bluuebunny/crossref_metadata_2025_split huggingface dataset:
Daily Remote Peritoneal Dialysis Monitoring: An Adjunct to Enhance Patient Care
Authors: Chand Deepa H. , Bednarz Dale 
Published: February 2020

Peritoneal dialysis (PD) is the preferred dialysis modality in children, but it relies on the patient or caregiver to perform dialysis daily at home. We describe the utilization of a modem transmission system in 2 pediatric PD patients to improve communication with the dialysis team, monitor compliance via frequent remote data collection, and decrease dialysis-related complications. A home dialysis modem was provided for each patient and connected to the home telephone line by the dialysis nurse. PD treatment data were transmitted daily to the dialysis unit, records entered into the patient's electronic medical record, and reviewed by the patient's PD nurse and/or pediatric nephrologist and adjustments made accordingly. This resulted in improved medical outcomes specifically related to fluid balance and cardiovascular health, ultimately facilitating renal transplantation in each case. In summary, the use of the ProCard (Baxter Healthcare, Deerfield, Illinois, USA) has improved the ability to monitor home PD patients effectively. However, the additional use of the modem to transmit data on a more frequent basis can further enhance the care of chronic continuous cycling PD patients and should be considered in more challenging medical situations.
Development of a Peritoneal Sclerosis Rat Model Using a Continuous-Infusion Pump
Authors: Komatsu Hirotaka , Uchiyama Koichi , Tsuchida Masahiro , Isoyama Naohito , Matsumura Masafumi , Hara Tomohiko , Fukuda Masashi , Kanaoka Yoshihiro , Naito Katsusuke 
Published: February 2020

Objective Encapsulating peritoneal sclerosis (EPS) is a serious complication of continuous ambulatory peritoneal dialysis. Previous studies have created peritoneal sclerosis rat models using daily intraperitoneal injection of chlorhexidine gluconate (CG), but this technique is cumbersome and thickening of the peritoneum makes it difficult to evaluate the injection site. We therefore aimed to make a rat model using a continuous-infusion pump. Methods Various concentrations of CG (5%, 8%, 10%, 12%, and 14%) in ethanol were dissolved in saline within the infusion pumps, each of which was placed in the lower abdominal cavity of a male Wister rat. After a peritoneal equilibration test was performed, the rats were sacrificed and the lower anterior parietal and visceral peritoneum was removed. Each excised peritoneum was analyzed by macroscopic and microscopic examinations, including immunohistochemistry for the expression of transforming growth factor-beta 1 (TGF-β1), vascular endothelial growth factor (VEGF), and alpha-smooth muscle actin (αSMA). The results were compared with those of control rats injected with ethanol dissolved in saline within the infusion pump and with no-pump rats. Results Two of the 5 rats in the 12% CG group and 3 of the 5 rats in the 14% CG group died of ileus within 14 days. All the rats in the 5%, 8%, and 10% CG groups survived to 28 days. Macroscopic examination in the 10% CG group showed bowel dilatation, bowel adhesion, and bloody ascites, similar to those seen in human EPS patients. All rats in each CG group showed the same extent of thickening of the submesothelial compact zone, proliferation of collagen fibers, and presence of numerous cells and neovascularization. Within same CG groups, an equal degree of thickening was observed at all sites of the peritoneum. TGF-β1, VEGF, and αSMA were highly expressed in the peritoneum of the 10% CG group. Conclusion We developed a novel method of creating a peritoneal sclerosis rat model using a continuous-infusion pump. Our technique is simple and highly reproducible, and will be useful in the study of peritoneal sclerosis mechanisms.
Factors Associated with Sudden Death in Peritoneal Dialysis Patients
Authors: Chow Kai Ming , Szeto Cheuk Chun , Kwan Bonnie Ching-Ha , Chung Kwok Yi , Leung Chi Bon , Li Philip Kam-Tao 
Published: February 2020

Background Relatively little is known of the epidemiology and predictors of sudden death in peritoneal dialysis (PD) populations. We aimed to identify the risk factors of sudden death among PD subjects. Methods To explore clinical correlates of sudden death in PD patients, we conducted a population-based case-control study using data from a single dialysis unit. Cases ( n = 24) were defined as all PD patients that met the criteria for sudden death during January 2003 through December 2006. We also selected 48 control subjects that were selected from the prevalent PD patient name list compiled in alphabetical order. Data on the hemoglobin, potassium, and calcium levels, residual renal function, dialysis adequacy, cardiovascular risks, comorbid conditions, concurrent use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and erythropoietin, electrocardiographic and echocardiographic findings were extracted from case notes and computer records. Confounders were controlled by logistic regression. Results Over a period of 4 years, 24 PD patients (mean age 61.4 ± 9.5 years, median duration of dialysis 3.1 years) experienced sudden death. Univariate analyses showed that patients that died suddenly were more likely to be male and to have diabetes mellitus, a history of smoking, and a lower small solute clearance as measured by Kt/V. Cases of sudden death were also more likely to have received blood transfusion within the previous 1 year. There were no significant differences between patients and controls for residual renal function, serum potassium levels, control of blood pressure and mineral metabolism, or hemoglobin levels. Multivariate regression analysis confirmed independent association between recent blood transfusion and increased odds of sudden death [adjusted odds ratio (OR) 5.18, 95% confidence interval (CI) 1.44 – 18.6]. Two other factors significantly associated with risk of sudden death were male gender (adjusted OR 4.16, 95% CI 1.14 – 15.2) and diabetes mellitus (adjusted OR 5.33, 95% CI 1.53 – 18.6). Conclusion This study shows that recent blood transfusion is associated with an increased likelihood of sudden death in PD patients. The mechanisms that underlie this observation are unclear.
Kinetic Analysis of Peritoneal Fluid and Solute Transport with Combination of Glucose and Icodextrin as Osmotic Agents
Authors: Galach Magda , Werynski Andrzej , Waniewski Jacek , Freida Philippe , Lindholm Bengt 
Published: February 2020

Background Controlling extracellular volume and plasma sodium concentration are two crucial objectives of dialysis therapy, as inadequate sodium and fluid removal by dialysis may result in extracellular volume overload, hypertension, and increased cardiovascular morbidity and mortality in end-stage renal disease patients. A new concept to enhance sodium and fluid removal during peritoneal dialysis (PD) is the use of dialysis solutions with two different osmotic agents. Aim To investigate and compare, with the help of mathematical modeling and computer simulations, fluid and solute transport during PD with conventional dialysis fluids (3.86% glucose and 7.5% icodextrin; both with standard sodium concentration) and a new combination fluid with both icodextrin and glucose (CIG; 2.6% glucose/6.8% icodextrin; low sodium concentration). In particular, this paper is devoted to improving mathematical modeling based on critical appraisal of the ability of the original three-pore model to reproduce clinical data and check its validity across different types of osmotic agents. Methods Theoretical investigations of possible causes of the improved fluid and sodium removal during PD with the combination solution (CIG) were carried out using the three-pore model. The results of computer simulations were compared with clinical data from dwell studies in 7 PD patients. To fit the model to the low net ultrafiltration (366 ± 234 mL) obtained after a 4-hour dwell with 3.86% glucose, some of the original parameters proposed in the three-pore model (Rippe & Levin. Kidney Int 2000; 57:2546-56) had to be modified. In particular, the aquaporin-mediated fractional contribution to hydraulic permeability was decreased by 25% and small pore radius increased by 18%. Results The simulations described well clinical data that showed a dramatic increase in ultrafiltration and sodium removal with the CIG fluid in comparison with the two other dialysis fluids. However, to adapt the three-pore model to the selected group of PD patients (fast transporters with small ultrafiltration capacity on average), the peritoneal pore structure had to be modified. As the mathematical model was capable of reproducing the clinical data, this shows that the enhanced ultrafiltration with the combination fluid is caused by the additive effect of the two different osmotic agents and not by a specific impact of the new dialysis fluid on the transport characteristics of the peritoneum.
Polyneuropathy in Diabetic and Nondiabetic Patients on Capd: Is There an Association with HRQOL?
Authors: Jovanovic Dijana B. , Matanovic Dragana D. , Simic-Ogrizovic Sanja P. , Stosovic Milan D. , Bontic Ana C. , Nesic Vidosava D. 
Published: February 2020

Background It is well known that patients with uremia, as well as patients with diabetes mellitus, develop polyneuropathy. Objectives The signs of polyneuropathy in diabetic and nondiabetic patients on continuous ambulatory peritoneal dialysis (CAPD) and their relation with age, duration of dialysis, biochemical parameters, dialysis adequacy, and health-related quality of life (HRQOL) were analyzed in the present study. Patients and Methods 65 CAPD patients (37 men, age 29 – 85 years, duration on dialysis 3 months to 14 years) were divided into two groups: group 1 was comprised of 20 diabetic patients (mean age 50.1 ± 13.2 years); group 2 was comprised of 45 nondiabetic patients (mean age 62.3 ± 9.7 years). Biochemical parameters, dialysis adequacy, and clinical signs were determined. Motor conduction velocity on the peroneal and tibial nerves and sensitive conduction velocity on the sural nerve were measured. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to measure the CAPD patients’ self-assessment of functioning and well-being using 4 component scores: physical component summary (PCS), mental component summary (MCS), kidney disease target issues, and patient satisfaction. Results Subjective symptoms were more intense in the diabetic patients and correlated with changes in peroneal and tibial distal motor latency (DML). Diabetic patients were significantly younger, had lower creatinine and higher glucose levels, and all analyzed pathological neurophysiological parameters were higher. Nondiabetic patients had prolonged latency of the F-wave on the peroneal nerve and the tibial nerve and reduced sensitive conduction velocity on the sural nerve. Significant correlations were found between the analyzed neurophysiological parameters and duration of dialysis and diabetes, glucose concentration, and dialysis adequacy in diabetic patients, and between neurophysiological parameters and age and dialysis adequacy in nondiabetic patients. Analysis of the 4 component scores of the KDQOL-SF revealed that diabetic patients had significantly better scores for PCS and MCS, which can be explained by their younger age. Patient satisfaction was worse in diabetic patients and correlated with duration of diabetes. In addition, significant correlations were established between PCS, MCS, and tibial DML (late neuropathic changes) in diabetic patients, and between MCS and tibial F-wave (early neuropathic changes) in nondiabetic patients. Conclusion Polyneuropathy was significantly worse in diabetic than in nondiabetic patients on CAPD. DML on the tibial nerve correlated with glucose concentration, dialysis adequacy, PCS, and MCS in diabetic patients, whereas in nondiabetic patients, dialysis adequacy and azotemia correlated with F-waves on the peroneal nerve and the tibial nerve but MCS only with F-wave on the tibial nerve.
A Combined Crystalloid and Colloid PD Solution as a Glucose-Sparing Strategy for Volume Control in High-Transport APD Patients: A Prospective Multicenter Study
Authors: Freida Philippe , Issad Belkacem , Dratwa Max , Lobbedez Thierry , Wu LieLing , Leypoldt John K. , Divino-Filho Jose Carolino 
Published: February 2020

Background Evidence is accumulating that the continuous exposure to high glucose concentrations during peritoneal dialysis (PD) is an important cause of ultrafiltration (UF) failure. The cornerstone of prevention and treatment of UF failure is reduction of glucose exposure, which will also alleviate the systemic impact of significant free glucose absorption. The challenge for the future is to discover new therapeutic strategies to enhance fluid and sodium removal while diminishing glucose load and exposure using combinations of available osmotic agents. Objectives To investigate in patients on automated PD (APD) with a fast transport pattern whether there is a glucose-sparing advantage to replacing 7.5% icodextrin (ICO) during the long dwell with a mixed crystalloid and colloid PD fluid (bimodal UF) in an attempt to promote daytime UF and sodium removal while diminishing the glucose strength of the dialysate at night. Design A 2 parallel arm, 4 month, prospective nonrandomized study. Setting PD units or university hospitals in 4 French and Belgian districts. Results During the 4-month intervention period, net UF and peritoneal sodium removal during the long dwell when treated by bimodal UF was about 2-fold higher than baseline (with ICO). The estimated percent change (95% confidence interval) from baseline in net daytime UF for the bimodal solution was 150% (106% – 193%), versus 18% (–7% – 43%) for ICO ( p < 0.001). The estimated percent change from baseline in peritoneal sodium removal for the bimodal solution was 147% (112% – 183%), versus 23% (–2% – 48%) for ICO ( p < 0.001). The estimated percent change from baseline in UF efficiency (24-hour net UF divided by the amount of glucose absorbed) was significantly higher ( p < 0.001) when using the bimodal solution was 71%, versus -5% for ICO. Conclusion Prescription of bimodal UF during the day in APD patients offers the opportunity to optimize the long dwell exchange in a complete 24-hour APD cycle. The current study demonstrated that a bimodal solution based on the mixing of glucose (2.6%) and icodextrin (6.8%) achieved the double target of significantly improving UF and peritoneal sodium removal by exploring a new concept of glucose-sparing PD therapy.
Seven-Year Follow-Up of Peritoneal Dialysis Patients in Taiwan
Authors: Shiao Chih-Chung , Kao Tze-Wah , Hung Kuan-Yu , Chen Yin-Cheng , Wu Ming-Shiou , Chu Tzong-Shinn , Wu Kwan-Dun , Tsai Tun-Jun 
Published: February 2020

Background There are no Taiwanese publications and only a few Asian publications on the long-term outcome of peritoneal dialysis (PD) patients. The aim of this study was to evaluate the outcome of PD patients in Taiwan during a 7-year follow-up period. Patients and Methods This study enrolled 67 patients (23 males, mean age 46.2 ± 14.5 years) on maintenance PD. We administered the Short-Form questionnaire on 30 September 1998 and recorded major events and outcomes until 30 September 2005. We compared differences in initial parameters between groups categorized by PD patient survival and PD technique survival. Causes of mortality and transfer to hemodialysis were determined. PD patient and PD technique survival rates were measured and risk factors for patient mortality and PD technique failure were analyzed. Results Those in patient survival or PD technique survival groups had lower mean age ( p < 0.001 and 0.018 respectively) and higher serum albumin level ( p = 0.015 and 0.041 respectively) compared to those that died or failed PD. The 7-year patient survival rate was 77% and the PD technique survival rate was 58%. The independent predictors for PD technique failure included lower Mental Component Summary scores [hazard ratio (HR) = 0.85, p = 0.031] and diabetes mellitus (HR = 4.63, p < 0.001), whereas lower serum albumin level (HR = 0.22, p = 0.031), lower Physical Component Summary scores (HR = 0.67, p = 0.047), and presence of diabetes mellitus (HR = 5.123, p = 0.009) were the independent predictors for patient mortality. Conclusion For our PD patients, both patient and technique survival rates are good. Better glycemic control, adequate nutrition, and enhancement of health-related quality of life are all of potential prognostic benefit.
Oral Health and Inflammation in Patients with End-Stage Renal Failure
Authors: Bayraktar Gulsen , Kurtulus Idil , Kazancioglu Rumeyza , Bayramgurler Isil , Cintan Serdar , Bural Canan , Bozfakioglu Semra , Issever Halim , Yildiz Alaattin 
Published: February 2020

Background/Aims End-stage renal disease (ESRD) patients have an increased risk of atherosclerotic complications. In both hemodialysis (HD) patients and the general population, it has become evident that inflammation plays an important role in the pathogenesis of atherosclerotic complications. Oral and dental problems in ESRD patients could be an important source of inflammation, thus treatment of these problems is important to protect these patients from potential infections. The decayed, missing, and filled teeth (DMFT) index is an indicator of oral and dental health status. Our aim was to analyze and compare salivary flow rate (SFR), salivary pH (SpH), salivary buffering capacity (SBC), and DMFT index and plaque index (PI) values in PD patients to HD patients and healthy controls (C) and establish the relationship between these parameters and C-reactive protein (CRP). Methods 76 PD patients, 100 HD patients, and 111 Cs were included in the study. SFR (milliliters/minute) was measured in stimulated whole saliva, SpH was measured using the Merck indicator, and SBC was measured according to the method of Ericsson: 1 mL whole saliva was added to 3 mL 0.005 N HCl and a stream of air was passed through this mixture for 20 minutes. Finally, DMFT index and PI values were calculated. Results No statistically significant differences were found in age or gender distribution among PD, HD, and C groups. There was also no significant difference in time on dialysis between PD and HD groups. SFR was significantly lower in the PD and HD groups than in the C group (1.30 ± 0.83 and 0.70 ± 0.32 vs 1.64 ± 0.45 mL/min) and lower in the HD than in the PD group ( p < 0.001). SpH (8.35 ± 0.43 and 8.12 ± 0.74 vs 7.16 ± 0.76) and SBC (7.39 ± 0.47 and 6.82 ± 0.70 vs 5.08 ± 0.73) were significantly higher in the PD and HD groups than in the C group and higher in the PD than in the HD group ( p < 0.05 and p < 0.001 respectively). The numbers of filled teeth were significantly higher in the PD than in the HD and C groups ( p < 0.001). DMFT index was significantly higher in the PD than in the HD group ( p < 0.001). Finally, PI values were significantly higher in the PD and HD groups than in the C group ( p < 0.001) and higher in the HD than in the PD group, although this was not statistically significant. In the present study, we also found higher CRP values in HD than in PD patients and a positive correlation between CRP and PI values in PD patients. Conclusions PD patients have higher SFR, SpH, and SBC values than HD patients; however, higher DMFT index and higher numbers of filled teeth were observed in PD patients. Compared to healthy controls, patients on dialysis had worse dental and periodontal findings, which might have a role in microinflammation in this group of patients.
Retroperitoneal Leakage as a Cause of Acute Ultrafiltration Failure: Its Associated Risk Factors in Peritoneal Dialysis
Authors: Lam Man Fai , Lo Wai Kei , Tse Kai Chung , Yip Terrence P.S. , Lui Sing Leung , Chan Tak Mao , Lai Kar Neng 
Published: February 2020

Background Ultrafiltration failure is an important clinical problem in patients on maintenance peritoneal dialysis (PD) and is associated with high morbidity and mortality. Acute ultrafiltration failure (AUFF) is usually secondary to mechanical problems with the peritoneal catheter or peritoneal leakage. Retroperitoneal leakage (RPL) is an important cause of AUFF and often poses diagnostic difficulty. Herein we analyze the incidence of AUFF secondary to RPL in our centers and study its associated risk factors. Methods After excluding causes due to mechanical problems with the peritoneal catheter, patients complicated by AUFF underwent computerized tomographic peritoneography (CTP) or magnetic resonance imaging of the peritoneal cavity (MRP) to determine any RPL. Other patients on maintenance PD without RPL served as controls for comparison of risk factors. Demographic and peritoneal membrane characteristics, including history of hernia and pleuroperitoneal leakage, were analyzed. Results During the 5-year study period, 36 patients in a cohort of 743 patients on maintenance PD developed AUFF. 23 of these 36 patients were found to have RPL, which was confirmed by either CTP ( n = 16) or MRP ( n = 7). The duration of PD at the time of RPL and the dialysate-to-plasma ratio of creatinine at 4 hours were 49.3 ± 24.5 (range 0.5 – 87.9) months and 0.70 ± 0.09 respectively. Incidences of hernia (52.2%) and pleuroperitoneal communication (34.8%) were significantly higher than in PD patients without RPL (13% and 7% respectively, p = 0.001). Logistic regression analysis identified hernia and pleuroperitoneal communication as the risk factors for RPL. The odds ratios for RPL with hernia and pleuroperitoneal communication were 6.62 [95% confidence interval (CI) 2.35 – 18.69, p < 0.001] and 6.23 (95% CI 1.83 – 21.19, p = 0.003) respectively. Conclusion RPL was not uncommon in patients with AUFF. A high index of suspicion for RPL is needed in the management of patients with history of hernia or pleuroperitoneal communication presenting with AUFF.