Showing papers on "Peritoneal dialysis published in 1977"

The nephrotoxicity of antimicrobial agents (second of three parts).

Abstract: Vancomycin Vancomycin is excreted chiefly by the kidney, with more than 80 per cent of the administered dose recovered in the urine within 24 hours.84 Its half-life is six hours. In patients with impaired renal function, very high serum concentrations accumulate,85 , 86 and the drug is not removed by either hemodialysis or peritoneal dialysis. Animal studies have found vancomycin to have little nephrotoxicity, although the highest concentrations of vancomycin are recovered in the kidneys of the animals post mortem.87 , 88 Although ototoxicity due to vancomycin has been clearly established in man, nephrotoxicity has not. Direct injection of 2-g doses intravenously into healthy . . .

Dialysis in the treatment of renal failure in patients with liver disease.

Abstract: The value and effects of treating renal failure by dialysis are analyzed in a series of 84 patients with various types of liver disease. Although none of the 25 patients with cirrhosis survived, six of 50 with fulminant hepatic failure recovered completely as did seven of nine patients with renal failure secondary to extrahepatic biliary tract obstruction or with liver and renal damage following episodes of severe hypotension. Dialysis was required for seven weeks before diuresis occurred in one patient in the latter group. Both peritoneal and hemodialysis satisfactorily controlled plasma urea and creatinine levels, except in patients with fulminant hepatic failure in whom this was only achieved by hemodialysis. Complications of dialysis were most common in patients with cirrhosis and fulminant hepatic failure and included hypotension, gastrointestinal bleeding, and intraperitoneal sepsis. Overall, the results show that dialysis is only worth attempting in those patients in whom recovery of the underlying liver lesion is possible, and even then treatment for prolonged periods may be necessary.

Method and apparatus for peritoneal dialysis

Abstract: Metabolic waste products from the blood of a patient are removed by pumping dialysis solution into the peritoneal cavity of the patient, and then (a) removing a portion of the dialysis solution from the peritoneal cavity which portion may vary from 1 percent to 90 percent of the total amount of dialysis solution administered to the peritoneal cavity and, (b) "cleaning" (removing metabolic waste products) this solution either through a dialyzer or by means of sorbent modules and then returning this same (cleansed) fluid into the peritoneal cavity. This cycle is repeated again and again until the desired amount of metabolic waste products are removed. Another subcutaneous peritoneal catheter is shown in the U.S. patent application Ser. No. 594,374 filed July 9, 1975, since abandoned in favor of Continuation-in-part Application Ser. No. 768,520 filed Feb. 14, 1977. This application discloses a dual catheter, two needle system devoted to cross-flow peritoneal dialysis, whereas the present invention is directed to single catheter and single needle system operating on a push-pull principle.

Fulminant Wilson's disease with haemolysis and renal failure: copper studies and assessment of dialysis regimens.

Abstract: Two girls, aged 12 and 17 years, presented with hepatocellular dysfunction and severe haemolysis due to Wilson9s disease (hepatolenticular degeneration). This was accompanied by acute renal failure. In the absence of renal function sufficient for the urinary excretion of penicillamine, studies were performed to assess the potential of peritoneal dialysis, ascites removal by ultrafiltration-reinfusion, and haemodialysis as alternative excretory pathways for copper. The greatest amount of copper, as judged by rising bath concentrations, seemed to be eliminated with haemodialysis. But this was accompanied by a progressive increase in serum copper concentrations with rapid clinical and biochemical deterioration leading to death within 48 hours. A small amount of copper was lost with ascites removal. Significant amounts of copper were removed during peritoneal dialysis (36 mumol/day (2287 microgram/day)), although a clinical response was not evident before haemodialysis was introduced. The administration of penicillamine orally, intravenously, or intraperitoneally produced no measurable increase in copper excretion into the peritoneal dialysate. Hence peritoneal dialysis alone appears to offer the greatest potential benefit with regard to both eliminating copper and altering the course of this fulminant form of Wilson9s disease.

Presentation, management, complications, and outcome of acute renal failure in childhood: five years' experience.

Abstract: During 1971-5, 72 episodes of acute renal failure were treated in 70 children aged up to 16 years. The commonest causes were renal hypoperfusion (31 cases), haemolytic-uraemic syndrome (12), glomerulonephritis (9), septicaemia (5), and congenital abnormalities (6). Though referral from other hospitals was generally prompt, 10 out of 51 patients had been observed for up to seven days before transfer. Dailysis was used in 44 cases, the most common complications of which were peritonitis in those treated with peritoneal dialysis and acute changes in fluid balance in those treated with haemodialysis. Altogether 37 patients fully recovered, 10 were discharged with chronically impaired renal function, 17 died, and six entered the dialysis and transplantation programme. The mortality fell from 33% in 1972 to 20% in later years, which was due solely to maintenance dialysis being available. Though all patients with irrevocable kidney failure who were suitable entered the dialysis and transplantation programme, with current financial restrictions we doubt whether we shall be able to find places for all such patients in the future.

Methotrexate and Hemodialysis

Abstract: Excerpt To the editor: Recent successful results using "high-dose" methotrexate with citrovorum factor rescue in the treatment of head and neck carcinoma and osteogenic sarcoma have led to more wid

Acute renal failure following copper sulphate intoxication.

Abstract: Eleven out of a series of twenty-nine patients (37-9%) with acute copper sulphate poisoning developed acute renal failure. Intravascular haemolysis appeared to be the chief factor responsible for renal lesions in these patients. Histological lesions observed in the kidney varied from those of mild shock to well established acute tubular necrosis. In one case, granulomatous lesions were seen in response to tubulorrhexis. Renal failure was the chief indication for dialysis in ten patients, whereas one patient was dialysed primarily for removal of copper. Notwithstanding the adequate control of uraemia by dialysis, only six of the eleven patients recovered. Septicaemia was responsible for death in three, hepatic failure in one and methaemoglobinaemia in another. It is postulated that release of copper from haemolysed red cells during acute haemolytic episodes may initiate, or contribute to, the development of renal damage.

Renal failure following snake bite. A clinicopathological study of nineteen patients.

Abstract: Clinical, hematological, and renal biopsy findings in 19 unselected patients with renal failure following snake bite, including eight bitten by Russell's viper, are presented. Hematological findings were variable and did not influence treatment. Renal histology was a good guide to prognosis; patients with normal histology recovered with conservative management, those with tubular necrosis responded well to dialysis, while those with cortical necrosis responded only partially. Peritoneal dialysis was found to be an adequate form of treatment in the majority of patients.

Pharmacokinetics of Amikacin During Hemodialysis and Peritoneal Dialysis

Abstract: The pharmacokinetics of amikacin were examined in six bilaterally nephrectomized patients undergoing hemodialysis and in four patients with a minimal residual renal function undergoing peritoneal dialysis. The mean elimination half-life before the dialysis was 86.5 h in the anephric patients and 44.3 h in the patients with minimal residual kidney function. The results from the anephric patients suggest that some extrarenal elimination of amikacin may occur. The mean volume of distribution was about 25% of the total body weight. This is in accordance with values reported from subjects with normal renal function. During hemodialysis the half-life decreased to less than 10% (5.6 h) of the pretreatment value. The effectiveness of peritoneal dialysis was less as the half-life decreased to only about 30% (17.9 h) of the pretreatment value. During the dialyses a significant correlation between the half-life of amikacin and the decrease in blood urea and serum creatinine was demonstrated. The pharmacokinetic data were used to make dosage regimen recommendations for the treatment of patients undergoing intermittent hemodialysis or peritoneal dialysis.

Peritoneal dialysis in children. Review of 8 years' experience.

Abstract: During the years 1968-75, 59 periods of peritoneal dialysis were performed on 44 children aged from 2 days to 17 years. The commonest complication was peritoneal infection, which affected 68% of those under 2 years and 30% of older children. This was satisfactorily treated in all but one case which was due to Candida albicans. The use of combined intramuscular and intraperitoneal gentamicin therapy is described. 2 patients died as a result of massive intraperitoneal haemorrhage and one had a nonfatal intestinal perforation. In experienced hands peritoneal dialysis is a convenient, effective, and reasonably safe way of treating acute renal failure; it is best performed in centres capable of handling complex metabolic problems and investigating and treating the underlying renal disease.

Effect of Dialysis on Hearing Acuity

Abstract: In order to determine the effect of dialysis on hearing acuity, 20 patients on chronic maintenance hemodialysis or peritoneal dialysis were followed with hearing examinations every 6 months over a fol

PREOPERATIVE SERUM CHOLINESTERASE CONCENTRATION IN CHRONIC RENAL FAILURE Clinical experience of suxamethonium in 81 patients undergoing renal transplant

Abstract: Serum cholinesterase concentrations were measured in 181 patients in chronic renal failure. Significant differences in cholinesterase concentrations were not found in patients undergoing dialysis and changes appear to be independent of the method of treatment used. Clinical experience with suxamethonium to facilitate tracheal intubation was satisfactory in 80 patients undergoing renal transplant. Apnoea occurred in one patient who was found subsequently to have atypical cholinesterase inheritance.

Sequential clearance and dialysance measurements in chronic peritoneal dialysis patients.

Abstract: The long-term efficiency of chronic peritoneal dialysis was investigated during a 10-months follow-up period in eight patients with indwelling Tenckhoff catheters by determining sequential urea, creatine and glucose clearances. Dialysis was performed in the hospital with nurses changing commercially prepared 2-liter dialysate bottles. Mean +/- SE urea clearance declined from an initial valua of 23.6 +/- 1.5 ml/min to 17.7 +/- 1.2 at the termination of the study. The mean glucose and creatinine clearance also decreased from 14.1 +/- 0.9 to 10.2 +/- 0.7 and from 17.5 +/- 1.9 to 12.9 +/- 1.0, respectively. All of these decreases were statistically significant (p less than 0.05) by paired t testing analysis. It is concluded that the efficiency of chronic peritoneal dialysis may decline during maintenance therapy and that sequential clearance measurements should be obtained in all chronic peritoneal dialysis patients.

Home peritoneal dialysis: 3 years' experience in Toronto

Abstract: From November 1972 to November 1975, 52 males and 39 females aged 11 to 71 years were trained for home peritoneal dialysis. Dialysis was performed through a permanent catheter 4 nights a week. The first 11 patients used the manual system, exchanging 2 / of dialysate solution every 50 to 60 minutes. Subsequently 73 patients used the automatic cycler and commercially available dialysate and 7 patients used Tenckhoff9s reverse osmosis peritoneal dialysis machine. The average duration of training was 15, 11.6 and 15 dialysis days, respectively, for the three methods. For the 83 patients followed up, the average duration of home dialysis was 8.3 months (range, 0.5 to 33 months); the total number of dialyses at home was 10 571. Ten received a transplant, 20 were transferred to hospital peritoneal dialysis or hemodialysis, 8 died and 48 continued with home dialysis. Twenty-three patients had a total of 33 episodes of peritonitis, an incidence of 27.7% among the patients in the program for up to 3 years or 0.3% among all the dialyses. By November 1975, 46 patients had returned to their predialysis lifestyle, 18 were working part-time, 10 were able to work but were not doing so, and 9 were unable to work or care for themselves.

Hemofiltration: treatment of renal failure by ultrafiltration and substitution.

Abstract: Hemofiltration, in contrast to hemodialysis or peritoneal dialysis, eliminates toxic substances accumulated in uremia by a process that is independent of molecular weight. By means of a special device, the ultrafiltrate of blood is replaced, up to the desired amount, by a modified Ringer's lactate solution. The application of this new method results in better control of severe hypertension, and controls calcium phosphate and lipid metabolism in a more physiologic manner than dialysis does, without additional drug therapy being necessary. Smaller amounts of fluid and a simplification of devices improve hygienic conditions and patient mobility.

Effect of intraperitoneal diuretics on solute transport during hypertonic dialysis.

Abstract: Hypertonic periotoneal dialysis in New Zealand white rabbits results in increased dialyzate volume, but the sodium content of net ultrafiltrate is 109.5 MEq/l, less than extracellular fluid sodium concentration. With intraperitoneal furosemide, mean net ultrafilrate sodium concentration increased significantly to 121.2 mE1/l while ethacrynic acid had no such effect and both drugs affected dialyzate volume very slightly. Hypertonic peritoneal dialysis increased urea clearance significantly above isotonic dialysis and the addition of ethacrynic acid increased clearances further (P LESS THAN.02). Added furosemide decreased urea clearances suggesting that the effect on sodium transport is not an overall permeability change. During isotonic peritoneal dialysis, furosemide increased peritoneal permeability, i.e. urea and creatinine clearances, but a significantly higher urea clearance resulted from intraperitoneal ethacrynic acid. Furosemide influx clearance average 0.31 ml/kg/min, a mean of 27 percent of the urea clearance. The data suggest that furosemide may be useful to prevent the hypernatremia that may complicate hypertonic peritoneal dialysis, but is not as efficacious as other vasoactive drugs in enhancing peritoneal permeability.

Short Dialysis, Middle Molecules, and Uremia

Abstract: The cause of the uremic syndrome remains unknown; the success of dialysis therapy suggests that retained, dialyzable, but unidentified toxic solutes may play a role. Since chronic peritoneal dialysis seems to prevent or improve uremic neuropathy as well as does hemodialysis, it has been suggested that retained solutes of "middle molecular weight" (500 to 5000 daltons) may be major toxins. Only body fluid concentrations of these larger solutes are presumed to be reduced by peritoneal dialysis as well as with hemodialysis, whereas small solute concentrations are relatively poorly controlled. There have been numberous hemodialysis studies to examine the toxic potential of "middle molecules" as compared with that of smaller solutes. Although the importance of "middle molecules" as toxins remains unproved, numberous factors influencing their concentrations in body fluid have been discovered. Studies have also shown a surprising tolerance of patients to many variations in dialysis strategies. Difficulties in defining adequate dialysis have been intensified.

Chronic Peritoneal Dialysis in the Management of Diabetics with Terminal Renal Failure

Abstract: Twelve diabetics with terminal renal failure were maintained on chronic peritoneal dialysis (PD) for 2–28 months (average 10 months). 7/12 survived more than 1 year. Blood glucose levels were well controlled by the use of supplemental, intradialysis, intraperitoneal insulin. The incidence of dialysis-related complications, including peritonitis was not significantly higher than in controls. Neurophysiological studies revealed a high incidence of neuropathy initially with progression in most patients. Radiological studies revealed initial vascular calcifications in 7 out of 12 patients with progression in 4. Retinopathy did not progress significantly. PD is a suitable alternative to hemodialysis in the management of end-stage diabetic nephropathy.

Acute renal failure following blunt civilian trauma

Abstract: Renal failure developed in 20 patients following blunt civilian trauma. Ten recovered normal renal function; 8 currently survive. Survivors and nonsurvivors did not differ in age, time from trauma to anuria, mean blood urea nitrogen or creatinine level prior to the first or to subsequent dialyses. However, there was an increased incidence of sepsis and liver failure in those who died. When outcome was related to site of injury, patients with closed head injury and/or intra-abdominal injury had a worse prognosis than those with thoracic or extremity injury only. Only 2 patients with perforated bowel survived; both had peritoneal dialysis combined with peritoneal lavage with antibiotic solutions. Mortality in patients with posttraumatic renal failure remains high; however, death is usually a result of associated complications rather than a result of the renal failure. Aggressive management of other complications of the trauma, especially sepsis or potential sepsis, is necessary. We recommend peritoneal dialysis combined with peritoneal antibiotic lavage where there is a potential for posttraumatic intra-abdominal sepsis associated with renal failure.

In search of a 24 hours per day artificial kidney.

Abstract: Wearable, 24 hrs per day, 7 days per week artificial kidneys are being developed. Patients will benefit from more even control of physiologic parameters than can be obtained with conventional intermittent dialysis. Improvement in economic and social circumstances will result. Both hemodialysis and peritoneal dialysis techniques are being miniaturized. Small REDY cartridges containing urease, zirconium phosphate, hydrous zirconium oxide and activated carbon are being utilized to regenerate dialysate. Hemodialyzers will be worn on the forearm and include long, wide, low resistance series blood flow paths to reduce the potential for thrombosis. Peritoneal effluent is regenerated and filtered by the sorbent cartridge and automatically cycled back into the peritoneal cavity.

Survival of patients treated for end-stage renal disease by dialysis and transplantation

Abstract: The results of treatment in 213 patients with end-stage renal disease who underwent hemodialysis, peritoneal dialysis or transplantation, or a combination, between 1962 and 1975 were analysed. Comparison by censored survival analysis showed significantly better (P less than 0.01) patient survival with the integrated therapy of dialysis and transplantation than with either form of dialysis alone. There was no significant difference in survival of males and females but survival at the extremes of age was poorer. Analysis of survival by major cause of renal failure indicated best survival in patients with congenital renal disease. Graft and patient survival rates at 1 year after the first transplantation were 42% and 69%. The major cause of death in this series was vascular disease but infection was responsible for 50% of deaths after transplantation. While integration of dialysis with transplantation produces best patient survival, this course is possible only when sufficient cadaver kidneys are available.

Pharmacokinetics of cefamandole in patients with renal failure.

Abstract: The pharmacokinetics of cefamandole were studied in four patients with stable renal failure, two patients undergoing peritoneal dialysis, and four patients undergoing hemodialysis. Peak concentrations of cefamandole in serum were achieved 1 to 2 h after intramuscular injection in the patients with stable renal impairment, and the concentrations declined slowly, with half-life values of 12.3 to 18 h. Cefamandole was removed only very slowly by peritoneal dialysis. Hemodialysis was more efficient in removing cefamandole, with serum half-life values ranging from 3.8 to 7.9 h. The mean apparent volume of distribution of cefamandole in these 10 patients was 21.92 liters, or 31% of the body weight.