bluuebunny/crossref_metadata_2025_split huggingface dataset:
Survival of Elderly Patients on Peritoneal Dialysis: Retrospective Study of 292 Patients, from 1982 to 1999
Authors: Vrtovsnik François , Porcher Raphaël , Michel Catherine , Hufnagel Gilles , Queffeulou Guillaume , Mentré France , Mignon Françoise 
Published: February 2020

Background Dialysis is becoming increasingly frequent in patients over 75 years of age. Age is a superimposed comorbid factor commonly associated with poor prognosis in these patients. Objective To analyze the survival of 292 patients aged over 75 years on initiation of peritoneal dialysis (PD) from September 1982 to September 1999. Design Retrospective study. Setting Nephrology department in a University Hospital. Results Mean age was 81.5 years (range 75 – 92 years); 178 patients were over 80 years and 60 patients were over 85 years. Sex ratio was 136F/156M. Ninety-day mortality rate was 12%. Excluding the first 3 months, median patient survival was 21.6 months; 226 patients died on PD and 24 were shifted to hemodialysis. Survival was inversely correlated with the Charlson combined comorbidity index (CCI), but independent of predialysis hemoglobin and serum albumin levels. Over three selected periods, 1982 – 1989, 1989 – 1995, and 1995 – 1999, an increase was found in mean age (79.7 ± 3.3, 82.6 ± 3.9, and 81.8 ± 4.4 years; p < 0.001), CCI (7.6 ± 1.59, 8.0 ± 1.52, and 8.5 ± 1.63; p = 0.01), and predialysis creatinine clearance (6.2 ± 2.3, 6.4 ± 2.4, and 9.8 ± 3.8 mL/minute; p < 0.001). Median survival was similar in the various selected periods (21.0, 21.5, and 25.4 months). The incidence of peritonitis decreased from 0.63 to 0.21 episodes per patient year. Conclusion From 1982 to 1999, mean age and comorbidity increased on initiation of dialysis in elderly patients, with no increase in mortality. Survival in elderly patients on PD was related to the age–comorbidity index.
Effects of Peritoneal Dialysis Solutions on the Secretion of Growth Factors and Extracellular Matrix Proteins by Human Peritoneal Mesothelial Cells
Authors: Ha Hunjoo , Cha Mi Kyung , Choi Hoo Nam , Lee Hi Bahl 
Published: February 2020

♦ Objective To compare the effects of different peritoneal dialysis solutions (PDS) on secretion of vascular endothelial growth factor (VEGF), transforming growth factor-β1 (TGFβ1), procollagen I C-terminal peptide (PICP), procollagen III N-terminal peptide (PIIINP), and fibronectin by cultured human peritoneal mesothelial cells (HPMC). ♦ Design Using M199 culture medium as control, commercial PDS containing 1.5% or 4.25% glucose and 40 mmol/L lactate [Dianeal 1.5 (D 1.5) and Dianeal 4.25 (D 4.25), respectively; Baxter Healthcare, Deerfield, Illinois, USA]; PDS containing 1.5% or 4.25% glucose with 25 mmol/L bicarbonate and 15 mmol/L lactate [Physioneal 1.5 (P 1.5) and Physioneal 4.25 (P 4.25), respectively; Baxter]; and PDS containing 7.5% icodextrin [Extraneal (E); Baxter] were tested. Growth-arrested and synchronized HPMC were continuously stimulated for 48 hours by test PDS diluted twofold with M199, TGFβ1 1 ng/mL, or different concentrations of icodextrin. VEGF, TGFβ1, and fibronectin secreted into the media were analyzed by ELISA, and PICP and PIIINP by radioimmunoassay. ♦ Results Dianeal 1.5, D 4.25, and P 4.25, but not P 1.5 and E, significantly increased VEGF secretion compared with control M199. D 4.25- and P 4.25-induced VEGF secretion was significantly higher than induction by D 1.5 and P 1.5, respectively, suggesting that high glucose may be involved in the induction of VEGF. Physioneal 1.5- and P 4.25-induced VEGF secretion was significantly lower than induction by D 1.5 and D 4.25, respectively, suggesting a role for glucose degradation products (GDP) in VEGF production. TGFβ1 secretion was significantly increased by D 4.25 and E. Icodextrin increased TGFβ1 secretion in a dose-dependent manner. All PDS tested significantly increased secretion of PIIINP compared with control. D 1.5- and D 4.25-induced PIIINP secretion was significantly higher than P 1.5, P 4.25, and E. Physioneal 4.25-induced PIIINP secretion was significantly higher than P 1.5, again implicating high glucose and GDP in PIIINP secretion by HPMC. There was no significant increase in PICP or fibronectin secretion using any of the PDS tested. Addition of TGFβ1 1 ng/mL into M199 control significantly increased VEGF, PICP, PIIINP, and fibronectin secretion by HPMC. ♦ Conclusions The present study provides direct evidence that HPMC can secrete VEGF, TGFβ1, and PIIINP in response to PDS, and that HPMC may be actively involved in the development and progression of the peritoneal membrane hyperpermeability and fibrosis observed in long-term PD patients. This study also suggests that both high glucose and GDP in PDS may play important roles in inducing VEGF and PIIINP production/secretion by HPMC.
Patients’ Descriptions of Specific Factors Leading to Modality Selection of Chronic Peritoneal Dialysis Or Hemodialysis
Authors: Wuerth Diane B. , Finkelstein Susan H. , Schwetz Olena , Carey Hugh , Kliger Alan S. , Finkelstein Fredric O. 
Published: February 2020

♦ Objectives There has been increasing interest in understanding how patients with chronic renal failure choose between chronic peritoneal dialysis (CPD) and hemodialysis (HD) for renal replacement therapy. The purpose of the present study was to examine the influences and specific factors that patients identify as significant in choosing a specific dialysis modality for treatment of their end-stage renal disease (ESRD). ♦ Patients and Design 40 patients (20 CPD, 20 HD) who had started dialysis within the preceding 6 months were randomly selected to participate in the study. A structured interview was conducted with the patients, discussing and exploring what factors patients thought were important in helping them decide their treatment modality. The format of the interview was open-ended. Based on patients’ comments, a taxonomy of the specific factors that influenced the patients’ decisions was developed. ♦ Setting The study was conducted in a freestanding CPD unit and two freestanding HD units. ♦ Results All 20 CPD patients reported choosing their treatment modality; only 8 of the 20 HD patients reported having a choice of treatment modality. 18 of the 22 patients who participated in predialysis educational programs opted for CPD. 83% of the patients reported that their physician was important in influencing their treatment choice; however, the CPD patients relied more on written material and the opinions of their spouse/significant other or other family members in making their decisions. Issues of autonomy and control were important for 95% of patients choosing CPD. Both CPD and HD patients cited a variety of treatment-specific factors. The three most frequently cited reasons for choosing CPD were ( 1 ) flexibility of schedule (19 patients), ( 2 ) convenience of performing CPD in their own home (19 patients), and ( 3 ) the option of doing dialysis at night while sleeping (8 patients). The 8 HD patients who selected their treatment modality cited the desirability of having a planned schedule (7 patients) and letting nurses or other take care of them (5 patients). ♦ Conclusions The present study explored factors perceived by patients as being important in determining their choice of renal replacement therapy. A taxonomy of patient influences and concerns has been developed to provide caregivers with a framework to structure their educational strategies and assist patients with progressive renal failure in making an informed choice of therapeutic modality for their ESRD treatment.
The Impact of Increasing the Daytime Dialysis Exchange Frequency on Peritoneal Dialysis Adequacy and Nutritional Status of Chinese Anuric Patients
Authors: Szeto Cheuk-Chun , Wong Teresa Yuk-Hwa , Chow Kai-Ming , Leung Chi-Bon , Wang Angela Yee-Moon , Lui Siu-Fai , Li Philip Kam-Tao 
Published: February 2020

♦ Objective To study the effect of increasing the daytime dialysis exchange frequency on dialysis adequacy and nutritional status of Chinese anuric patients. ♦ Setting University teaching hospital. ♦ Patient 100 anuric patients on continuous ambulatory peritoneal dialysis (CAPD). ♦ Design 50 patients had one additional daytime 2-L exchange (intervention group); the dialysis regimen remained unchanged in the other 50 patients (control group). ♦ Outcome Dialysis adequacy [Kt/V, weekly creatinine clearance (wCCr), and net ultrafiltration (UF)] and nutritional status [serum albumin, dietary protein intake, represented by normalized protein nitrogen appearance (nPNA), and percent lean body mass (%LBM)] were measured at 0 and 6 months. ♦ Results Baseline dialysis adequacy and nutritional indices were comparable between the two groups. In the control group, all parameters remained stable at month 6. In the intervention group, there were significant increases in UF, Kt/V, wCCr, nPNA, and %LBM from months 0 to 6. The improvement in nPNA was affected by daily exchange volume. In 30 patients, the number of exchanges was increased from 3 to 4 per day; their Kt/V and nPNA rose significantly from month 0 to month 6. In the other 20 patients, the number of exchanges was increased from 4 to 5 per day; there was a significant increase in Kt/V but nPNA remained static. The change in nPNA correlated inversely with Kt/V at month 0 (Pearson's r = –0.352, p = 0.012). Multivariate analysis with a general linear model showed that age, Kt/V at month 0, and 3 dialysis exchanges per day at month 0 (versus 4 exchanges) were independent predictors of the change in nPNA. ♦ Conclusions Increasing the number of peritoneal dialysis exchanges effectively increased Kt/V in Chinese anuric CAPD patients. However, the improvement in nPNA correlated inversely with baseline Kt/V. Although increasing the number of exchanges from 3 to 4 per day improved nPNA, increasing the number of daily exchanges beyond 4 may not improve nPNA further.
How to Reduce 3-Deoxyglucosone and Acetaldehyde in Peritoneal Dialysis Fluids
Authors: Zimmeck Thomas , Tauer Andreas , Fuenfrocken Michael , Pischetsrieder Monika 
Published: February 2020

Objective 3-Deoxyglucosone (3-DG) and acetaldehyde were found to be the major reactive carbonyl compounds in conventional heat-sterilized peritoneal dialysis fluids (PDFs). The aim of this study was to identify factors in the production of PDFs promoting or inhibiting the formation of acetaldehyde and 3-DG. Design Single-chamber bag PDFs with different buffer systems and pH values were analyzed for acetaldehyde. 3-Deoxyglucosone was determined in double-chamber bag PDFs with different pH values, in commercially available samples, and in double-chamber products stored under defined conditions. Results Acetaldehyde was found in the presence of lactate and malate, whereas in 2-hydroxybutanoate-buffered solution propionaldehyde was detected instead. Between pH 5.0 and 6.0 the acetaldehyde content in lactate-buffered solutions increased strongly. The concentration of 3-DG in the chamber containing glucose in double-chamber bags increased between pH 3.0 and 5.0 by a factor of 6. 3-Deoxyglucosone concentrations in commercially available products vary greatly, reflecting the different pH values of these products. A time- and temperature-dependent reaction leads to a reduction in 3-DG and an increase in 5-hydroxymethyl-furan-2-carbaldehyde during storage. Conclusion Acetaldehyde is produced by a reaction that requires both lactate and glucose. Thus, its formation can be prevented by a separation of the reaction partners, glucose and lactate, in a double-chamber bag. In double-chamber bags, pH greatly influences the formation of 3-DG. Minimal formation is observed in the region of pH 3.0. This finding should be taken into account for the development of new double-chamber bag PDFs.
Results of Peritoneal Equilibration Test during Treatment with Polyglucose Dialysis Solution
Authors: Grzegorzewska Alicja E. , Antczak-Jȩdrzejczak Danuta , Leander Magdalena 
Published: February 2020

Background Results of peritoneal equilibration test (PET) suggest prolonged effect of polyglucose dialysis solution (PG-DS) on peritoneal permeability. Objectives An evaluation of dialysate-to-plasma ratio (D/P) of urea, D/P creatinine, and D/D0 glucose (ratio of dialysate glucose at designated dwell time to dialysate glucose at 0 dwell time), and mass transfer area coefficients (KBD) of these solutes in PET before introduction, during administration, and after discontinuation of PG-DS in patients treated with continuous ambulatory peritoneal dialysis (CAPD). Design Single-center prospective study with PG-DS; retrospective selection of the control group. Setting Peritoneal dialysis unit in a university hospital. Patients Fourteen patients (11 males; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months. 7.5% PG-DS was used for the overnight exchange. After discontinuation of the PG-DS, standard dialysis solutions, as previously used, were reintroduced. The control group was selected to match both CAPD duration and peritoneal permeability of the patients in the PG-DS group at the start of the study. Methods Standard PET was carried out at 1.6 ± 0.8 months before the introduction of PG-DS (study period I, n = 14), after 1.2 ± 0.6 months’ use of PG-DS (study period II, n = 14), after 4.4 ± 0.8 months’ use of PG-DS (study period III, n = 11), after 8.8 ± 2.2 months’ use of PG-DS (study period IV, n = 9), and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11). Patients in the control group underwent PET at similar time intervals (control periods I – V). Results In the PG-DS group, a tendency toward increased peritoneal permeability for urea and creatinine was shown during the consecutive study periods. D/D0 glucose was significantly higher only in the PET performed during use of PG-DS (periods II – IV) compared to results obtained in period I. In the control group, both D/P and KBD of both urea and creatinine remained unchanged, but KBD glucose was higher in the first 2 hours of the PET in control period V compared to respective values in control period III. Conclusion Changes in peritoneal permeability are observed in CAPD patients treated with PG-DS. These changes may be at least partially related to the administration of polyglucose.
Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function
Authors:   for the Centers for Medicare & Medicaid Services Peritoneal Dialysis Core Indicators Study Group, Rocco Michael V. , Frankenfield Diane L. , Prowant Barbara , Frederick Pamela , Flanigan Michael J. 
Published: February 2020

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.
Recurrent Hemoperitoneum Complicating Continuous Ambulatory Peritoneal Dialysis
Authors: Tse Kai-Chung , Yip Pok-Siu , Lam Man-Fei , Li Fu-Keung , Choy Bo-Ying , Chan Tak-Mao , Lai Kar-Neng 
Published: February 2020

♦ Objectives To study the clinical features, clinical outcomes, and peritoneal transport characteristics of patients with recurrent hemoperitoneum complicating continuous ambulatory peritoneal dialysis (CAPD). ♦ Design Single-center retrospective case review of patients on CAPD over a 10-year period. ♦ Setting Renal Unit in Queen Mary Hospital, a tertiary-care referral center in Hong Kong. ♦ Patients 549 patients were available for review. 46 patients (8.4%) had at least one episode of hemoperitoneum during their course of CAPD; 25 patients had only one episode of hemoperitoneum and they were excluded. The remaining 21 patients (3.8%) had two or more episodes of hemoperitoneum and they were included for review. ♦ Main Outcome Measures Basic demographic factors and the etiology and episodes of hemoperitoneum were recorded. Clinical outcomes included continuation on peritoneal dialysis, conversion to hemodialysis (HD), renal transplantation, and death. The reason for conversion to HD, the causes of death, and serial peritoneal equilibration tests (PET) using dialysate-to-plasma ratio of creatinine (D/P creat) and ratio of dialysate glucose at hours 4 and zero of the dwell (D4/D0) with standard 2-L 2.5% glucose dialysate were assessed. ♦ Results There were 549 patients with total of 91 episodes of recurrent hemoperitoneum affecting 21 patients (3.8%). Mean age was 50.2 years (range 24 – 76 years) and mean duration of dialysis was 61.6 months (range 2 – 166 months). There were 14 female patients (66.7%) and 7 male patients (33.3%). The average number of hemoperitoneum episodes was 4.3 per patient (range 2 – 12). The mean time interval of the first hemoperitoneum episode from commencement of peritoneal dialysis was 10.5 months (range 1 – 37 months, SD 9.7 months). Most cases were due to retrograde menstruation in females and unknown cause in males. Two patients had intra-abdominal pathology accounting for hemoperitoneum. Thirteen patients (61.9%) continued CAPD, 2 (9.5%) underwent renal transplantation, and 2 (9.5%) were converted to long-term HD. The reason for conversion to HD was related to hemoperitoneum in 1 patient (4.8%) only. Four patients (19.0%) died; the causes of death were unrelated to hemoperitoneum. There was no correlation between recurrent hemoperitoneum and peritonitis episodes ( p = 0.18). There was no significant association between hemoperitoneum episodes and clinical outcomes ( p = 0.91) or survival ( p = 0.52). None of the patients developed ultrafiltration failure on long-term follow-up. ♦ Conclusions Recurrent hemoperitoneum is a benign complication of CAPD, with no significant long-term effects on patient survival, predisposition to peritonitis, or ultrafiltration failure.
A Novel Objective Nutritional Score for Children on Chronic Peritoneal Dialysis
Authors: Edefonti Alberto , Picca Marina , Paglialonga Fabio , Loi Silvana , Grassi Maria Rosa , Ardissino Gianluigi , Marra Giuseppina , Ghio Luciana , Fossali Emilio 
Published: February 2020

Objectives To establish a novel nutritional score based on a series of objective parameters capable of detecting protein-calorie malnutrition in children being treated with chronic peritoneal dialysis (CPD), to test the score in a healthy pediatric population, and to apply it to children on CPD to evaluate their nutritional status. Study Population 264 healthy school children (mean age 8.69 ± 3.26 years, range 3.05 – 14.98 years) and 29 patients treated with CPD for 1.75 ± 1.02 years (mean age 10.54 ± 6.28 years, range 2.8 – 15.24 years). Methods Nutritional status was evaluated by means of three sets of measurements: anthropometric (A1 and A2) and bioimpedance analysis (BIA) measurements. Anthropometry included two sets of measures: set A1 consisted of height (H), weight (W), and body mass index (BMI); set A2 consisted of midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA). The BIA measurements included reactance, phase angle, and distance. All parameters are expressed as standard deviation scores (SDS). Tanner's, Rolland–Cachera's, and Frisancho's data were used as references for H, W, BMI, MAMC, AMA, and AFA; personal data obtained from 551 healthy boys and girls were used for the BIA indices. The nine anthropometry and BIA parameters were given scores of 1 to 5: 5 = > 0 SDS, 4 = ≤ 0 and > –1 SDS, 3 = ≤ –1 and > –2 SDS, 2 = ≤ –2 and > –3 SDS, and 1 = ≤ –3 SDS. Average scores were established for each of A1, A2, and BIA, and then summed to obtain the anthropometry–BIA nutrition (ABN) score. To establish the cutoff value between normal nutritional status and malnutrition, the method was first applied to the 264 healthy children; distribution percentiles were calculated for each area score and the ABN score. The ABN score corresponding to the 3rd percentile was considered the limit of normality and then applied three times to the 29 children on CPD, for a total of 87 nutritional assessments. Results The score corresponding to the 3rd percentile in the population of healthy children was 10.33. Among the CPD-treated children, 41.4% of the ABN scores were higher than 10.33 (indicating a state of normal nutrition) and 58.6% were lower (indicating various degrees of malnutrition). Severe malnutrition was found in only 1.1% of the cases. The values of all nine A1, A2, and BIA parameters, as well as serum albumin levels, were significantly higher in patients with an ABN score > 10.33 than in those with a score < 10.33. Conclusion The ABN score is a simple and objective method of assessing, in clinical practice, the nutritional status of children on CPD.