate the effect on the patient's acidbase status of a 39 mmol/L bicarbonate-buffered continuous ambulatory peritoneal dialysis (CAPD) solution. Design This was an open, controlled, cross-over, two-center study in 9 patients. After three months of treatment with a 34 mmol/L bicarbonate-buffered solution (to) patients were switched to a 39 mmol/L bicarbonate-containing solution for four weeks. At the end of the study period (t4) patients were again treated with a 34 mmol/L bicarbonate-buffered CAPD solution for one month (t8). Results Mean venous plasma bicarbonate level significantly increased during the study and decreased at the baseline level during the control period (to = 22.94±2.54, t1 = 26.74±3.07, t2=28.47±2.68, t3=28.11±3.56, t4=28.71±3.27, t8=24.94±2.56). Arterial blood pH and plasma bicarbonate significantly increased during the study and significantly decreased attheend of the control period (pH: to= 7.37±0.04, t4= 7.42±0.04, t8= 7.37±0.06. Bicarbonate: t0= 21.97±2.57, t4= 25.85±2.02, t8= 21.87±2.89). The changes in plasma bicarbonate during the study period were inversely correlated with the metabolic acid production calculated from the protein catabolic rate and with the apparent distribution space for bicarbonate (ABS) of patients. Conclusions The 39 mmol/L bicarbonate-buffered CAPD solution improved the patient's acid-base status. Potential undesirable metabolic alkalosis could be prevented by analyzing the ABS and the metabolic acid production of patients.
Icodextrin'S Effects on Peritoneal Transport
Authors: Krediet Raymond T. , Ho-Dac-Pannekeet Marja M. , Imholz Alexander L.T. 
Published: February 2020

Objective To give a survey of the principles of peritoneal fluid transport in general, followed by an analysis of the effects of icodextrin on the transport of fluid and solutes. Design A review of the literature and of data on the effects of icodextrin in continuous ambulatory peritoneal dialysis (CAPD) patients at the Academic Medical Center, Amsterdam. Results Icodextrin had no effect on the mass transfer area coefficients of low molecular weight solutes. Also no effect was found on the clearances of albumin and larger serum proteins. Due to convective transport, the clearance of β2-microglobulin was greater with icodextrin than with glucose solutions. Icodextrin was especially superior to glucose in the induction of net ultrafiltration during long dwells, during peritonitis, and in patients with ultrafiltration failure caused by a large effective peritoneal surface area. Conclusion Icodextrin has no effect on the permeability characteristics of the peritoneal membrane, but increases convective flow through the small-pore system. As a result, the peritoneal clearance of β2-microglobulin is higher than with glucose-based solutions.lcodextrin is especially indicated for long dwells and in patients with impaired ultrafiltration caused by a large peritoneal surface area, leading to high transport rates of low molecular weight solutes.
A Randomized Controlled Trial of a Bicarbonate and a Bicarbonate/Lactate-Containing Dialysis Solution in Capd
Authors: Coles Gerald A. , Gokal Ram , Ogg Chisholm , Jani Fiona , O'Donoghue Donal T. , Cancarinu Giovanni C. , Maiorca Rosario , Tranaeus Anders , Faict Dirk , De Vos Catherine 
Published: February 2020

Objective To evaluate the safety and efficacy of bicarbonate and bicarbonate/lactate-based PD fluids. Design A randomly allocated prospective controlled trial lasting eight weeks. Setting Five renal units in Europe. Patients Individuals who have been treated by CAPD for at least three months and who have had at least one month's therapy with 40 mmol/L lactate PD fluid. Those with recent infection, diabetes or other serious illness are excluded. Forty-seven individuals have entered the study so far. Interventions Patients are randomly allocated to three groups. Group 1 receive 40 mmol/L lactate dialysate, Group 2 are given 38 mmol/L bicarbonate fluid and Group 3 are tested with a 25 mmol/L bicarbonate and 15 mmol/L lactate dialysate. Outcome measures The primary outcome measure is the plasma bicarbonate level. Adverse events and ease of use of the two-chambered bags used by Groups 2 and 3 are also being assessed. Results To date, plasma bicarbonate levels have been the same in all treatment groups up to the end of the trial period. There are no differences in serum lactate levels. No side effects are attributable to the test fluids. The patients have managed the two-chambered bags successfully. Conclusion This trial is still ongoing, but to date, neutral bicarbonate based fluids have been as effective as lactate dialysate in treating uremic acidosis.
Calcium Kinetic Studies in Patients on Capd: Improvement of Secondary Hyperparathyroidism without Concomitant Improvement of Calcium Turnover
Authors: Kurz Peter , Tsobanelis Theoharis , Brunkhorst Reinhard , Roth Paul , Werner Eckhard , Schoeppe Wilhelm , Vlachojannis Jannis 
Published: February 2020

Objective An association between the development of low turnover osteopathy and the form of dialysis treatment, that is, continuous ambulatory peritoneal dialysis (CAPD), has been described. To examine the effect of a year-long CAPD treatment on calcium (Ca) turnover, 12 patients were studied prior to and one year after initiation of CAPD treatment with a dialysate calcium of 1.75 mmol/L. Design A prospective analysis. Setting Academic teaching hospital dialysis unit. Patients Twelve patients with an average age of 54.8 years (range: 23 76 years) at commencement of dialysis and after 13 months of CAPD treatment. Measurements Calcium kinetic studies were performed using two calcium isotopes: 45Ca as an oral tracer and 47Ca as an intravenous tracer. Measurements of plasma and whole body activities were performed over a four week period. From these measurements, kinetic parameters describing calcium turnover in different compartments were studied. These measurements were repeated after a mean time of 13.4 months. Patients were not treated with vitamin D, but received aluminum and calcium -containing phosphate binders, in order to keep inorganic phosphate below 2.0 mmol/L and calcium within the normal range. Results After one year on CAPD, serum levels of calcium increased from 2.2 mmol/L to 2.35 mmol/L. Inorganic phosphate also increased from 1.4 mmol/L to 1.9 mmol/L, despite increased use of oral phosphate binders. Serum levels of intact parathyroid hormone (i PTH) decreased from 51.2 pmol/L to 28.3 pmol/L. Alkaline phosphatase did not change, nor did serum levels of vitamin D. Despite improvement of serum iPTH levels and better control of serum calcium, the kinetic parameters describing calcium turnover in the different calcium pools did not improve. In addition, the calcium retention of bone remained below normal range and did not rise. Perhaps more importantly, the relationship between Ca efflux and Ca retention did not change. While Ca retention remained low, plasma Ca efflux was normal. This imbalance was seen at the beginning of CAPD and did not change under CAPD. Conclusion These data demonstrate that, after one year of CAPD treatment without vitamin D treatment, calcium turnover did not improve, despite a significant fall in serum iPTH levels. Studies on a larger number of patients are warranted to verify these results.
Limitation of Small-Solute Exchange across the Visceral Peritoneum: Effects of Vibration
Authors: Zakaria El Rasheid , Carlsson Ola , Rippe Bengt 
Published: February 2020

Objective To evaluate the importance of the peritoneal membrane diffusion resistances to small solutes prevailing outside the capillaries in the visceral versus the parietal peritoneum during acute peritoneal dialysis (PD). Design Experimental study in anesthetized Wistar rats undergoing PD in a single exchange (120 min) using 1.36% Dianeal as dialysis fluid. Vibration, using a standard laboratory shaker at 10 Hz, was used to induce dialysate mixing and reduce the impact of “unstirred layers” in intact and eviscerated rats. Nonvibrated rats served as controls. Measurements The mass transfer area coefficient (PS) for chromium 51-ethylenediamine tetraacetic acid (51 Cr-EDTA), continuously infused intravenously, the plasma-to -peritoneal clearance (CI→D) of radioiodinated (1251) serum albumin (human) (RISA), as well as the total clearance out of the peritoneal cavity (CI) of Evans blue labeled albumin, given as an intraperitoneal volume marker, and the portion of this C1 reaching the plasma per unit time (CI→P) were assessed. Results In intact rats there was a marked increase in PS for 51Cr -EDTA, from 0.297:I: 0.036 mL/min to 0.642 :I: 0.122 mL/min (n = 7, p < 0.01), and a moderate increase in CI and CI→D, from 37.6 :I: 1.3 μL/min to 63.3 :I: 9.0 μL/min and from 6.04 :I: 0.51μL/min to 9.54 :I: 0.93 μL/min (n = 7, p < 0.05), respectively, upon vibration. However, the plasma absorption clearance of albumin (CI→P) was unchanged after vibration. Furthermore, in eviscerated rats, vibration caused no significant changes in either of the exchange parameters measured. Conclusion In conclusion, the visceral peritoneal transport of small solutes is normally limited by the presence of diffusion resistances outside the capillaries, which may be markedly reduced by “stirring” of the dialysate by vibration. Normally, the parietal, rather than the visceral, peritoneum is the major site for small-solute mass transfer in stationary animals. However, the visceral peritoneum apparently becomes increasingly important after stirring. The moderate increases in transperitoneal clearances of macromolecules occurring upon vibration, which were quite unexpected, indicate that vibration may also increase the dialysatelperitoneal membrane contact and/ or cause some recruitment of capillaries.
Ten Years’ Experience with Capd in a Nursing Home Setting
Authors: Anderson John E. 
Published: February 2020

Objective We reviewed our experience with end-stage renal disease (ESRD) patients treated with continuous ambulatory peritoneal dialysis (CAPD) in a nursing home with the aims of describing their demographic and clinical characteristics, evaluating CAPD technique success and patient outcomes. Setting University-based, teaching nursing home. Design Retrospective review of patients in our nursing home treated with CAPD between 1 June 1986 and 1 June 1996. Patients One hundred and nine patients: 66 (60.5%) were female and 59 (54%) were white. Their mean age was 62.7 years ± 12.8 SD (range 31 -88). Females were significantly older than males (64.9 years ± 10.7 SD vs 59.1 years ± 14.6 SD, p < 0.05). Sixty-eight (62.4%) were diabetics. Main outcomes studied:Cox -adjusted patient survival. Cause of death. Peritonitis and hospitalization rates. Logistic analysis of predictors of discharge home. Results Six and 12-month survival rates were 51.7% and 37.2%, respectively. Age greater than 75, poor functional status, coronary artery disease (CAD), and decubitus ulcers were significant mortality risks. Vascular disease was the leading cause (41.7%) of death. The peritonitis rate in the nursing home was 1.19 episodes per patient year. Gram-positive organisms predominated. The hospitalization rate was 22.4 days per patient year. Gangrene/ stump infections and peritonitis accounted for 14% and 10% of admissions. Those patients admitted for rehabilitation and with higher activity of daily living (ADL) scores were more likely, and those with diabetes, age ≥75, and CAD less likely to be discharged. Conclusions We continue to believe that peritoneal dialysis is a reasonable option for ESRD patients placed in nursing homes. Technical problems do not limit its use, but overall poor patient outcomes are an important issue. Patients, their families, and referring physicians should be informed of the limited survival expectations particularly for the very old and/or severely functionally impaired patient. Patients whose discharge is anticipated on admission are those most likely to return to the community and are the most likely to truly benefit from nursing home placement.
Measuring Compliance with Prescribed Exchanges in Capd and Ccpd Patients
Authors: Bernardini Judith 
Published: February 2020

Objective To measure compliance with prescribed exchanges in continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) patients using inventories of home dialysis supplies; to determine the reliability of the ratio of measured to predicted creatinine (MIP) in predicting compliance with prescribed exchanges; to determine the effects of the ingestion of preformed creatine on the excretion of creatinine. Design A prospective analysis. Setting A university dialysis center. Patients Twenty patients on home peritoneal dialysis (PD). Measurements An inventory of supplies during two home visits over a 4 -8 week interval determined the number of PD exchanges performed. This number was divided by the number of exchanges prescribed for the period to determine the percent compliance. Three consecutive days of dialysate and urine were measured with all food consumed recorded during those days. MIP creatinine ratios and dietary protein intake (DPI) for each day were calculated. Results Of the patients tested, 8120 (40%) were found to be noncompliant with the prescribed number of exchanges based on the home visit inventories, performing a mean of 75% of their exchanges. There was no significant difference in the MIP creatinine ratios of compliant and noncompliant patients, nor were the MIP ratios distributed differently for compliant and noncompliant patients. The MIP ratios did not vary significantly over the 3 days. There was no correlation between the measured creatinine on a given day and the DPI for the same day. Conclusion Based on assessment of the patient's inventory, 40% of the patients studied were noncompliant with their prescribed exchanges, indicating this is a serious and common problem in PD patients. The MIP creatinine ratio is not a predictor of compliance in PD. We suggest the use of home visit inventories to assess compliance in PD patients.
Adequacy of Dialysis in Automated Peritoneal Dialysis: A Clinical Experience
Authors: Rodriguez Ana Marla Fernández , Dlaz Nicanor Vega , Cubillo Leocadia Palop , Laborda Eduardo Baamonde , Umpierrez Adelaida Morales , Perez Borges Patricia , Zurita Manuel Navarro , Toledano Celia Plaza 
Published: February 2020

Objectives To compare the peritoneal clearances of urea and creatinine in continuous ambulatory peritoneal dialysis (CAPD) with three types of automated peritoneal dialysis (APD): continuous cycling peritoneal dialysis (CCPD), 50% tidal peritoneal dialysis (TPD), and 25% TPD and to assess the usefulness of the peritoneal equilibration test (PET) in predicting peritoneal clearances in overnight APD. Patients Eleven uremic patients (mean age 44.5 ± 15.45 years with a mean time on dialysis of 42.63 ± 25.62 months) were included in the study. Measurements PET for urea and creatinine following Twardowski's method. Peritoneal clearances for urea and creatinine CAPD: samples of blood and dialysate within 24 hours. APD: blood mean levels of urea and creatinine before and after nighttime dialysis. Dialysate: urea and creatinine in nocturnal and daytime dialysate. Results Peritoneal clearance of creatinine was 38.14 ± 9.99 L/week/1.73 m2 in CAPD, 44.28 ± 12.4 L/week/1.73 m2 in CCPD, 50.07 ± 17.86 L/week/1.73 m2 in 50% TPD (p < 0.05) and 40.18 ± 6.65 L/week/1.73 m2 in 25% TPD. Peritoneal clearance of urea improved significantly in the three modalities of APD: 51.91 ± 12.58 L/week/1.73 m2 in CAPD; 66.7 ± 9.9 L/week/1. 73 m2 in CCPD (p < 0.05); 76.3 ± 14.5 L/week/1. 73 m2 in 50% TPD (p < 0.001) and 64.3 ± 11.4 L/week/1.73 m2 in 25% TPD (p < 0.05). The dialysatel plasma (DIP) ratio of creatinine at 30,60, 120,180, and 240 minutes showed significant correlation with nighttime APD clearance. Nevertheless, only the DIP ratio of urea at 30, 60, and 120 minutes correlated with overnight APD clearance. Conclusions A remarkable improvement was observed with APD regarding the clearance of urea mainly when 50% tidal peritoneal dialysis was used, whereas it was less noticeable in the clearance of creatinine. The PET is a helpful tool in predicting overnight peritoneal clearances of creatinine but it is less useful in predicting urea clearance.