bluuebunny/crossref_metadata_2025_split huggingface dataset:
Follow-Up Study of Peritoneal Fluid Kinetics in Infants and Children on Peritoneal Dialysis
Authors: De Boer Alberdina W. , Van Schaijk Theodora C.J.G. , Willems Hans L. , De Haan Anton F.J. , Monnens Leo A.H. , Schröder Cornelis H. 
Published: February 2020

Objectives To study longitudinal changes in trans-capillary ultrafiltration (TCUF) and marker clearance (MC), as a reflection of lymphatic absorption, in children on peritoneal dialysis (PD). To present data on fluid kinetics in infants younger than 2.5 years, using an intraperitoneal volume of 1200 mL/m2 body surface area (BSA). Design The study involved a 4-hour dwell of 1200 mL/m2 BSA of dialysis fluid containing 3.86% glucose with Dextran 70 as volume marker. Cumulative TCUF and cumulative MC were measured. Setting A tertiary-care university hospital. Patients A follow-up period of 33 months of serial (1 – 4) peritoneal equilibration tests (PETs) was studied in 20 children with a median age of 6.4 years (range 2.1 – 15.4 years). Fluid kinetics in 5 additional infants with a median age of 1.4 years (range 0.5 – 2.5 years) was measured. Results Cumulative TCUF was 1041 mL/1.73 m2 at 1 – 3 months after start of PD, 1026 mL/1.73 m2 at 7 – 9 months, 1021 mL/1.73 m2 at 11 – 13 months, and 756 mL/ 1.73 m2 at 26 – 33 months (NS). Cumulative MC was 235 mL/1.73 m2 at 1 – 3 months after start of PD, 311 mL/ 1.73 m2 at 7 – 9 months, 395 mL/1.73 m2 at 11 – 13 months, and 509 mL/1.73 m2 at 26 – 33 months (NS). In infants, cumulative TCUF was 755 ± 237 mL/1.73 m2; cumulative MC was 400 ± 214 mL/1.73 m2. Conclusions Transcapillary ultrafiltration and marker clearance do not change in children > 2.5 years during the period studied. Fluid kinetics does not differ between infants < 2.5 years and older children when intraperitoneal volumes of 1200 mL/m2 BSA are used.
Comparison of Intraperitoneal and Subcutaneous Epoetin Alfa in Peritoneal Dialysis Patients
Authors: Johnson Curtis A. , Wakeen Maureen , Taylor Claude A. , Zimmerman Stephen W. , Burkart John , Bhattacharya Abhik , Kosorok Michael R. 
Published: February 2020

Objective To compare the efficacy of intraperitoneal (IP) and subcutaneous (SC) administration of epoetin alfa in patients receiving peritoneal dialysis (PD). Design A 32-week prospective, randomized, cross-over experimental design. Setting Two university-based outpatient PD centers. Patients Twenty adult PD patients receiving stable doses of SC epoetin alfa enrolled in the study. Thirteen patients completed 32 weeks of follow-up. Intervention Patients were randomly assigned to receive either SC or IP epoetin alfa at the start of the study. Dose adjustments were made to maintain baseline hematocrit ± 3 percentage points. Following 16 weeks of treatment, patients crossed over to the other route of administration for an additional 16 weeks. Intraperitoneal epoetin alfa was administered into an empty peritoneal cavity for approximately 8 hours before resuming dialysis. End-of-study IP epoetin alfa doses required to maintain target hematocrit were given twice weekly ( n = 1), once weekly ( n = 11), or once every other week ( n = 1). All patients received iron supplements to maintain or exceed prestudy iron parameters. Main Outcome Measure Prior to the study, the primary outcome measure was defined as the difference in epoetin alfa dose between IP and SC administration. Results Thirteen patients completed the study. The area under the dosing-requirement curve for IP epoetin alfa was larger than for SC administration ( p = 0.0029), and the slope of the 16-week dose-requirement curve was greater for IP administration ( p = 0.017), suggesting greater dose stability for SC administration. Paired analysis indicated greater IP intrapatient dose requirements ( p < 0.0001). The mean difference in SC versus IP doses was 5000 ± 1510 units per week. Some patients required escalating IP doses to maintain target hematocrit values. Iron administration and iron stores were similar in both groups. Conclusion Intraperitoneal epoetin alfa may be a suitable alternative for some patients for whom SC dosing is undesirable. Large IP versus SC dosing differences noted in a few patients are unexplained, but may result from interpatient variability in IP epoetin alfa absorption. Intraperitoneal dosing into an empty peritoneum can be done safely and effectively.
Impact of Peritoneal Membrane Function on Long Term Clinical Outcome in Peritoneal Dialysis Patients
Authors: Davies Simon J. , Phillips Louise , Griffiths Anne M. , Russell Lesley H. , Naish Patrick F. , Russel Gavin I. 
Published: February 2020

It is increasingly clear that peritoneal membrane transport status has clinical implications. The role of the peritoneum in dialysis delivery becomes para mount once residual renal function is lost, particularly as the membrane characteristics may change for the worse with time on treatment. These findings have several important implications: Clinicians need to take solute transport character istics into account as they assess their patients. Adverse effects of high solute transport include reduced ultrafiltration, solute removal (in particular, sodium), and increased peritoneal protein losses. A need exists to replace lost residual renal function, not just with enhanced solute removal, but also with adequate salt and water removal. The interpretation of urea and creatinine clear ances in anuric PD patients needs further consideration and validation. Hypoalbuminemia in PD patients will result from the combined effects of high protein losses, over hydration, comorbidity, and malnutrition.
Blood Flow Does Not Limit Peritoneal Transport
Authors: Flessner Michael F. , Lofthouse Joanne 
Published: February 2020

Objective We investigated the assumption that blood flow to the microvessels underlying the peritoneum does not limit solute or water exchange between the blood and the dialysis fluid. Design Small plastic chambers were affixed to the serosal side of the liver, cecum, stomach, and abdominal wall of anesthetized rats. Solutions that contained labeled solutes or that were made hypertonic were placed into the chambers, which restricted the area of transfer across the tissue to the base of the chamber and which permitted calculation of mass or water transfer rates on the basis of area. The local blood flow was monitored continuously with a laser Doppler flowmeter during three periods of observation: control, after 50% -70% reduction of the blood flow, and postmortem. Results Urea transfer across all serosa, except for the liver, showed no difference in mean mass transfer coefficient (cm/min) between control (0.0038 0.0046) and after 70% flow reduction (0.0037 -0.0040), but demonstrated a significant decrease with blood flow equal to zero (0.0020). These tissues demonstrated small but insignificant decreases in osmotic water flow into the chamber (0.7 -0.9 μL/min/cm2 under control conditions versus 0.4 -0.7 μL/min/cm2 with reduced blood flow). The liver demonstrated limitations in water and solute transport with a 70% decrease in blood flow. Conclusion Because the liver makes up a small part of the peritoneal area, we conclude that large drops in blood flow do not limit overall solute or water transfer across the peritoneum during dialysis, and therefore acute peritoneal dialysis may be an appropriate modality for ICU patients in shock and renal failure.
Tuberculous Peritonitis
Authors: Prakash K.C. 
Published: February 2020

Although the general incidence of peritonitis has declined considerably with improvement in connectology, tuberculous peritonitis is still a major problem in patients who are from endemic regions and who belong to high risk groups. The problem stems mainly from less sensitive diagnostic tools. Confirmation of tuberculous peritonitis is based on mycobacterial culture of the peritoneal fluid, which takes a few weeks. For patients in whom tuberculous peritonitis cannot be confirmed, therapeutic trial has been recommended. Treatment of tuberculous peritonitis consists in removing the peritoneal catheter and initiating antituberculosis medications, though the dosage and duration of antituberculosis medication are not yet well defined. Early initiation of antituberculosis medication has been shown to preserve good ultrafiltration and solute clearance by the peritoneal membrane.
Effects of Peritoneal Rest on Peritoneal Transport and Peritoneal Membrane Thickening in Continuous Ambulatory Peritoneal Dialysis Rats
Authors: Kim Yong-Lim , Kim Sung-Ho , Kim Jun-Hong , Kim Seog-Jae , Kim Chan-Duck , ChO Dong-Kyu , Kim Yong-Jin , Moberly James B. 
Published: February 2020

Objective To evaluate the effects of peritoneal rest on peritoneal transport and morphology in a rat model of peritoneal dialysis. Design Twenty-four rats (Sprague-Dawley, male, 250 300 g) were divided into three groups: group 1 (control, n = 6) without dialysis, group 2 (n = 9) sacrificed immediately after 3 weeks of dialysis, and group 3 (n = 9) sacrificed after 4 weeks of peritoneal rest after 3 weeks of dialysis. Both dialysis groups were dialyzed twice daily with an intraperitoneal instillation volume of 25 mL of 3.86% dextrose solution for 3 weeks. Peritonitis was induced by supplementing the dialysis fluid with lipopolysaccharide (5 μg/mL) on days 8, 10, and 12 in both dialysis groups. Peritoneal equilibration tests were performed on each animal at baseline. The equilibration tests were repeated at the 4th and the 8th week of dialysis. Morphometric analyses of the peritoneal membrane were carried out in tissue specimens obtained at the time of sacrifice. Results The DIDo ratio for glucose at two hours in groups 2 and 3 at the beginning of week 4 was significantly lower than at baseline, indicating an increase in peritoneal permeability to glucose after 3 weeks of dialysis. DIDo in group 3 at the beginning of week 8, after 4 weeks of peritoneal rest, was significantly higher than at week 4. The drain volume in groups 2 and 3 at week 4 was significantly lower than at baseline; however, the drain volume in group 3 at week 8 was significantly higher than at week 4. The thickness of the parietal peritoneal membrane in group 3 was significantly greater than in group 1 and less than in group 2 (group 1, 11.4 ± 7.6 μm; group 2, 37.5 ± 18.4 μm; group 3,21.4 ± 12.1 μm). Conclusions Peritoneal rest improves ultrafiltration in rats by decreasing the hyperpermeability of glucose and also reduces the degree of peritoneal thickening. These data suggest that dialysis -induced changes in peritoneal transport and morphology are reversible under the conditions of peritoneal rest in this experimental model.
Socioeconomic Aspects of Peritoneal Dialysis in North America: Role of Non Medical Factors in the Choice of Dialysis
Authors: Venkataraman Vijaya , Nolph Karl D. 
Published: February 2020

Patients initiating dialysis therapy must make a choice between hemodialysis (HD) and peritoneal dialysis (PD). Controversy persists over the relative merits of each modality in the treatment of end-stage renal disease (ESRD). Issues relating to survival, morbidity, economics, and patient characteristics will all determine the final choice of therapy. Non medical factors are the most important determinant of dialysis modality selection. In the United States, HD has been the more commonly used modality, while PD is underrepresented. This disparity arises from multiple factors including reactions (sometimes incorrect) to the healthcare financing structure, physician biases, and changing demographic patterns in the ESRD population. We discuss these issues and present collected evidence showing that increased use of PD may have substantial overall benefit.
Comparison of Two Different Kt/V Methods in Continuous Ambulatory Peritoneal Dialysis Patients
Authors: Sanlidag Canan , Ccedil;avdar Caner , Sifil Aykut , Hastaoglu Sadiye , üretmen Pinar , çamsari Taner 
Published: February 2020

Dialysis adequacy has gained particular interest for the assessment of the quality of dialysis in patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Kt/V is used as a test of dialysis adequacy in HD and CAPD patients. The aim of this study was to compare two different Kt/V methods in CAPD patients. A practical method for the calculation of Kt/V will be suggested at the end of this prospective study. The study group included 28 patients. Each patient received CAPD therapy four times per day. During the study, CAPD dialysate samples for a period of 24 hours were obtained by two different methods. One is a modified method for obtaining samples by the patient at home; the other is the conventional method. For study purposes only, we told the patients using the modified method to bring all the bags to the center (contrary to the aim of the modified method). In the first method (modified method), CAPD patients collected 24-hour dialysate and urine samples at home and brought all of the materials to the hospital. A 10 mm3 dialysate sample was drawn from each CAPD dialysate bag, and then a total of 40 mm3 dialysate was mixed in a beaker. A sample of 10 mm3 of dialysate was taken from the mixture in the beaker, and then this dialysate sample, urine, and 5 mm3 venous blood were sent to the laboratory for urea nitrogen (UN) and creatinine level determinations. In addition to these tests, 24-hour dialysate and urine volumes and the patients’ weight and height were measured, and Kt/V values were calculated. In the second method (classic method), all the bags from the 24-hour period were collected and mixed in a big bucket, and then a 10 mm3 sample was taken. The remaining procedures were the same as for the first method. Mean Kt/V values were calculated separately for the two methods and were found to be 2.48 by the modified method and 2.52 by the classic method. The results of the two methods were compared with the Wilcoxon paired t-test, which showed no statistically significant difference (p = 0.5228). In conclusion, two different Kt/V methods can be used in CAPD patients. However, the modified method is easily performed, and CAPD patients can collect and take the dialysate and urine samples at home, and bring these materials to the renal unit without transportation problems.
Current Status of Peritoneal Dialysis in Korea: Efforts to Achieve Optimal Outcome
Authors: Han Dae-Suk , Hwang Jae-Ha , Kang Duk-Hee , Song Hyun-Yong , Noh Hyunjin , Shin Sug-Kyun , Lee Seoung-Woo , Kang Shin-Wook , Choi Kyu-Hun , Ha Sung-Kyu , Lee Ho-Yung 
Published: February 2020

Since its introduction in 1981, peritoneal dialysis (PD) has become firmly established as an effective mode of renal replacement therapy and serves an increasing patient population in Korea. The latest registry data indicate that about 3700 end-stage renal disease patients are maintained on chronic PD, representing 24.1% of the country's dialysis population. The majority (93.3%) of these patients are on continuous ambulatory peritoneal dialysis (CAPD) using the two-bag disconnect system, while only 3.3% are on automated PD. Under current renal reimbursement policies, most dialysis patients have to pay 20% of dialysis fees. Thus CAPD patients on 4 x 2-L daily exchanges pay about US$200 per month, not including medication and travel costs. Traditionally, most PD centers in Korea have used the “standard” prescription of 4 exchanges of 2 L of solution for most of their patients. A recent survey of 1467 patients who commenced CAPD in 1997 revealed that 84% of these patients were initially prescribed 4 x 2-L exchanges, while 12% were given a daily volume of 6 L. With this standard prescription, the percentages of Korean CAPD patients initially achieving the adequacy target of Kt/V urea ≥ 2.0 and standardized creatinine clearance (SCCr) ≥ 60 L/week/ 1.73 m2, were 74.4% and 82.1%, respectively. It is likely that, among current Korean CAPD patients, a much lower percentage will achieve the clearance targets compared to this initial outcome, but the precise data are not available. However, it is not clear whether the levels of small-solute clearance recommended for optimal PD outcomes, and proposed by the NKF-DOQI guidelines, will bring the expected benefits to Korean patients. Overall survival of Korean PD patients appears to be as good as, or even better than, that in most other countries. Recently, a single large PD center reported patient survival of 92.1%, 85.6%, 81.4%, and 67.6% at 1, 2, 3, and 5 years respectively. Other centers also reported similar outcomes. As in other countries, cardiovascular deaths predominate among Korean patients: death was due to cardiac causes in 29%, to vascular causes in 21%, and to infectious causes in 24%. Peritonitis is the most important barrier to prolonged use of CAPD in Korea, and more PD patients transfer to hemodialysis because of peritonitis than in other countries. To further reduce the morbidity and mortality of Korean PD patients, various control measures need to be implemented that can reduce or prevent peritonitis and other infectious complications. Also, to further improve long-term patient outcome, Korean nephrologists need to establish and practice optimal clearance targets in the chronic care of these patients.
Case of pembrolizumab-induced myocarditis presenting as torsades de pointes with safe re-challenge
Authors: Lee Dae Hyun , Armanious Merna , Huang Jessica , Jeong Daniel , Druta Mihaela , Fradley Michael G 
Published: February 2020

Introduction Pembrolizumab is an immune checkpoint inhibitor targeting the programmed death receptor with clinical effect on multiple malignancies including sarcoma. Associated cardio-toxicities include myocarditis, cardiomyopathy, heart failure, and arrhythmias. Although in most cases of immune checkpoint inhibitor cardiotoxicity the offending agent is discontinued, we report a case of successful and safe re-challenge with a checkpoint inhibitor in a patient with mild myocarditis. Case report We describe a 37-year-old female with alveolar soft part sarcoma, metastatic to the lungs on cycle 13 of pembrolizumab who presented with dyspnea, cough, and vague chest discomfort. Telemetry showed bigeminal bradycardia that transitioned to self-terminating torsades de pointes. Cardiac MRI showed subtle patchy T2 signal increase within the left ventricular septum without late gadolinium uptake, suggesting mild focal myocarditis. Management and outcome: The patient was started on a steroid taper without additional arrhythmias. We have re-challenged the patient who safely tolerated re-challenge with pembrolizumab despite an episode of torsades de pointes and documented myocarditis. She continues to receive pembrolizumab at seven months after the initial event without further cardiovascular events. Discussion To the best of our knowledge, this is the first reported case of successful re-challenge of pembrolizumab after an episode of myocarditis. In patients with mild myocarditis and no evidence of left ventricular dysfunction, re-challenge may be a viable option. However, close monitoring for the development of heart failure, cardiomyopathy, or serious arrhythmias is necessary to ensure patient safety.
One-year results of gonioscopy-assisted transluminal trabeculotomy: Evaluation of prognostic factors
Authors: Cubuk Mehmet Ozgur , Unsal Erkan 
Published: February 2020

Purpose: To present the results and complications of gonioscopy-assisted transluminal trabeculotomy in adults with open-angle glaucoma using our different approaches during and after surgery. Method: A retrospective comparative study was designed. Patients with regular 12-month follow-up history were included. Two groups were defined: group 1 comprised patients with open-angle glaucoma who underwent gonioscopy-assisted transluminal trabeculotomy surgery alone; group 2 included patients with open-angle glaucoma who underwent combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction. A 30% reduction in preoperative intraocular pressure or postoperative intraocular pressure below 18 mm Hg was considered as surgical success. The success rate, alteration in intraocular pressure, alteration in best-corrected visual acuity, alteration in the need for antiglaucomatous medications, surgical complications, and the need for additional glaucoma surgery were evaluated and compared between the groups. Multivariate logistic regression analysis was used to show the association between the surgical success and possible prognostic factors. Results: A total of 37 eyes fulfilled the inclusion criteria and were analyzed in this study. An overall mean decrease in intraocular pressure of 11.3 ± 9.3 mm Hg was shown at 12 months (p < 0.001). The medication-free surgical success rate was 37.8% (14/37), and the surgical success rate with medication was 91.8% (33/37) at 12 months. Surgical outcomes were similar between patients who underwent gonioscopy-assisted transluminal trabeculotomy alone and those who had combined gonioscopy-assisted transluminal trabeculotomy and cataract extraction (p > 0.05). The most common postoperative complication was hyphemia (89.1%). There were no complications that threatened best-corrected visual acuity. Multivariate logistic regression analysis revealed one significant association between the presence of blood in Schlemm’s canal and surgical success (odds ratio = 1.47; 95% confidence interval = 1.25–1.68; p = 0.047). Conclusion: This study showed that the gonioscopy-assisted transluminal trabeculotomy procedure is an effective and minimally invasive form of glaucoma surgery. Its effect was related to intraoperative blood in Schlemm’s canal.
Selective Nonoperative Management of Abdominal Stab Wounds with Isolated Omental Evisceration is Safe: A South African Experience
Authors: Kong V. Y. , Weale R. D. , Blodgett J. M. , Madsen A. , Laing G. L. , Clarke D. L. 
Published: February 2020

Background and Aims: Selective nonoperative management of abdominal stab wound is well established, but its application in the setting of isolated omental evisceration remains controversial. The aim of the study is to establish the role of selective nonoperative management in the setting of isolated omental evisceration. Materials and Methods: A retrospective study was conducted over an 8-year period from January 2010 to December 2017 at a major trauma center in South Africa to determine the outcome of selective nonoperative management. Results: A total of 405 consecutive cases were reviewed (91% male, mean age: 27 years), of which 224 (55%) cases required immediate laparotomy. The remaining 181 cases were observed clinically, of which 20 (11%) cases eventually required a delayed laparotomy. The mean time from injury to decision for laparotomy was <3 h in 92% (224/244), 3–6 h in 6% (14/244), 6–12 h 2% (4/244), and 12–18 h in 1% (2/244). There was no significant difference between the immediate laparotomy and the delayed laparotomy group in terms of length of stay, morbidity, or mortality. Ninety-eight percent (238/244) of laparotomies were positive and 96% of the positive laparotomies (229/238) were considered therapeutic. Conclusion: Selective nonoperative management for abdominal stab wound in the setting of isolated omental evisceration is safe and does not result in increased morbidity or mortality. Clinical assessment remains valid and accurate in determining the need for laparotomy but must be performed by experienced surgeons in a controlled environment.