bluuebunny/crossref_metadata_2025_split huggingface dataset:
In-Vitro Evaluation of an UL TRA Violet Germicidal Connection System for CAPD
Authors: Holmes Clifford J. , Miyake Cynthia , Kubey Winnie 
Published: February 2020

We have evaluated UV irradiation of the setlbag connection as a method of eliminating organisms causing peritonitis among CAPD patients. In the first phase of the study, spike lumens of CAPD transfer sets were inoculated with C. albicans, which are known to be relatively resistant to UV light. After irradiation, results showed a 61og 10 reduction in microbial population. In the second phase, the spikes were contaminated by touch. Following irradiation, 100% of the contaminated spikes were disinfected. These data indicate that UV germicidal systems can achieve a significant reduction of contaminating microbial population on a CAPD transfer-set spike. Continuous ambulatory peritoneal dialysis (CAPD) is now a well-accepted therapy for end-stage renal disease (I). However, peritonitis remains a potential complication of this therapy. Several methods have been proposed for preventing microorganisms from entering the peritoneum via the primary (set-to-bag) connection. Such approaches have included placement of membrane filters in the fluid transfer set (2), use of disinfectant solutions (3), and recently the “sterile welding” technique (4). A gennicidal system, which uses ultraviolet (UV) light as the disinfecting source, has recently become available. Ultraviolet light has beeen utilized in industry and medicine for a number of years and for a number of applications, e.g., disinfecting operating rooms (5) and sterilizing water and packaging materials (6). The present paper describes the evaluation of ultraviolet irradiation as a means of disinfecting the CAPD transfer set-to-bag connection.
Gallbladder Stones, Cholecystitis and Cholecystectomy in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Nelson William , Khanna Ramesh , Mathews Raymond , Yeung Harry , Wu George , Vas Stephen , Oreopoulos Dimitrios 
Published: February 2020

This paper describes a prospective three-year study using abdominal ultrasound examination in 114 new CAPD patients. Gallbladder disease was common (22.8%) and four of 16 patients with gallstones (25%) required cholecystectomy after 1–14 (i 7.8 months) on CAPD. Two of these four had evidence of peritonitis in association with cholecystitis. Also we analyzed the clinical course of eight patients on chronic PD who underwent cholecystectomy. They had no serious morbidity, and all returned to chronic PD. While abdominal pain is one of the main features of CAPD-related peritonitis, other causes of abdominal pain may be more difficult to evaluate in the patient on peritoneal dialysis (PD); such causes potentially are more serious because they threaten the continuance of PD as a mode of therapy. Cholecystitis related to cholelithiasis is one such possible cause of abdominal pain. However, since ultrasonography can reliably and non-invasively detect the presence of gallstones, we have used it prospectively to screen patients entering our CAPD training program. This paper reports our findings and the subsequent course of those found to have gallstones during a three-year period. In addition we also reviewed the feasibility of cholecystectomy, its hazards and outcome in eight patients on chronic peritoneal dialysis who underwent this procedure at Toronto Western Hospital in the past seven years.
The Assessment of Peritoneal Function Using a Single Hypertonic Exchange
Authors: Nikolakakis Nik , Stuart R. , Timothy C. Rodger , Goodship H. J. , Fletcher Kate , Ashcroft Rosalind , Wilkinson Robert , Ward Michael K. 
Published: February 2020

Peritoneal ultrafiltration, creatinine clearance and glucose absorption were measured in 56 CAPD patients using a single hypertonic exchange with a four-hour dwell. The intraindividual coefficient of variation for these parameters was less than 5 % and the results obtained correlated significantly with those obtained using a six-hour dwell. Ultrafiltration capacity was independent of clearance values but glucose absorption correlated directly with clearance and inversely with ultrafiltration levels (p < 0.001). Multiple regression analysis showed a decline in four-hour clearance values with time on CAPD (p < 0.001), and an increase in glucose absorption after four hours with Frezenius hypertonic solution (p < 0.02) but no other effect of patient age, sex, body surface area, serum albumin, duration of CAPD treatment, peritonitis history or dialysate brand on these indices of peritoneal function. It is important to monitor peritoneal function in patients treated by CAPD and these results indicate that a single, timed, hypertonic exchange is a reproducible test of ultrafiltration, clearance and glucose absorption. Loss of peritoneal function is reported as a cause of failure of CAPD (1–5) although we have limited information concerning sequential changes in the peritoneal membrane with time (6–8) and no agreement over the most appropriate investigation to monitor its permeability (9–11). The International Co-operative Study measured ultrafiltration capacity using a four-hour, two-litre hypertonic exchange (9). This study examines the reliability of such a single, timed exchange to measure peritoneal clearance, glucose absorption and ultrafiltration and evaluates the influence of demographic factors on these parameters.
Peritoneal Cavity Lymphatics
Authors: Khanna Ramesh , Mactier Robert , Twardowski Zbylut J. , Nolph Karl D. 
Published: February 2020

Lymphatic drainage of particulate matters from the peritoneal cavity occurs mainly from lacunae located in the diaphragm. These are a triple-layered structure consisting of mesothelium, a loose network of connective tissue and endothelium. Absorption of particles may occur via gap junctions, through the cells or via vesicles. Whole blood can be removed fairly rapidly from the peritoneal cavity. Respiration plays an important role in the absorption of particles through lymphatics. Intra-abdominal pressure and posture are other factors which influence lymphatic flow rate in the peritoneal cavity. Little is known about the influence of drugs on lymphatic flow rate from the peritoneal cavity.
Peritoneal Functional Parameters after Five Years on Continuous Ambulatory Peritoneal Dialysis (CAPD): The Effect of Late Peritonitis
Authors: Selgas R. , Muñoz J. , Cigarran S. , Ramos P. , L-Revuelta K. , Escuin F. , Miguel J. L. 
Published: February 2020

Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 ± 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 ± 2.6 mL/min. Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different. Early episodes of peritonitis (those occurring <36 months after starting CAPD) did not influence long-term function. However, late peritonitis (occuring >36 months since initiation) induced a decrease in urea-MTC (22.3 ± 6 to 15.8 ± 3.9, p < 0.05), creatinine-MTC (9.4 ± 3.1 to 7.4 ± 2.5, p < 0.05), and a corresponding increase in UF (1.25 ± 0.4 to 1.4 ± 0.3, mL/min, p < 0.05). Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed. After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.
Peritoneal Catheters and Exit -Site Practices: Toward Optimum Peritoneal Access
Authors: Gokal Ram , Ash Stephen R. , Helfrich G. Baird , Holmes Cliff J. , Joffe Preben , Nichols W. Kirt , Oreopoulos Dimitrios G. , Riella Miguel C. , Slingeneyer Alain , Twardowski Zbylut J. , Vas Stephen I. 
Published: February 2020

The peritoneal catheter is the CAPD patient's lifeline. Advances in catheter knowledge have made it possible to access the peritoneal cavity safely and maintain access over an extended period of time. Infection at the exit site remains a major problem, a solution for which is being extensively researched. The successful outcome of a catheter in an individual depends on meticulous care and adherence to sound principles of catheter insertion and management. The guidelines provided in this publication represent the consensus based on the extensive experience of several major centers worldwide.
Effective Continuous Ambulatory Peritoneal Dialysis following Abdominal Aortic Aneurysm Repair
Authors: Schmidt Rebecca J. , Cruz Cosme , Dumler Francis 
Published: February 2020

+ Objective To review a single center's experience with the initiation and maintenance of continuous ambulatory peritoneal dialysis (CAPD) in 8 patients with a history of abdominal aortic aneurysm repair (AAAR). + Design Retrospective case review with long-term follow-up. +Patients (or Participants) Eight patients with multiple medical problems including a history of abdominal aortic aneurysm repair and end-stage renal failure who received peritoneal dialysis catheters between December 1986 and July 1991. + Main Outcome Measures Success of catheter implantation and maintenance of continuous ambulatory peritoneal dialysis; incidence of peritoneal infection and long-term complications; overall clinical course. + Results Over five years 8 patients with a history of reconstructed abdominal aortic aneurysm received peritoneal dialysis catheters without complication and dialyzed successfully for 88 patient-months in total. Three patients had a total of five episodes of peritonitis, at an incidence of 0.68 episodes per patient per year, a rate not significantly different from that of our overall CAPD patient population (1.09) and that reported by other groups. + Conclusion Our experience suggests that historical AAAR poses no significant risk to and should not preclude the implementation of continuous ambulatory peritoneal dialysis. Indeed, CAPD offers a safe and optimal dialytic alternative for patients with historical abdominal aortic aneurysm repair in whom compromised cardiovascular hemodynamics may significantly influence morbidity and survival.
Endothelin-1In Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients: A Preliminary Study
Authors: Lightfoot Barbara O. , Caruana Ralph J. 
Published: February 2020

Objective To determine the effects of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) on endothelin-1 (ET-1) levels in patients with endstage renal disease (ESRD) and to assess the relationship between plasma ET-1 levels and selected patient parameters. Design Prospective, non randomized comparison study. Setting Outpatient CAPD and HD units of a university medical center. Participants Twelve ESRD patients (6 on CAPD and 6 on HD) and 5 healthy normotensive subjects. Interventions CAPD patients had blood and peritoneal dialysate samples collected and measurements made following an overnight exchange. HD patients had blood collected and measurements made at 0 hours (basal) and again at 3 hours during a midweek HD session. Blood samples were also collected from normal subjects and served as ET-1 controls. Measurements ET-1 and patient parameters (creatinine, peritoneal dialysate volume, blood pressure, bodyweight, age, and treatment duration) were determined. Data are reported as the mean ± one standard deviation. Results Plasma and dialysate ET-1 levels in the CAPD group were 19.5±4.2 pglmL and 9.2±4.2 pglmL, respectively. The control group plasma and unused dialysate contained no detectable ET-1 «3.0 pg/mL, the limit of detection). The peritoneal clearance of ET-1 was less than that of creatinine (2. 29±0.69 mL/minute vs 4.22±0.66 mL/minute, p=0.005). The basal (0 hour) plasma ET-1 level in the HD group (16.5±7.8 pg/mL) did not differ from that of the CAPD group, p=0.423. Furthermore, no differences in patient parameters were detected between the CAPD and basal HD groups. Although the mean arterial pressure (MAP) decreased during HD, the plasma ET-1 level at 3 hours (13.5±5.4 pg/mL) remained unchanged from the basal level, p=0.307. An analysis of pooled data from the CAPD and HD groups revealed no significant correlation between plasma ET-1 and MAP, body weight, creatinine, or treatment duration. There was, however, a positive correlation between plasma ET-1 and age (r=0.643, p=0.024). Conclusions Plasma ET-1 levels are elevated in both CAPD and HD patients. Despite the clearance of ET-1 by the peritoneal membrane, plasma ET-1 levels in CAPD patients are elevated to the same extent as levels observed in HD patients. Preliminary results show a positive correlation between plasma ET-1 and age in the absence of renal function. This finding remains to be examined in a larger ESRD population.
Continuous Ambulatory Peritoneal Dialysis Catheter Infections: Diagnosis and Management
Authors: Flanigan Michael J. , Hochstetler Linda A. , Langholdt Donita , Lim Victoria S. 
Published: February 2020

Purpose To develop diagnostic and treatment strategies for peritoneal dialysis catheter exit-site and tunnel infections. Population All consenting peritoneal dialysis patients performing home dialysis through the University of Iowa Hospitals and Clinics Home Dialysis Training Center. This is a state-owned teaching hospital serving a rural population of approximately one million people in Iowa and western Illinois. Methods Four dialysis nurses collected information on a prospectively designed data acquisition tool. Patients were randomly assigned to one of two treatment groups, intraperitoneal vancomycin plus oral rifampin or oral trimethoprim/ sulfamethoxazole (TMP/SMX), and their initial antibiotic therapy determined by that assignment. If the infection was gram -negative, the initial antibiotics were discontinued and an alternative therapy begun. Therapy was initiated by the nursing staff and required physician notification within 48 hours. Results There were 126 recorded catheter infections (exit-site, tunnel, or cuff infection) resulting in a rate of 0.67 episodes per patient year of exposure. Staphylococcus aureus was isolated from the majority (60%) of these events. Pseudomonas aeruginosa was the next most common isolate and accounted for 21% of infections. Rubor, dolor, and turgor are the classic signs of inflammation, and at least one of these was present in 79% of the episodes. Isolated pericatheter erythema or serous discharge was associated with a minimal risk «2%) of catheter loss. The presence of a purulent exit-site discharge identified patients who had a 30% chance of failing systemic antibiotic therapy and a 20% risk of catheter loss. The concurrent presence of exit-site tenderness or swelling identified the most severe infections. Staphylococcal infections responded equally well to local cleaning and vancomycin plus rifampin (86% cured) or oral trimethoprim/sulfamethoxazole (89% cured) therapy. Gram-negative infections were frequent (27%) and appeared to respond best to a combination of tobramycin and ciprofloxacin. Conclusion Exit-site/tunnel inflammation is detectable by patients and can be used to guide therapy. An isolated finding of erythema or serous discharge is not indicative of an acute infection and may not require systemic antibiotics. The presence of purulence identifies patients at risk for catheter loss, and these patients benefit from systemic therapy. The combination of a purulent exit-site discharge plus pericatheter tenderness or swelling identifies patients likely to suffer treatment failure and require subsequent catheter removal. The cure rate of gram -positive catheter infections treated with vancomycin plus rifampin was indistinguishable from that achieved with oral trimethoprim/sulfamethoxazole (p = 0.99).
Are Aldehydes in Heat-Sterllized Peritoneal Dialysis Fluids Toxic in Vitro?
Authors: Wieslander Anders P. , Andrén Anders H.G. , Nilsson-Thorell Carin , Muscalu Natalia , Kjellstrand Per T.T. , Rippe Bengt 
Published: February 2020

Objective Chemical analysis of several brands of peritoneal dialysis fluids (PD fluids) has revealed the presence of 2-furaldehyde, 5-HMF (5-hydroxymethylfuraldehyde), acetaldehyde, formaldehyde, glyoxal, and methylglyoxal. The aim of this study was to investigate if the in vitro side effects caused by glucose degradation products, mainly formed during heat sterilization, are due to any of these recently identified aldehydes. Design Cell growth media or sterile filtered PD fluids were spiked with different concentrations ofthealdehydes. Measurements In vitro side effects were determined as the inhibition of cell growth of cultured mouse fibro blasts or stimulated superoxide radical release from human peritoneal cells. Results Our results demonstrate that the occurrences of 2-furaldehyde, 5-HMF, acetaldehyde, formaldehyde, glyoxal, or methylglyoxal in heat-sterilized PD fluids are probably not the direct cause of in vitro side effects. In order to induce the same magnitude of cell growth inhibition as the heat-sterilized PD fluids, the concentrations of 2-furaldehyde, glyoxal, and 5-HMF had to be 50 to 350 times higher than those quantified in the PD fluids. The concentrations of acetaldehyde, formaldehyde, and methylglyoxal observed in the heat-sterilized PD fluids were closer to the cytotoxic concentrations although still 3 to 7 times lower. Conclusion Since none of these aldehydes caused in vitro toxicity at the tested concentrations, the toxicity found in PD fluids is likely to be due to another glucose degradation product, not yet identified. However, it is possible that these aldehydes may still have adverse effects for patients on peritoneal dialysis.
Malfunctioning Peritoneal Dialysis Catheter Repaired by Laparoscopic Surgery
Authors: Julian Thomas B. , Ribeiro Ulysses , Bruns Frank , Fraley Donald 
Published: February 2020

Objectives To review peritoneal dialysis catheter failures and to describe a technique of repairing malpositioned catheters. Design Two prospective case reports utilizing this technique are reported. Setting A tertiary care hospital. Patients Two patients on chronic peritoneal dialysis with malfunctioning catheters. Intervention Both patients underwent reposition of their malpositioned continuous ambulatory peritoneal dialysis catheters by laparoscopic suture technique. Main Outcome Measures Outcome was measured by the successful return of adequate peritoneal dialysis. Results Both case studies show correction of malpositioned catheters with the return of successful peritoneal dialysis. Conclusion The repositioning and suture application of malpositioned Tenckhoff catheters by laparoscopic surgery is a viabletechnique that can salvage the majority of mal positioned catheters and save the patients additional hospital time and recovery.
Analysis of Ultrafiltration Failure in Peritoneal Dialysis Patients by Means of Standard Peritoneal Permeability Analysis
Authors: Pannekeet Marja M. Ho-Dac , Atasever Bektaş , Struijk Dirk G. , Krediet Raymond T. 
Published: February 2020

Background Ultrafiltration failure (UFF) is a complication of peritoneal dialysis (PD) treatment that occurs especially in long-term patients. Etiological factors include a large effective peritoneal surface area [measured as high mass transfer area coefficient (MTAC) of creatinine], a high effective lymphatic absorption rate (ELAR), a large residual volume, or combinations. Objective The prevalence and etiology of UFF were studied and the contribution of transcellular water transport (TCWT) was analyzed. A new definition of UFF and guidelines for the analysis of its etiology were derived from the results. Setting Peritoneal dialysis unit in the Academic Medical Center in Amsterdam. Design Cross-sectional study of standard peritoneal permeability analyses (4-hr dwells, dextran 70 as volume marker) with 1.36% glucose in 68 PD patients. Patients with negative net UF (change in intraperitoneal volume, dlPV < 0 mL) were analyzed further using 3.86% glucose, whenever possible. Results Among 68 patients (duration of PD 0.3 -178 months), 39 had negative net UF with 1.36% glucose. These patients had greater MTAC creatinine and glucose absorption, and higher ELAR (p < 10–4) than the patients with positive UF. dIPV and transcapillary UF rate (TCUFR) were lower (p < 10–5). Twenty of these patients could be studied using 3.86% glucose. dlPV was greater than 400 mL/4 hr in this test in 12 patients, implying that no clinically important UFF was present. Ultrafiltration failure (dIPV < 400 mL) was found in 8 patients, giving a prevalence of 23%. This last group had been treated with PD for a longer period (p = 0.03), had higher ELAR (p = 0.07), but lower residual volume (p = 0.03), and lower TCUFR (p = 0.01). Ultrafiltration failure was associated with a high MTAC creatinine in 3 patients, a high ELAR in 4 patients, and a combination of factors in one. As an additional possible cause, TCWT was studied, using the sodium gradient in the first hour of the dwell, corrected for diffus ion (dNA). Five patients had dNA > 5 mmol/L, indicating normal TCWT. The 3 patients with dNA < 5 mmol/L tended to be treated longer (p = 0.19) and had lower TCUFR (p = 0.04). A smaller difference was found between dlPV 3.86% and 1.36% (p = 0.04) compared to the dNA > 5 mmol/L group, but no differences were present for MTAC creatinine, ELAR, residual volume, or glucose absorption. Conclusions ln addition to known factors, impairment of TCWT can be a cause of UFF. A standardized dwell with 1.36% glucose overestimates UFF. Therefore, 3.86% glucose should be used for identification of patients with UFF, especially because it provides additional information on TCWT. Ultrafiltration failure can be defined as net UF < 400 mL/4 hr with 3.86% glucose during a 4-hour exchange.