Showing papers in "Peritoneal Dialysis International in 2001"
TL;DR: The emergence of high-level MuRSA in CPD patients after a 4-year practice of continuous use of mupirocin in a small number of patients in a peritoneal dialysis unit is reported.
Abstract: ObjectiveTo determine the prevalence of the carriage of Staphylococcus aureus (SA), methicillin-resistant Staphylococcus aureus (MRSA), and mupirocin-resistant Staphylococcus aureus (MuRSA) in chro...
160 citations
TL;DR: There was a significantly higher preservation of RRF in HD patients on polysulfone versus cuprophane membranes, indicating an additional effect of biocompatibility, such as less generation of nephrotoxic substances by the membrane.
Abstract: ObjectivesResidual renal function (RRF) is of paramount importance to dialysis adequacy, morbidity, and mortality, particularly for long-term continuous ambulatory peritoneal dialysis (CAPD) patien...
126 citations
TL;DR: This study reviews publications on the history of cancer antigen 125, the background of its use as a marker of mesothelial cell mass, determination in peritoneal effluent, and its practical use in both the follow-up of peritoneAL dialysis (PD) patients and as a markers of in vivo biocompatibility of dialysis solutions.
Abstract: ObjectiveThis study reviews publications on the history of cancer antigen 125 (CA125), the background of its use as a marker of mesothelial cell mass, determination in peritoneal effluent, and its ...
117 citations
TL;DR: Results suggest a beneficial effect on lipid profiles of CAPD patients with the use of an overnight dwell with icodextrin, which was not accompanied by a decrease in fasting plasma glucose.
Abstract: ⇔ Objective: To examine whether a reduced daily glucose load by overnight application of the less-absorbed glucose polymer icodextrin would have favorable effects on lipid profiles of continuous ambulatory peritoneal dialysis (CAPD) patients. ⇔ Study Design: Randomized crossover study with two subsequent periods of 6 weeks. ⇔ Setting: Home PD unit of a secondary-care hospital. ⇔ Patients: Twenty-one nondiabetic CAPD patients (15 male, 6 female; mean age 50.3 ± 11.8 years). ⇔ Intervention: Participants were randomly assigned to receive an overnight dwell with either standard glucose solution or with a 7.5% icodextrin-containing solution. ⇔ Main Outcome Measures: Relation between reduction in the total amount of intraperitoneal infused glucose and parameters of glucose (plasma glucose, insulin, and HbA 1C ) and lipid metabolism [free fatty acids, plasma lipids, lipoproteins, and low density lipoprotein (LDL) subfraction profile]. ⇔ Results: After the icodextrin dwells, a reduction of plasma total cholesterol (from 5.43 ± 0.85 to 4.86 ± 0.70 mmol/L, p < 0.001) and LDL cholesterol (from 3.38 ± 0.87 to 2.93 ± 0.73 mmol/L, p = 0.001) was observed. Also, high density lipoprotein (HDL) cholesterol (from 0.95 ± 0.27 to 0.90 ± 0.24 mmol/L, p = 0.029) was reduced, but the plasma total cholesterol-to-HDL ratio remained similar. Plasma free fatty acids and triglyceride levels tended to decrease (from 0.16 ± 0.10 to 0.13 ± 0.08 mmol/L, p = 0.06, and from 2.14 ± 1.96 to 1.92 ± 1.03 mmol/L, respectively). Evaluation of LDL subfraction profiles after ultracentrifugation showed a more buoyant LDL subfraction profile with fewer dense LDL particles in 6 patients and no changes in 14 patients after icodextrin. The effects on lipids were not accompanied by a decrease in fasting plasma glucose (from 5.76 ± 1.29 to 5.86 ± 0.80 mmol/L) or insulin levels (from 19.5 ± 14.4 to 20.3 ± 13.0 mU/L). ⇔ Conclusion: These results suggest a beneficial effect on lipid profiles of CAPD patients with the use of an overnight dwell with icodextrin.
112 citations
TL;DR: The focus is now shifting from “dialysology” to studies of the pathophysiology of uremia and its complications, and this brief review focuses on the so-called MIA syndrome, because the presence of this syndrome has a dramatic effect on patient survival as well as on the health and function of the peritoneum.
Abstract: The clinical outcomes of peritoneal dialysis (PD) patients and the ongoing health and function of the peritoneum obviously depend on a number of genetic and non genetic systemic factors. During the last two decades, much of the emphasis in PD and in hemodialysis (HD) has been on improving dialysis adequacy, especially with regard to small-solute removal. That factor is definitely of importance to improved clinical outcomes, but systemic factors—such as the various nutrition, immunologic, and cardiovascular abnormalities in uremia, often aggravated by an underlying disease—are increasingly being recognized as even more important determinants of outcomes. Thus, the focus is now shifting from “dialysology” to studies of the pathophysiology of uremia and its complications. In this brief review, we focus on the so-called MIA syndrome (malnutrition, inflammation, and atherosclerosis), because the presence of this syndrome has a dramatic effect on patient survival as well as on the health and function of the peritoneum.
103 citations
TL;DR: By inhibiting the production of TGFβ1, enalapril can preserve peritoneal histology,peritoneal function, and remodeling of mesothelial cells in a rat model of experimental PF.
Abstract: ObjectivePeritoneal fibrosis (PF) is one of the most serious causes of failure in continuous ambulatory peritoneal dialysis (PD). Although the underlying mechanism responsible for the genesis of PF...
93 citations
TL;DR: In this article, the authors assess employment status in new endstage renal disease (ESRD) patients at the start of dialysis and after 1 year, and determine whether demographic and clinical variables and physical and psychosocial functioning are risk factors for loss of employment after one year of kidney dialysis.
Abstract: ¨ Objective: To assess employment status in new endstage renal disease (ESRD) patients at the start of dialysis and after 1 year, and to determine whether demographic and clinical variables and physical and psychosocial functioning at the start of dialysis are risk factors for loss of employment after 1 year of dialysis. ¨ Design: Prospective follow-up study in which 38 of 48 Dutch dialysis centers participate. ¨ Patients: 659 patients who had started on dialysis and who were between 18 and 65 years old were included. Patients were re-examined after 12 months. ¨ Main Outcome Measures: Demographic data, physical and psychosocial functioning with the Short-Form Health Survey (SF-36), and data on employment status were obtained using questionnaires. Nephrologists provided the clinical data. ¨ Results: At the start of dialysis, 35% of patients were employed, in contrast to 61% of the general Dutch population. Within 1 year, the proportion of employed patients decreased from 31% to 25% of hemodialysis patients, and from 48% to 40% of peritoneal dialysis patients. In patients who were working at the start of dialysis, independent risk factors for loss of work within 1 year were impaired physical and psychosocial functioning [odds ratio physical: 3.4, 95% confidence interval (%CI), 1.0 ‐ 11.2; odds ratio psychosocial: 4.2, 95% CI, 1.2 ‐ 14.2]. ¨ Conclusions: As the percentage of employed patients at the start of dialysis is about half the expected percentage, loss of work is an important issue in both predialysis and dialysis patients. Improvements in physical and psychosocial functioning are potentially preventive of loss of work in patients who are employed when they start dialysis.
88 citations
TL;DR: Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD.
Abstract: ✦ Objective: To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program. ✦ Design: Cohort study. ✦ Setting: Tertiary care, teaching hospital located in Mexico City. ✦ Patients: All patients from our CAPD program (1985 -1997) were retrospectively studied. ✦ Interventions: Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors. ✦ Main Outcome Measures: End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997). ✦ Results: 627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (± SE) was 5.1 ± 0.6 years. In the univariate analysis, the following variables were associated (p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 ± 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated (p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors. ✦ Conclusions: Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.
86 citations
TL;DR: Peritoneal dialysis would appear to be a good option for patients with failing allografts, although infection risk is an important issue and co-morbidity is the predominant determinant of survival.
Abstract: BackgroundPatients returning to dialysis treatment after a period with a functioning allograft represent a special case in the integrated care model of renal replacement therapy. They are known to ...
85 citations
TL;DR: The numbers of patients treated with PD have, in absolute terms, stayed relatively constant in recent years, but this represents a significant relative decline in PD, and a period of stagnation compared to the remarkable growth of the modality in the 1980s and early 1990s.
Abstract: T h e p e r i o d f r o m t h e i n i t i a l d e s c r i p t i o n o f c o n t i n u ous ambulatory peritoneal dialysis (CAPD) in 1977 until 1995 was a time of remarkable expansion in the use of peritoneal dialysis (PD) (1,2). The modality quickly went from its very low level of use prior to 1977 to a situation in the early 1980s where it was the modality of treatment for about 35% of all Canadian end-stage renal disease (ESRD) patients and about 14% of their U.S. counterparts. Furthermore, as numbers of dialysis patients continued to expand dramatically throughout the 1980s, PD maintained this degree of “penetration.” Thus, the total number of North Americans managed with the modality exceeded 33 000 in 1995, more than twice the number in 1988 and three times that in the early 1980s (1,2). The second half of the 1990s did not, however, see a continuation of this trend and, at the end of the decade, the latest registry reports showed a significant decline in the percentage of all dialysis patients managed on PD (1,2). The numbers of patients treated with PD have, in absolute terms, stayed relatively constant in recent years. However, against a background of 6% – 10% growth per annum in the total numbers of patients treated with dialysis, this represents a significant relative decline in PD, and a period of stagnation compared to the remarkable growth of the modality in the 1980s and early 1990s. Thus, in the U.S., the percentage of prevalent patients on PD has declined from 14% in 1994 to just over 10% in 1998, the most recent year for which registry data are available (Figure 1) (1). In Canada, the decline is similar, from 37% of prevalent patients in 1994 to 27% in 1998 (Figure 2) (2). Decline in the use of PD as initial therapy in incident patients is also striking and became apparent earlier. In the U.S., there was a drop from 15.8% of patients in 1990 to 14.8% in 1995, and then down to less than 10% in the preliminary estimate for 1998 (Figure 3) (3,4). In Canada, PD use in incident ESRD patients fell from 36% in 1993 to 28% in 1995, and to 22% in 1998 in Canada (Figure 4) (2). In addition, both countries have seen a major switch within the PD population from CAPD % o f al l C dn d ia ly si s pa tie nt s on P D
83 citations
TL;DR: The European Paediatric Peritoneal Dialysis Working Group was established in 1999 by pediatric nephrologists with a major interest in peritoneal dialysis (PD) to establish expert guidance in important clinical areas associated with PD, in conjunction with other members of the multidisciplinary team.
Abstract: Correspondence to: A.R. Watson, Children & Young People’s Kidney Unit, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB United Kingdom. watpaed@aol .com Received 15 August 2000; accepted 12 January 2001. a A. Edefonti, Clinica Pediatrica C and D de Marchi, University of Milan, Italy; M. Fischbach, Hôpital de Hautepierre, Strasbourg, France; G. Klaus, University of Marburg, Marburg, Germany; K. Ronnholm, University of Helsinki, Helsinki, Finland; C. Schröder, Wilhelmina Kinderziekenhuis, Utrecht, The Netherlands; E. Simkova, University Hospital Motol, Prague, Czech Republic; D. Stefanidis, A&P Kyriakou Children’s Hospital, Athens, Greece; A. Zurowska, Medical University of Gdansk, Gdansk, Poland; J. Vande Walle, University Hospital, Ghent, Belgium; F. Schaefer, University Hospital, Heidelberg, Germany; A. Alonso, Hospital Infantil La Paz, Madrid, Spain; V. Strazdins, University Hospital, Riga, Latvia. Chronic peritoneal dialysis (CPD) is the dialysis modality of choice in many European countries (1). It has enabled children of all ages, from neonates to young adults, to be successfully treated while awaiting the ultimate goal of renal transplantation. Since end-stage renal failure (ESRF) is comparatively rare in children, their care needs to be concentrated in designated tertiary-care centers. This is essential if children are to benefit from the support of an experienced multidisciplinary team. The European Paediatric Peritoneal Dialysis Working Group was established in 1999 by pediatric nephrologists with a major interest in peritoneal dialysis (PD). Currently, the group has representatives from 12 European countries. One of the functions of the group is to establish expert guidance in important clinical areas associated with PD, in conjunction with other members of the multidisciplinary team. The relatively small number of pediatric patients has resulted in few controlled comparative studies in CPD, but there are increasing numbers of reports of clinical experience based on cooperative work via registries. These guidelines were initiated and discussed at three meetings of the group and developed through eight drafts by email discussion with the principle authors, one of whom is a senior pediatric renal nurse (CG). They are opinion based, incorporating the cumulative clinical experience of the group members and relevant literature. These guidelines emphasize the importance of preparation of the child and family, the attention to detail to secure peritoneal access, and the importance of postinsertion catheter and exit-site care. Preparation for home PD should follow a proper training program, and the need for continuing support to the child and family at home is stressed.
TL;DR: Most renal failure patients can be expected to have problems accessing PD therapy in developing countries in Asia, and some possible ways to reduce the cost barriers to PD in those countries are providing more public funding for treating dialysis patients and reducing the complication rate for PD.
Abstract: Countries in Asia vary significantly in culture and socioeconomic status. Dialysis costs and reimbursement structures are significant factors in decisions about the rates and modalities of renal replacement therapy. From our survey of Asian nephrologists conducted in 2001, a number of observations can be made. In many developing countries, the annual cost of continuous ambulatory peritoneal dialysis (CAPD) is greater than the per-capita gross national income (GNI). The median cost of a 2-L bag of peritoneal dialysis (PD) fluid is around US$5. The absolute cost of PD fluid among countries with significant differences in per-capita GNI actually varies very little. Thus, most renal failure patients can be expected to have problems accessing PD therapy in developing countries in Asia. In countries with unequal reimbursement policies for PD versus hemodialysis, a lack of incentive to prescribe PD also exists. Automated PD is nearly non existent in many developing countries in Asia. Some possible ways to reduce the cost barriers to PD in those countries include individual governments providing more public funding for treating dialysis patients; dialysate-producing companies reducing the cost of their products; physicians using appropriately smaller exchange volumes (3 x 2 L) in some Asian patients with smaller body sizes and with residual renal function; and reducing the complication rate for PD (for example, peritonitis) thereby reducing the costs required for treatment and hospitalization.
TL;DR: The data suggest that the use of B/L solution is associated with reduced intraperitoneal inflammation and potential for angiogenesis and may, over time, help to restore peritoneal homeostasis and therefore preserve the function of the membrane inPeritoneal dialysis.
Abstract: ♦ ObjectiveConventional lactate-buffered peritoneal dialysis (PD) solutions have several bioincompatible characteristics, including acidic pH, lactate buffer, and the presence of glucose degradatio...
TL;DR: HRQOL of APD patients is at least equal to HRQol of CAPD patients, and the mental health of APd patients was found to be better than that ofCAPD patients.
Abstract: ObjectiveData on health-related quality of life (HRQOL) of automated peritoneal dialysis (APD) patients are scarce. The objectives of this study were (1) to explore HRQOL of APD patients and compar...
TL;DR: Preliminary data provide evidence for a correlation between solute clearance and growth, with RRF exerting a significant influence on that outcome, and appear to contradict the presumed equivalence of PD and native clearance in children with ESRD.
Abstract: ♦ ObjectiveOur study evaluated growth as a clinical outcome measure of peritoneal dialysis (PD) adequacy in children with end-stage renal disease (ESRD).♦ DesignThis retrospective single-center stu...
TL;DR: Patients on CAPD showed evidence of a higher degree of hypercoagulation than HD patients, suggesting hemostatic abnormalities in end-stage renal failure may be affected to some extent by the choice of renal replacement therapy.
Abstract: ♦ Objective: Disturbances in hemostasis are common findings in uremic patients. Both bleeding diathesis and thrombosis are observed. The purpose of this study was to assess whether renal replacement therapy in the form of hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD) affects coagulation and fibrinolysis in patients with end-stage renal failure. ♦ Design: Comparison of hemostatic measures in patients on CAPD, HD, and matched healthy controls. ♦ Setting: Department of Nephrology and Internal Medicine, Bialystok University School of Medicine. ♦ Patients and Methods: Twenty-four HD patients and 23 CAPD patients were evaluated with respect to platelet aggregation, hemostatic parameters, serum lipids, lipoprotein(a), and cytokines [tumor necrosis factor alpha (TNF α) and interleukin1 (IL-1)]. ♦ Interventions: Four exchanges of CAPD per day, using 2.0 L dialysate over a period of 25 ± 31 months; or 4 ‐ 5 hours of HD 3 times per week for a period of 31 ± 22 months. ♦ Results: Platelet aggregation in whole blood and platelet-rich plasma was significantly impaired in both groups of dialyzed patients compared to healthy volunteers. Markers of endothelial cell injury (thrombomodulin and von Willebrand factor) were significantly higher in HD and CAPD patients compared to the control group. A similar pattern of changes was observed for lipoprotein(a), fibrinogen, tissue factor pathway activity, and factor VII activity. Activity of factor X was significantly enhanced in CAPD compared to HD patients and controls. Euglobulin clot lysis time was significantly prolonged in HD and CAPD patients over controls, being more prolonged in CAPD patients. Markers of ongoing coagulation (thrombin‐antithrombin complexes and prothrombin fragments 1+2) were higher in uremic patients, significantly higher in CAPD than in HD. A marker of ongoing fibrinolysis (plasmin‐antiplasmin complexes) was higher in uremic patients but was lower in CAPD than in HD patients. Concentrations of TNFα and IL-1 were higher in HD than in CAPD patients. ♦ Conclusion: Patients on CAPD showed evidence of a higher degree of hypercoagulation than HD patients. Thus, hemostatic abnormalities in end-stage renal failure may be affected to some extent by the choice of renal replacement therapy.
TL;DR: Peritoneal dialysis remains an appropriate therapy for pediatric ARF from many causes, even in severely ill children requiring vasopressor support.
Abstract: BackgroundWhile the use of continuous renal replacement therapies in the management of children with acute renal failure (ARF) has increased, the role of peritoneal dialysis (PD) in the treatment o...
TL;DR: A reduction in the great cardiovascular mortality in peritoneal dialysis patients as nowadays observed can only be expected when more attention is paid to better control of hypervolemia and hypertension in these patients.
Abstract: ObjectivesTo review the factors that impact control of blood pressure and euvolemia in peritoneal dialysis patients.DesignReview of the most recent publications on this subject; inclusion of some p...
TL;DR: The present article reviews the extant studies on the functional and structural alterations of the peritoneal membrane in long-term PD and focuses on the evidence for dialysate bioincompatibility in the genesis of these changes.
Abstract: Correspondence to: A. De Vriese, Renal Unit, University Hospital, OK12, De Pintelaan 185, Gent B-9000 Belgium. an.devriese@rug.ac.be S long-term peritoneal dialysis (PD) requires preservation of the transport function of the peritoneal membrane. Adequate dialysis is not only a matter of achieving the targets for Kt/Vurea and creatinine clearance, but also—and maybe even more importantly—of maintaining an optimal volume status. The development of ultrafiltration failure (UFF) remains one of the most important causes of treatment drop-out. It is also associated with a poor prognosis. Evidence is mounting that the incidence of UFF increases with time spent on PD, suggesting that the peritoneal membrane is progressively damaged during PD. However, the nature and the causes of the structural and functional alterations of the peritoneal membrane in long-term PD remain to be fully defined. Undoubtedly, continuous exposure to unphysiologic dialysis solutions is an important pathogenetic element in this respect. In addition, the repeated acute inflammatory damage conferred by recurrent peritonitis episodes and the chronic low-grade inflammation associated with the uremic state are likely to contribute. The present article reviews the extant studies on the functional and structural alterations of the peritoneal membrane in long-term PD. In addition, it focuses on the evidence for dialysate bioincompatibility in the genesis of these changes. Finally, therapeutic strategies with the potential to preserve long-term peritoneal membrane function and structure are addressed.
TL;DR: It is concluded that late failed renal transplant patients starting dialysis are at increased risk of complications and have strikingly higher mortality rates than non-Tx patients.
Abstract: BackgroundEarly renal transplant failure necessitating a return to dialysis has been shown to be a poor prognostic factor for survival. Little is known about the outcome of patients with late trans...
TL;DR: The collection of more detailed data on practice patterns would enable future studies to elucidate the cause-and-effect relationship between CAPD descriptors and technique failure, and hence assist in clinical decision-making.
Abstract: ObjectiveAlthough important enhancements to continuous ambulatory peritoneal dialysis (CAPD) have occurred since its inception, few studies have explicitly evaluated trends over time in CAPD techni...
TL;DR: The incidence, etiology, and prognosis of EPS will be further clarified by periodic observation of dropouts until the end of March 2003, in which the incidence, clinical features, and variation in mortality rates for EPS are determined.
Abstract: ♦ ObjectiveEncapsulating peritoneal sclerosis (EPS) is recognized as a serious complication of peritoneal dialysis. The aim of this study was to determine the incidence, clinical features, and vari...
TL;DR: An integrated approach to the treatment of ESRD could start with PD in a large percentage of patients, especially those who will receive a kidney transplant within 2 – 3 years, and this approach could lead to a significant saving, relieve the pressure on dialysis units, and allow a larger number of E SRD patients to be treated.
Abstract: Technological advances such as those that allow the delivery of an adequate dialysis dose to a larger percentage of patients, minimization of peritoneal membrane damage with more biocompatible solutions, and lower peritonitis rates will undoubtedly improve retention of patients on peritoneal dialysis (PD) for longer periods. Currently, only 15% of the world dialysis population is managed by PD. Peritoneal dialysis has many advantages over hemodialysis, and if end-stage renal disease (ESRD) patients are fully informed about them, the proportion of patients who would prefer this treatment would rise to 25%-30%. An integrated approach to the treatment of ESRD could start with PD in a large percentage of patients, especially those who will receive a kidney transplant within 2 - 3 years. With the present epidemic of ESRD, this approach could lead to a significant saving, relieve the pressure on dialysis units, and allow a larger number of ESRD patients to be treated.
TL;DR: BIA is more sensitive than anthropometry in detecting alterations in body composition of children on PD, and the prevalence of malnutrition, high at the commencement of PD, decreases during the first year of treatment but not over the long term.
Abstract: ObjectiveTo evaluate the sensitivity of anthropometry and bioelectrical impedance analysis (BIA) in detecting alterations in body composition of children treated with peritoneal dialysis (PD), and ...
TL;DR: Peritoneal dialysis training is an important factor that influences the rate of peritonitis and the results of this survey reinforce the value of the time committed to this effort.
Abstract: ObjectivePeritonitis is the leading cause of technique failure in pediatric patients on peritoneal dialysis. A survey was developed to determine what impact, if any, training practices and staffing...
TL;DR: The relationship between HP infection, anorexia, and malnutrition in peritoneal dialysis patients and the normalized equivalent of protein–nitrogen appearance (nPNA), and residual renal function (RRF) is explored to find significant linear correlations between the following markers of nutrition and certain questions on the VAS.
Abstract: OBJECTIVE Helicobacter pylori (HP) infection has frequently been found in dialysis patients. Chronic infections induce overproduction of pro-inflammatory substances. Inflammation has been associated with cachexia and anorexia. We explored the relationship between HP infection, anorexia, and malnutrition in peritoneal dialysis (PD) patients. PATIENTS AND METHODS The study included 48 clinically stable PD patients divided into four groups: HP+ with anorexia (group I, n = 12); HP+ without anorexia (group II, n = 4); HP- with anorexia (group III, n = 5); and HP- without anorexia (group IV, n = 27). Infection with HP was diagnosed by breath test. Anorexia was evaluated using a personal interview and an eating motivation scale (VAS). The VAS included five questions that are answered before and after eating. The questions concern desire to eat, hunger, feeling of fullness, prospective consumption, and palatability. Biochemical markers of nutrition and inflammation were also determined. RESULTS At baseline, group I showed lower scores for desire to eat, hunger sensation, prospective consumption, and palatability. They also showed lower lymphocyte counts, prealbumin, transferrin, serum albumin, normalized equivalent of protein-nitrogen appearance (nPNA), and residual renal function (RRF). In addition, the same group showed higher levels of C-reactive protein (CRP) and more sensation of fullness than the remaining groups. In the entire series, we found significant linear correlations between the following markers of nutrition and certain questions on the VAS: albumin with before-lunch desire to eat (r = 0.38, p < 0.05), and prealbumin with before-lunch hunger (r = 0.41, p < 0.05) and after-lunch hunger (r = -0.35, p < 0.05). Negative linear correlations were found between albumin and fullness before lunch (r = -0.45, p < 0.01), and between prealbumin and before-lunch desire to eat (r = -0.39, p < 0.05). Negative linear correlations were also seen between CRP and albumin (r = -0.35, p < 0.05) and between CRP and prealbumin (r = -0.36, p < 0.05). Similarly, CRP showed a negative correlation with before-lunch desire to eat (r = -0.38, p < 0.05) and afterlunch desire to eat (r = -0.45, p < 0.01). After HP eradication, group I showed a significant increase in markers of nutrition and in VAS scores for almost all questions. Simultaneously, they showed a decrease in CRP level. Significant differences were also found in lymphocyte count (1105 +/- 259.4 cells/mm3 vs 1330.8 +/- 316 cells/mm3, p < 0.05), nPNA (0.9 +/- 0.16 g/kg/day vs 1.07 +/- 0.3 g/kg/day, p < 0.05), prealbumin (26.7 +/- 6.5 mg/dL vs 33.9 +/- 56.6 mg/dL, p < 0.01), albumin (3.48 +/- 0.3 g/dL vs 3.67 +/- 0.35 g/dL, p < 0.05), CRP (1.16 +/- 1.14 mg/dL vs 0.88 +/- 1.2 mg/dL, p < 0.054), before-lunch desire to eat (56.6 +/- 6.8 vs 72.2 +/- 4, p < 0.001), after-lunch desire to eat (5.4 +/- 2.6 vs 12.3 +/- 2, p < 0.01), hunger before lunch (55.4 +/- 5.4 vs 73.1 +/- 4.6, p < 0.001), hunger after lunch (5.8 +/- 2.9 vs 11 +/- 4, p < 0.01), fullness before lunch (36.6 +/- 10.3 vs 18.7 +/- 8.8, p < 0.001), consumption after lunch (5 +/- 4.7 vs 17.5 +/- 18, p < 0.05), and palatability (61 +/- 5.3 vs 74.1 +/- 4.1, p < 0.001). CONCLUSION Infection with HP is associated with anorexia, inflammation, and malnutrition in PD patients. Eradication of HP significantly improves this syndrome. Residual renal function seem to have a protective effect on appetite preservation. The present study supports the hypothesis of the involvement of inflammation in the pathogenesis of malnutrition in PD patients.
TL;DR: Modality of PD and patient demographic factors do not contribute to the rate at which RRF is lost in incident PD patients, and cardiac disease was the only variable affecting decline of RRF.
Abstract: ObjectiveTo determine whether gender, race, diabetes, peritoneal dialysis (PD) modality, and comorbid conditions influence loss of residual renal function (RRF).DesignRetrospective study of inciden...
TL;DR: Exposure to LPS and daily Dianeal or physiologic saline leads to peritoneal fibrosis and neoangiogenesis and may be valuable for evaluating short-term interventions to prevent membrane damage.
Abstract: ObjectivesPeritoneal membrane changes are related to daily exposure to non physiologic dialysate and recurrent acute inflammation. We modified a daily infusion and inflammation model and evaluated ...
TL;DR: In this study, ambulatory nighttime systolic BP load > 30% had an independent association with LVH, and the result that CCPD patients had a higher LVMI than CAPD patients may be due to a relative volume overload during the daytime inCCPD patients.
Abstract: ObjectiveTo examine the relation between the results of ambulatory 24-hour blood pressure monitoring (ABPM) and left ventricular mass index (LVMI), then to find the independent determinant for left...
TL;DR: The results of this study suggest that, to provide adequate concentrations for susceptible organisms over a 24-hour period, current intermittent vancomycin dosing recommendations for PD-related peritonitis need to be changed to 35 mg/kg intraperitoneally on day 1, then 15mg/kg IP thereafter (i.e., once daily) in APD patients.
Abstract: The pharmacokinetics of intravenous (i.v.) vancomycin was studied in automated peritoneal dialysis (APD) patients who received a single i.v. dose of vancomycin (15 mg/kg total body weight). Dialysate samples were collected at the beginning, middle, and end of dwells 1-3 (on-cycler), and at the end of dwells 4 and 5 (off-cycler), for a 24-hour period. Blood samples were collected at the beginning, middle, and end of dwells 1-3 (on-cycler), and at the end of dwell 5 (off-cycler) for a 24-hr period. Pharmacokinetics parameters were calculated assuming a one-compartment model. Glomerular filtration rate (GFR) and vancomycin clearance (CI) values were normalized to 1.73 m2. Ten patients [4 males, 6 females; 47.4 +/- 9.9 years of age (mean +/- SD)] who had received PD for a median 3.5 months (range 2-66 months) were studied. Dwell times were 2.3 +/- 0.1 hours on cycler and 7.3 +/- 0.1 hours off cycler. Vancomycin half-life was significantly different on-cycler than off-cycler (11.6 +/- 5.2 hr vs 62.8 +/- 33.0 hr; p < 0.001). Vancomycin total CI (CI(T)) was 7.4 +/- 2.0 mL/min. Renal CI (CI(R)) and PD CI (CI(PD)) accounted for 23.6% and 28.0% of CI(T). respectively. CI(R) correlated with GFR (CI(R) = 0.90 GFR - 1.01; r2 = 0.79; p = 0.008). Mean vancomycin serum and dialysate end-of-dwell concentrations were above minimum inhibitory concentration of susceptible organisms (5 micro/mL) for the first cycler and the second ambulatory exchanges only. The results of this study suggest that, to provide adequate concentrations for susceptible organisms over a 24-hour period, current intermittent vancomycin dosing recommendations for PD-related peritonitis need to be changed to 35 mg/kg intraperitoneally on day 1, then 15 mg/kg i.p. thereafter (i.e., once daily) in APD patients.