bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment Modality Selection in 150 Consecutive Patients Starting Esrd Therapy
Authors: Prichard Sarah S. 
Published: February 2020

Objective The purpose of this study was to assess the reasons for treatment modality selection between hemodialysis (HD) and peritoneal dialysis (PD) in 150 consecutive patients in a single center. Design This study is a retrospective study using chart review as the data collection method. Setting A single tertiary care university teaching hospital. Patients One hundred and fifty consecutive patients starting end-stage renal disease (ESRD) therapy at the Royal Victoria Hospital in Montreal were assessed. Their treatment modality at 6 weeks after starting dialysis was recorded as their treatment modality. Patients transplanted or who died prior to that 6 week period were excluded. Main Outcome Measures The treatment modality, that is, either HD or PD, at 6 weeks after the initiation of ESRD was the modality assigned to the patient. Results One hundred and fifty patients started ESRD therapy of whom 83 went to HD and 67 to PD. Thirty-one patients were directed to HD, including 20 for social reasons, 3 with ostomies, and 6 with unsuitable abdomens. Fourteen patients were directed to PD, including 10 with severe cardiovascular disease, 3 with no vascular access, and one for geographical reasons. Of 31 diabetics who were encouraged to do PD, 17 went to PD and 14 to HD (10 for social reasons, 3 refused PD, and one with an inappropriate abdomen). Seventy-four patients were initially eligible for either PD or HD. Fifty percent (37) went to PD and 50% to HD. Of those going to HD, 15 went to self-care HD, of whom 7 had prior exposure to HD. Eleven were not informed regarding PD. There was no gender preference for PD versus HD. Conclusion We conclude that among informed patients, if given a choice of treatment modality, the majority will choose self-care dialysis including continuous ambulatory peritoneal dialysis (CAPD) or selfcare HD.
Erythropoietin Treatment Decreases Cardiovascular Morbidity and Mortality in Capd Patients
Authors: Bajo Maria Auxiliadora , Selgas Rafael , Castro Maria Jose , Jiménez Carlos , Fernández-Reyes Maria Jose , Del Peso Gloria , De Alvaro Fernando , Sanchez-Sicilia Luis 
Published: February 2020

Objective To analyze the effects of recombinant human erythropoietin (rHuEPO) therapy on cardiovascular (CV) morbidity and mortality among continuous ambulatory peritoneal dialysis (CAPD) patients. Design Retrospective comparative study. Setting CAPD unit in a university hospital. Patients Forty-two patients on rHuEPO treatment for at least one year were compared with an rHuEPO nonuser group of 113 patients. Subcutaneous rHuEPO doses were adjusted to a hemoglobin objective level of 10.5 -13.5 g/ dL. Fifty-seven patients were considered as high cardiovascular risk (HCVR), 17 in the rHuEPO group and 40 in the rHuEPO nonuser group. Ninety-eight patients were classified as low cardiovascular risk (LCVR), 25 of whom were in the rHuEPO group. Results The incidence of cardiovascular morbidity was more frequent in the rHuEPO nonuser than in the rHuEPO user group (40% vs 22%) and in HCVR than in LCVR patients (59.6% vs 20.4%). By multiple logistic regression analysis, the best model to explain the development of cardiovascular morbidity comprises rHuEPO treatment, CV risk, and age. In the rHuEPO user group, HCVR and LCVR patients did not show significant differences in survival, while in the rHuEPO nonuser group, HCVR patients had a lower survival rate than LCVR patients (p = 0.0003). Cox proportional hazards model revealed that LCVR patients had an excellent prognosis compared with HCVR patients in the rHuEPO nonuser group, but this difference disappeared in the rHuEPO user group. Conclusion These data show a beneficial effect of rHuEPO treatment on cardiovascular morbidity and mortality in CAPD patients, evidenced by the elimination of the correlation between prior cardiovascular risk and subsequent mortality.
Fibrinogen and Fibrinolytic Activity in Capd Patients with Atherosclerosis and Its Correlation with Serum Albumin
Authors: Kim Kyung Jo , Yang Won Seck , Kim Soon Bae , Lee Sang Koo , Park Jung Sik 
Published: February 2020

Objective It has been suggested that hypoalbuminemia in dialysis patients leads to a hypercoagulable state, however, the relationship between serum albumin and fibrinogen or fibrinolytic activity has not been well-documented. The aim of this study was to investigate the changes of fibrinogen, tissue plasminogen activator (tPA), plasminogen activator inhibitor type-1 (PAI-1), and lipid levels in continuous ambulatory peritoneal dialysis (CAPD) patients with atherosclerosis, and the relationship between those factors and serum albumin. Design A cross-sectional study. Setting A university hospital. Patients Twenty CAPD patients with atherosclerosis, 49 CAPD patients without atherosclerosis, and 33 normal controls were included. Presence of atherosclerosis was determined by positive results in a stress thallium singlephoton emission computed tomography or an ankle brachial index less than 0.9. Coronary angiography and/ or Doppler ultrasound of extremities were followed for the patients with positive results to confirm atherosclerotic cardiovascular disease. Main outcome measures tPA and PAI-1 levels were determined with ELISA method, and fibrinogen with thrombin time method. Serum albumin and lipids were also measured. Results Serum albumin and HDL -cholesterol levels were significantly lower, and the ratio of total cholesterol/ HDL was significantly higher, in CAPD patients than in normal controls. CAPD patients with atherosclerosis had significantly higher fibrinogen, tPA, and PAI-levels than other groups. tPA was an independent predictor of atherosclerotic vascular disease in CAPD patients in stepwise logistic regression analysis. Serum albumin level was inversely correlated with fibrinogen (r = -0.28; p < 0.05) in CAPD patients, but not with tPA or PAI-1 levels. PAI-1 level was correlated with tPA (r = 0.37; p < 0.01) and triglycerides (r = 0.32; p < 0.05). Conclusions Association of high levels of fibrinogen and PAI-1 with lipid disorders may be of importance in the development of atherosclerosis in CAPD patients. Hypoalbuminemia may contribute to atherosclerosis via increased synthesis of fibrinogen.
Adequate Dialysis? Measurement of Ktn in a Pediatric Peritoneal Dialysis Population
Authors: Walk Twiggy L.M. , Schröder Cornelis H. , Reddingius Roel E. , Lelivelt Marga , Monnens Leo A.H. , Willems Hans L. 
Published: February 2020

Objective To measure the urea and creatinine kinetics in a pediatric population Patients and Methods In 19 children treated with peritoneal dialysis (PD) KT/V, urea and creatinine clearances (Ccr) were measured. Thirteen children were on continuous ambulatory peritoneal dialysis (CAPD) and 6 on nightly intermittent peritoneal dialysis (NIPD). Results Mean KT/V per week was 2.31 ±0.78 and mean creatinine clearance 74 ±47 L/week/1. 73 m2. There was no difference in dialytic KT/V between patients treated with CAPD and NIPD (1.75 ±0.21 vs 1.76 ±0.50). The correlation between KT/V urea and creatinine clearance was 0.9 (p<0.001). There was a clear relationship of these parameters with residual renal function, but not with age or blood urea level. A weak positive correlation was found with serum albumin and protein intake. Conclusions Mean KT/V in this patient group was higher than the values reported for most adult patient groups. Residual renal function considerably contributes to this high KT/V. It is not clearly defined which KT/ V should be aimed for, since criteria for adequate dialysis are multifactorially determined and therefore difficult to interpret.
Chronic Administration of Iron Dextran into the Peritoneal Cavity of Rats
Authors: Park Sang-Eun , Twardowski Zbylut J. , Moore Harold L. , Khanna Ramesh , Nolph Karl D. 
Published: February 2020

Objective To determine the influence of chronic iron dextran administrations into the peritoneal cavity of rats on function and anatomy of the peritoneal membrane, as well as on erythropoiesis and serum iron. Design Prospective randomized animal study. Setting Animallaboratory. Animals: 36 Sprague-Dawley rats. Interventions The rats were divided into three groups (n = 12). The animals were given standard 1.5% Dianeal (control group) or 1.5% Dianeal containing iron dextran in a concentration of 2 mg/L [Iow-dose group (LDG)] or 10 mg/L [high-dose group (HDG)]. Main outcome measures On the 8th day, at 3 months, and at 6 months a 2-hour peritoneal equilibration test (PET) and blood tests including hematocrit, serum iron, and total iron-binding capacity (TIBC) were done. After the final PET at 6 months, the peritoneal membrane was evaluated by gross inspection and by light microscopy. Results Hematocrit and serum iron levels increased only in the HDG and LDG. Peritoneal transport of small solutes decreased significantly in the HDG compared to baseline. All cases of the HDG group revealed peritoneal adhesions and fibrosis around the peritoneal catheter as well as massive iron deposits on the peritoneum. Similar but less pronounced changes were found in the LDG. Conclusions These findings suggest an efficient absorption of iron from the peritoneal cavity of rats, however, dialysate iron dextran concentrations of 2 mg/L or greater are toxic to the peritoneal membrane. Therefore, future studies should be performed to determine the minimal effective and nontoxic iron dextran concentrations for intraperitoneal administration.
Insulin Stimulates the Activity of Na+/K+-Atpase in Human Peritoneal Mesothelial Cells
Authors: Witowski Janusz , Breborowicz Andrzej , Topley Nicholas , Martis Leo , Knapowski Jan , Oreopoulos Dimitrios G. 
Published: February 2020

Objective To assess the effect of insulin on the Na+/ K+-ATPase expression and activity in human peritoneal mesothelial cells (HPMC). Methods HPMC were isolated from the omental tissue of non-uremic patients, grown to confluence and rendered quiescent by serum deprivation for 24 hours. The activity of Na+/K+-ATPase was determined by measuring the ouabain-sensitive86Rb uptake. To assess whether the effect of insulin was related to changes in [Na+]i the sodium influx was measured with 22Na and the activity of Na+/K+ -A TPase was assessed in the presence of amiloride. Expression of Na+/K+ -A TPaseα1’ α2 and β1-subunit mRNAs was determined by RT/PCR. Results Exposure of HPMC to insulin resulted in a time and dose-dependent increase in the Na+/K+-ATPase activity. After 60 minutes the ouabain-sensitive 86Rb up take (cpm/104 cells) was increased from 6650±796 in control cells to 9763±1212 in HPMC exposed to 100 mU/ mL insulin (1.5-fold increase; n=4, P<0.05). In addition, incubation of HPMC with 100 mU/mL insulin resulted in a time-dependent increase in the 22Na influx. Pre-exposure of HPMC to 1 mM amiloride reduced the activity of Na+/K+-A TPase but did not block the stimulatory effect of insulin. RT/PCR analysis revealed that HPMC constitutively expressed α1 and β1-subunit mRNAs while the α2-subunit mRNA was barely detectable. Exposure of HPMC to insulin for up to 24 hours was not associated with any changes in the expression of either α1’ α2 or B1-subunit. Conclusion Insulin stimulates the Na+/K+-ATPase activity in HPMC in a time and dose-dependent manner. This effect appears to mediated by an increase in [Na+]i and is not related to alterations in Na+/K+-ATPase subunit mRNAs expression.
Hyperleptinemia in Patients with End-Stage Renal Disease Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Dagogo-Jack Samuel , Ovalle Fernando , Landt Michael , Gearing Barbara , Coyne Daniel W. 
Published: February 2020

Objective To determine whether the increased plasma leptin levels reported in hemodialyzed patients is a feature of end-stage renal disease or an artifact of hemodialysis, we studied plasma levels in patients treated exclusively by continuous ambulatory peritoneal dialysis (CAPD). Design Prospective comparison of end points in CAPD patients and matched healthy subjects. Setting Tertiary care institutional dialysis center. Participants Fifty-six healthy subjects, age 50.8 ± 2.3 years, body mass index (BMI) 27.7 ± 1.3 kg/m2, recruited through public announcement, and 36 patients with end-stage renal disease, age 51.0 ± 2.4 yr, BM128.2 ± 1.3 kg/m2, enrolled in a CAPD treatment program. Intervention Four exchanges of CAPD per day, using 2.0, 2.5, or 3.0 L of dialysate over a period of 1 -96 months (median 22 mth). Main Outcome Measures The primary outcome measure was plasma leptin concentration. Secondary measures included plasma glucose, insulin, C-peptide, and cortisol concentrations; and residual renal function and dialysis adequacy (Kt/V). Results Plasma leptin levels in CAPD patients were 27.1 -490 ng/mL(women)and 1.3 -355 ng/mL(men); the levels in healthy subjects were 2.0 84.7 ng/mL (women) and 1.8 -55.4 ng/mL (men). The mean leptin levels were 5-fold higher among CAPD-treated men than control men (49.9 ± 18.4 vs 9.8 ± 2.5 ng/mL, p < 0.001) and 7.5-fold higher among CAPD-treated women than control women (220 ± 28.1 vs 29.3 ± 3.7 ng/mL, p < 0.0001). Female gender and BMI were the strongest predictors of hyperleptinemia in CAPD patients. Conclusion These results indicate that hyperleptinemia is a feature of terminal renal failure, not an artifact of hemodialysis.
Risk Factors for Developing Peritonitis Caused by Micro-Organisms of Enteral Origin in Peritoneal Dialysis Patients
Authors: Caravaca Francisco , Ruiz-Calero Rosa , Dominguez Carmen 
Published: February 2020

Objective To investigate the risk factors associated with the development of peritonitis caused by enteral bacteria in peritoneal dialysis patients, including the prescription of gastric acid inhibitors as a potential risk factor. Design Retrospective single-center study. Setting Tertiary university hospital. Patients an d Main Outcome Measures Fifty-five patients who entered into our continuous ambulatory peritoneal dialysis (CAPD) program during the last 6 years were included. Multiple logistic regression analysis was used to establish the best determinants over the development of at least one episode of enteric peritonitis. The predictive variables included in the model were: age, gender, diabetic versus nondiabetic, polycystic versus nonpolycystic kidney diseases, history of constipation, presence or absence of moderate/severe malnutrition, peritoneal transport characteristics, peritoneal protein losses, rate of exit-site infections, rate of total peritonitis, intestinal abnormalities, and treatment with inhibitors of gastric acid secretion. Results The total number of peritonitis episodes during the studied period was 88, which clustered in 34 of 55 patients. Fourteen (16%) were caused by enteric microorganisms in 10 patients: Escherichia coli (6), Klebsiella sp (2), Enterobacter sp (1), and Enterococcus sp (5). Nine of 10 patients who developed enteric peritonitis were on gastric acid inhibitors (3 patients on omeprazole and 6 patients on H2-antagonists), while 15 of 45 patients who did not develop enteric peritonitis were on gastric acid inhibitors (all of them on H2-blockers). There were temporal relationships between the start of gastric acid inhibitors and the development of enteric peritonitis in 6 of 9 patients who were on this medication. Four of 10 patients who developed enteric peritonitis had diverticulosis. Ten of 45 patients who did not develop enteric peritonitis had been diagnosed with diverticulosis of the colon or sigmoid prior to entry to CAPD. The unique patient who was not on gastric acid inhibitors and developed enteric peritonitis, had been diagnosed with chronic atrophic gastritis with achlorhydria. By multiple logistic regression analysis, the treatment with gastric acid inhibitors was the only independent variable that entered into the best predictive equation over the development of enteric peritonitis (Iog likelihood ratio = -26.077, odds ratio = 18; 95% CI odds ratio: 2 - 155). Conclusion Gastric acid inhibitors may increase the risk for developing enteric peritonitis in peritoneal dialysis patients.
Autonomic Function in Patients on Continuous Ambulatory Peritoneal Dialysis
Authors: Jassal Sarbjit V. , Allen Judith A. , Douglas James F. , Stout Robert w. 
Published: February 2020

Objective To investigate sympathetic function in the peripheries of patients on chronic ambulatory peritoneal dialysis (CAPD) using noninvasive techniques. Design Comparison of peripheral blood flowresponses in sympathetic vasoconstrictor reflexes in CAPD patients and matched control subjects. Setting Tertiary care hospital and research institution. Patients Twenty-three clinically stable CAPD patients and 23 control subjects matched for age, sex, and drug therapy. Main Outcome Measures Sympathetic activity assessed from the reductions in hand and foot blood flow induced by a deep breath and by body surface cooling. Cardiac autonomic activity measured by the changes in heart rate produced by deep breathing, a Valsalva maneuver, and standing from lying. Results A deep breath induced mean decreases in hand blood flow of 65.1% in the patients and 82.8% in their matched controls. Corresponding reductions in the foot were 46.0% and 70.0%. Body surface cooling reduced mean hand blood flow by 50.3% in the patients an d 71.8% in the control subjects. Corresponding values in the foot were 26.7% and 43.6%. The differences in response between the patients and their matched control subjects were all significant (p < 0.01). Cardiac autonomic function assessed by standard tests of heart rate variability was significantly impaired in the patients compared with the control subjects in two of the three tests used (p < 0.001). Conclusions Cardiovascular autonomic impairment can affect the peripheral circulation as well as the heart in patients on dialysis, and this may have implications for cardiovascular homeostasis.
The Effect of Antibiotic Prophylaxis on the Healing of Exit Sites of Peritoneal Dialysis Catheters in Rats
Authors: Pecoits-Filho Roberto F.S. , Twardowski Zbylut J. , Khanna Ramesh , Kim Yong-Lim , Goel Sharad , Moore Harold 
Published: February 2020

Objective To evaluate the influence of intraperitoneal (IP) antibiotic (AB) prophylaxis on the quality of healing and infection rates of exit sites in peritoneal dialysis catheters. Study Design Twenty-one Sprague-Dawley rats were dialyzed 3 times per day for 6 weeks. Dianeal solution containing AB was used for all the rats during the first 5 days. The animals were randomized on the sixth day into three groups: group A (AB-free after randomization), group B (AB for 3 weeks), and group C (AB during 6 weeks). Scores were given to each exit site according to the observation. Mean scores from each group were compared in an attempt to find significant differences between the groups. Dialysate and exit-site drainage samples were taken weekly for microbiology. Results Eight episodes of peritonitis were diagnosed, six in group A and two in group B. The most common bacteria causing peritonitis were gram-negative rods. The mean scores were not significantly different between groups C and B throughout the study, even after the discontinuation of the prophylaxis. Group A, when compared to the other two groups, had significantly higher scores after the second week and throughout the rest of the study. Conclusion Intraperitoneal antibiotic prophylaxis for 3 weeks after catheter implantation is an effective way to prevent early colonization of exit sites, providing a better healing quality and lower incidence of catheter-related infection. Although the extension of the prophylaxis for 6 weeks seems to be beneficial, it was not statistically proven in this study.
The Italian Registry of Pediatric Chronic Peritoneal Dialysis: A Ten-Year Experience with Chronic Peritoneal Dialysis Catheters
Authors: Rinaldi Stefano , Sera Francesco , Verrina Enrico , Edefonti Alberto , Perfumo Francesco , Sorino Palma , Zacchello Graziella , Andreetta Barbara , Ardissino Gianluigi , Bassi Sergio , Capasso Giovanni , Caringella Domenica A. , Gianoglio Bruno , Gusmano Rosanna , Rizzoni Gianfranco 
Published: February 2020

Objective To analyze the data from 347 peritoneal catheters implanted in 249 pediatric patients aged ≤ 15 years at start of chronic peritoneal dialysis (CPD). Design Restrospective study of the data collected between 1986 and 1995, in 20 dialysis centers, from the Italian Registry of Pediatric Chronic Peritoneal Dialysis. Data collection for each pediatric catheter included: catheter type, site and technique of insertion, complications, duration, and reason for removal or replacement. Results Fifty catheters were inserted in patients under 2 years of age, 50 in patients aged 2 5 years and 247 in patients over 5 years of age. Catheter types included 307 (88.5%) Tenckhoff (286 double cuff, 21 single cuff) and 40 (11.5%), double-cuff, Valli-type catheters. All catheters were surgically implanted and omentectomy was performed in 83.5% of cases; the entry-site was in the midline in 136 cases (39.2%) and paramedian in 211 (60.8%). During 6076 CPD months we observed 274 catheter related complications: 182 catheter infections (exit-site and/or tunnel infection), 23 leakages, 19 obstructions, 19 cuff-extrusions, 14 dislocations, 6 hemoperitoneum, 10 other (incidence of one complication every 21.8 dialysis months). A significant reduction of catheter-related complications occurred in the last five years, compared with the first 5 years. One hundred and six catheters were removed due to catheter-related causes: infection (83 cases), obstruction (11), dislocation (4), outer-cuff extrusion (3), leakage (2), bowel incarceration (2), and bowel infarction (1). Catheter survival was 72.2% at 12 months, 52.3% at 24 months, 32.8% at 36 months, and 25.7% at 48 months. Significantly lower catheter survival was found in younger children (0 2 years) compared with two other age groups (2 5 years, and > 5 years). No significant correlation was found between catheter survival and catheter entry-site (midline vs paramedian). Conclusions Catheter-related infections were confirmed to be the most common complication and most frequent cause of peritoneal catheter removal. In addition, catheter survival rate was worse in younger children, indicating that more effort should be made to improve peritoneal catheter survival particularly in this age group.
W(h)ither psychiatry? Contemporary challenges in Australian mental health workforce design
Authors: Rosenberg Sebastian , Hickie Ian 
Published: February 2020

Objective: To consider the changing profile of Australia’s mental health workforce and the implications, particularly for specialist psychiatry services. Method: We analyse data from a national collection that describes changes in the workforce over a decade, to 2017–2018. Results: While single practitioner-based psychological services flourish, other areas of more complex and team-based care are struggling to remain relevant. Psychiatry and mental health nursing, two areas that previously led Australia’s response to complex mental illness, are under enormous pressure. Conclusion: The shifting balance of specialised mental health workforces is affecting the mental healthcare available in each region of Australia. Questions arise regarding the desired or optimal mix of professionals we wish to deploy. What roles should each professional group play and how should they work together? What does this mean for how various groups should be trained and paid? These data challenge the role specialist psychiatry wishes to play in leading reform. Current mental health reforms risk foundering should psychiatrists fail to take up the challenge of leadership.