Showing papers on "Peritoneal dialysis published in 1985"
TL;DR: The quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the generalpopulation.
Abstract: We assessed the quality of life of 859 patients undergoing dialysis or transplantation, with the goal of ascertaining whether objective and subjective measures of the quality of life were influenced by case mix or treatment. We found that 79.1 per cent of the transplant recipients were able to function at nearly normal levels, as compared with between 47.5 and 59.1 per cent of the patients treated with dialysis (depending on the type). Nearly 75 per cent of the transplant recipients were able to work, as compared with between 24.7 and 59.3 per cent of the patients undergoing dialysis. On three subjective measures (life satisfaction, well-being, and psychological affect) transplant recipients had a higher quality of life than patients on dialysis. Among the patients treated with dialysis, those undergoing treatment at home had the highest quality of life. All quality-of-life differences were found to persist even after the patient case mix had been controlled statistically. Finally, the quality of life of transplant recipients compared well with that of the general population, but despite favorable subjective assessments, patients undergoing dialysis did not work or function at the same level as people in the general population.
1,127 citations
TL;DR: This extensive review describes the settings for continuous arteriovenous hemofiltration (CAVH) and attempts to compare it to traditional dialysis therapies for acute renal failure.
131 citations
TL;DR: The most characteristic features of cutaneous involvement in RHT and CAPD patients were: cutaneous xerosis, pruritus, infectious manifestations and disorders of pigmentation.
Abstract: 94 uremic patients, 68 on regular hemodialysis treatment (RHT) and 26 on chronic ambulatory peritoneal dialysis (CAPD), were followed for up to 20 months in search of dermatological manifestations 79
127 citations
TL;DR: This study supports Tenckhoff's observation that the authors can expect the lowest complication rate with double-cuff catheters with an arcuate tunnel, convex upwards, and recommends a new catheter permanently bent between the cuffs to eliminate one of the forces responsible for cuff extrusion.
Abstract: In 1968 to ensure optimal function of a permanent catheter during periodic peritoneal dialysis, Tenckhoff recommended that a double-cuff catheter be inserted so that a slightly arcuate subcutaneous...
111 citations
TL;DR: Computer simulations using a distributed model approach compared favorably with the experimental measurements and established the validity of this approach in peritoneal dialysis transport studies, which demonstrated decreasing concentration profiles in all visceral tissues.
Abstract: Peritoneal dialysis transport studies were carried out in anesthetized rats. Injections of [14C]EDTA were made by intravenous bolus or intraperitoneal dialysis solution, and blood and peritoneal fl...
107 citations
TL;DR: In patients with chronic renal failure prolactin levels were similar regardless of the method of dialysis, and hyperprolactinemia occurs infrequently and, when it occurs, is mild.
104 citations
TL;DR: In rats intraperitoneal injections of a mixture of antiseptic spray and dialysate produced an inflammatory reaction in the submesothelial tissues, which might represent the early changes of a fibrotic process.
Abstract: Sclerosing peritonitis now is recognized as an extremely serious complication of peritoneal dialysis. In Glasgow II of 162 patients on CAPD developed sclerosing peritonitis. All 11 came from a grou...
90 citations
TL;DR: The present preliminary study was undertaken to determine whether the effluent dialysate of patients undergoing CAPD contained a similar surfaceactive material -a finding that would imply its presence on the peritoneal membrane.
Abstract: The dialysis effluent of patients on continuous ambulatory peritoneal dialysis contains a surface-active material (SAM). This is composed of phospholipids; on thin-layer chromatography, this appear...
90 citations
TL;DR: Aluminum in the dialysate appears to be the major source of the metal in chronic renal failure patients who develop aluminum toxicity; some patients develop toxicity who are only on treatment with aluminum-containing phosphate-binding agents.
Abstract: In the presence of normal renal function, a high concentration of aluminum in drinking water has been implicated as a factor in the etiology of a neurological syndrome in one specific geographical area. The role of aluminum as a toxic agent in other neurological disorders, where renal function is normal, is controversial. Aluminum is absorbed from the gastrointestinal tract and is normally excreted by the kidneys in the urine. In patients with chronic renal failure, aluminum appears to be of proven toxicological importance. In these patients the accumulation of aluminum in tissues causes an encephalopathy (dialysis encephalopathy or dialysis dementia), a specific form of metabolic bone disease (osteomalacic dialysis osteodystrophy), and an anemia and also plays an etiological role in some of the other complications associated with end-stage chronic renal disease. A failure in the normal renal excretory mechanism accounts for the tissue accumulation in chronic renal failure. The majority of chronic renal failure patients who develop aluminum toxicity are on long-term treatment with either hemo- or peritoneal dialysis; some patients develop toxicity who are only on treatment with aluminum-containing phosphate-binding agents. Aluminum in the dialysate appears to be the major source of the metal in chronic renal failure patients who develop aluminum toxicity. The aluminum content of the dialysate depends primarily on the content of the water with which it is prepared; there may be some contribution from the chemicals used in the concentrate which is added to the water. Some domestic tap-water supplies contain aluminum in high concentration, either naturally or because aluminum has been added as a flocculant in the purification process.(ABSTRACT TRUNCATED AT 250 WORDS)
81 citations
TL;DR: Fungal peritonitis occurred in 17 patients on chronic peritoneal dialysis, with Candida parapsilosis and Candida albicans as the most common species.
Abstract: Fungal peritonitis occurred in 17 patients on chronic peritoneal dialysis. The incidence of infection per 100 patient-dialysis months was 0.36 for patients on intermittent peritoneal dialysis and 1.6
79 citations
TL;DR: Comparing the type and frequency of mechanical and infectious complications attributable to the devices and procedures used for chronic peritoneal dialysis (PD) in contemporaneous groups of patients undergoing continuous ambulatory PD (CAPD) or intermittent PD (IPD), mechanical complications related directly to the catheter and its placement proved to be equally frequent during CAPD and IPD.
Abstract: The present report summarizes the mechanical and infectious complications attributable to the devices and procedures used for chronic peritoneal dialysis (PD), comparing the type and frequency of such complications in contemporaneous groups of patients undergoing continuous ambulatory PD (CAPD) or intermittent PD (IPD). Mechanical complications related directly to the catheter and its placement proved to be equally frequent during CAPD and IPD. On the other hand, mechanical complications related to increased intraperitoneal pressure were more frequent during CAPD. In most instances mechanical complication can be managed without permanent interruption of chronic PD. Peritonitis occurs more frequently during CAPD (1.6 episodes per patient-year) than during IPD (0.4 episodes per patient-year), with a tendency to more frequent peritonitis among diabetics, children, patients with white blood cell abnormalities, patients with catheter cuff or tunnel inflammation, and during the 1st month of treatment. Medical therapy eradicates peritonitis and allows continuation of chronic PD with retention of the catheter in more than 90% of episodes, although special problems may be encountered with fungal, pseudomonal, and some coagulase-positive staphylococcal infections.
TL;DR: The finding of more than 50% polymorphonuclear leukocytes in the dialysate was a more sensitive indicator of peritonitis than was an absolute cell count of 100 cells/microL.
TL;DR: The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed and only 22 of the 115 patients had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.
Abstract: The experience with CAPD using the Tenckhoff catheter in 115 patients over a 7 year period has been reviewed. The general indications for CAPD in the patient with chronic renal failure are the mental and physical ability of the patient or his relatives to perform CAPD. In our series, diabetes mellitus has been a relative indication for CAPD, because diabetic patients often have vascular disease severe enough to make long-term hemodialysis difficult. The general contraindications are abdominal problems such as hernias, abdominal wall infections, inflammatory bowel disease, adhesions, and gastrointestinal stomas. Other contraindications are lumbar disk disease and respiratory insufficiency. The surgical principles of catheter insertion have been described. Complications associated with the Tenckhoff catheter were either mechanical (intraabdominal organ injury, incisional hernia, catheter leakage, catheter occlusion, or catheter dislodgement), or infectious (peritonitis or abdominal wall infection). The single most common organism isolated from effluent dialysate in 65 patients with peritonitis was Staphylococcus epidermidis in six patients (9.2 percent), and in 20 patients (30.8 percent), no organism could be isolated. For those patients who had peritonitis, the average frequency was at 8.9 months of CAPD. There were only three deaths (3 percent) directly related to the Tenckhoff catheter and these were due to peritonitis and sepsis. Only 22 (19 percent) of the 115 patients in this series had to discontinue CAPD because of its ineffectiveness or the patient's or relative's inability to perform CAPD.
TL;DR: The results suggest that, in the patients participating in these studies, spike contamination may have been an infrequent cause of peritonitis.
Abstract: In continuous ambulatory peritoneal dialysis (CAPD), peritonitis frequently is assumed to result from spike contamination during bag exchanges. An ultraviolet germicidal chamber has been developed, which disinfects the spike and the solution-bag outlet before spike insertion. This report summarizes the results of a multicenter trial carried out to determine if this device reduces the incidence of peritonitis in patients on CAPD. Ten centers contributed 167 patients who were followed during a base-line historical control period for a minimum of four months. Thereafter, 93 patients were randomized to a control group, and 74 to the test group. After an interim period for retraining (both groups) and change over (test group), a trial period of nine months was undertaken. Peritonitis rates and actuarial analyses of time-to-peritonitis showed no significant differences between historical and trial periods in either group, or between groups during either period. In both groups, rates of peritonitis were consistently lower than rates reported in the National Registry. The results suggest that, in the patients participating in these studies, spike contamination may have been an infrequent cause of peritonitis. In the U.S.A. over 9000 patients with end-stage renal disease are maintained on continuous ambulatory peritoneal dialysis (CAPD) (I). A peritonitis rate of 1.6 episodes per patient year represents the national average in the latest report of the U.S.A. CAPD Registry (2). Most clinicians assume that spike contaminations during bag exchanges are responsible for some portion of these episodes. Popovich, Moncrief and colleagues have described preliminary experiences with an ultraviolet germicidal system shown to disinfect intraspike contaminations with solutions containing 200,000 organisms per ml (3–4). An integrated dose of ultraviolet light within the germicidal chamber kills microorganisms before spike insertion into a fresh bag of solution. An improved chamber has been made available for clinical trials by Travenol Laboratories Inc (Deerfield, Illinois) (5). This study summarizes the results of a multicenter trial designed to test the effects of this germicidal chamber on the frequency of peritonitis in a population of patients maintained on CAPD.
TL;DR: In this article, the deficiency of water-soluble vitamins may occur in uremic patients mainly because of restricted consumption and of loss during chronic hemo-and peritoneal dialysis.
Abstract: Deficiencies of water-soluble vitamins may occur in uremic patients mainly because of restricted consumption and of loss during chronic hemo- and peritoneal dialysis. Although the daily requirement fo
TL;DR: Continuous cyclic peritoneal dialysis (CCPD) as mentioned in this paper is based on the concept of continuous equilibration dialysis proposed by Popovich et al. CCPD uses multiple short nocturnal exchanges, while the patient is connected to the cycler and a long diurnal exchange with the patient ambulatory Thus it is a virtual reversal of the CAPD schedule.
Abstract: Continuous cyclic peritoneal dialysis (CCPD) is based on the concept of continuous equilibration dialysis proposed by Popovich et al, but incorporates the automation provided by a cycler [1,2] CCPD uses multiple short nocturnal exchanges, while the patient is connected to the cycler and a long diurnal exchange with the patient ambulatory Thus, it is a virtual reversal of the CAPD schedule The primary objective of CCPD is to provide automated, continuous peritoneal dialysis in a convenient manner, freeing the daytime hours from all procedures The secondary goal is to reduce the rate of peritonitis
TL;DR: This review addresses the clinical pharmacokinetic aspects of drug therapy in patients undergoing peritoneal dialysis and considers the efficiency of thePeritoneal membrane as a dialysing membrane, the effects of peritoneAL dialysis on the pharmacokinetics of drugs, and the application of pharmacokinetically principles to the adjustment of drug dosage regimens in peritoneic dialysis patients.
Abstract: Peritoneal dialysis has become an accepted treatment modality for end-stage renal disease The introduction of continuous ambulatory peritoneal dialysis (CAPD) has further popularised this technique The need for adjustment of drug dosage in patients with endstage renal disease and the need for supplemental dosages following haemodialysis are well recognised Little documentation exists concerning the need for supplemental drug dosage in patients on peritoneal dialysis Knowledge of the influence of peritoneal dialysis on the elimination of specific drugs is essential to the rational design of dosage regimens in patients undergoing this dialysis technique This review addresses the clinical pharmacokinetic aspects of drug therapy in patients undergoing peritoneal dialysis and considers: the efficiency of the peritoneal membrane as a dialysing membrane; the effects of peritoneal dialysis on the pharmacokinetics of drugs; the pharmacokinetic models and estimation methods for peritoneal dialysis clearance and the effects of peritoneal dialysis on drug elimination; the influence of the pharmacokinetic parameters of drugs on drug dialysability; and the application of pharmacokinetic principles to the adjustment of drug dosage regimens in peritoneal dialysis patients Data on drugs which have been studied in peritoneal dialysis are tabulated with inclusion of pharmacokinetic and dialysability information
TL;DR: A successful case of intrapleural instillation of tetracycline is reported to induce a pleural symphysis and prevent recurrence of peritoneal dialysis-related hydrothorax in a patient who refused any alternative mode of dialysis.
TL;DR: In patients with multiple peritoneal catheter placements, subsequent catheters did not have a lower survival; this was not affected by sex, type of catheter, or use of radiography during placement.
Abstract: Peritoneal catheter survival and complications were determined retrospectively over an eight-year period.Two hundred and twenty-two peritoneal catheters were placed in 124 patients; the 107 failure...
TL;DR: In this paper, a retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4-year period revealed a 5 percent incidence of abdominal wall hernias.
Abstract: This retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4 year period revealed a 5 percent incidence of abdominal wall hernias. Inguinal hernias were frequently manifested as unilateral scrotal swelling. Hernias too small to be appreciated by physical examination were easily demonstrable with intraperitoneal instillation of technetium 99m sulfur colloid through the continuous ambulatory peritoneal dialysis catheter. This procedure was also useful when differentiating dialysate leaks from inguinal hernia in the early and late postoperative periods. Recurrences developed in 27 percent of the herniorrhaphies. Factors contributing to the development of abdominal wall hernias in continuous ambulatory peritoneal dialysis patients include uremia, obesity, anemia, and chronically elevated intraperitoneal pressures.
TL;DR: The incidence of abdominal hernias in 827 CAPD patients was one per 104.2 cathetermonths, with a range among dialysis centers of one hernia per 47.4 to 779.0 catheter-months.
Abstract: Of 1365 patients on continuous ambulatory peritoneal dialysis (CAPD) identified by a literature review, 174 (12.7%) developed one or more abdominal hernias. Twenty-three per cent of these hernias w...
Journal Article•
TL;DR: The paramedian technique resulted in a reduction in the incidence of dialysate leak, incisional hernia and extrusion of the cuff, which led to the abandonment of the midline insertion and the exclusive use of the paramedians technique for permanent dialysis catheter insertion at this institution.
Abstract: Three hundred and twenty-three permanent peritoneal dialysis catheters were inserted in 233 patients by two different methods (midline and paramedian). The paramedian technique resulted in a reduction in the incidence of dialysate leak, incisional hernia and extrusion of the cuff. These results have led to the abandonment of the midline insertion and the exclusive use of the paramedian technique for permanent dialysis catheter insertion at our institution.
TL;DR: The ratio of the vasodilating prostaglandins to the vasoconstrictors and their metabolites (PGF2α and TXB2) increased from 6·6 to 10·5 during peritoneal inflammation.
Abstract: The peritoneal generation of arachidonic acid metabolites was studied in eight patients with end-stage renal disease undergoing continuous ambulatory peritoneal dialysis (CAPD) during infection-free periods and during bacterial peritonitis. The prostacyclin metabolite 6-keto-PGF1 alpha was found to be the major prostanoid generated by human peritoneal mesothelium (1090 ng (6h)-1, SEM 86, n = 8) followed by lesser amounts of PGE2 (142 ng (6 h)-1, SEM 26, n = 8), PGF2 alpha (162 ng (6 h)-1, SEM 27, n = 8) and TXB2 (59 ng (6 h)-1, SEM 5, n = 8). During peritonitis a significant increase of all prostaglandins and TXB2 occurred (P less than 0.001). The ratio of the vasodilating prostaglandins and their metabolites (PGE2 and 6-keto-PGF1 alpha) to the vasoconstrictors and their metabolites (PGF2 alpha and TXB2) increased from 6.6 to 10.5 during peritoneal inflammation. Augmented peritoneal clearances of creatinin and urea and increased losses of proteins during peritonitis as well as the enhanced peritoneal generation of prostanoids were reduced to basal values by adequate antibiotic therapy. The present results suggest that the increased peritoneal blood flow during peritonitis, probably responsible for the observed changes of peritoneal transport properties, may be induced by a change in the ratio of vasoactive prostaglandins generated by peritoneal mesothelial cells.
TL;DR: CAPD, as a form of treatment for end-stage renal disease, satisfactorily controls the osteodystrophy associated with renal failure in the majority of patients, and a high incidence of non-visceral metastatic calcification is noted.
Abstract: The biochemical data and drug histories related to bone disease were extracted from the case records of 47 patients who had been treated by continuous ambulatory peritoneal dialysis (CAPD) for more than two years. These data were reviewed in conjunction with the skeletal surveys done over the same period in all patients, with particular reference to secondary hyperparathyroidism, osteomalacia and non-visceral metastatic calcification. Paired bone biopsies were available in 20 of these patients and the histology was quantitated. In the majority of our patients secondary hyperparathyroidism was controlled or improved on CAPD. Osteomalacia also improved in two of the three patients in whom it was initially present and did not develop in any patient whilst on CAPD. We did, however, note a high incidence of non-visceral metastatic calcification. Small vessel calcification developed in 19.6 per cent of patients, large vessel calcification developed in 23.9 per cent and soft tissue calcification developed in 21.7 per cent of patients. We conclude that CAPD, as a form of treatment for end-stage renal disease, satisfactorily controls the osteodystrophy associated with renal failure in the majority of patients. The significance of the high incidence of non-visceral metastatic calcification remains to be established.
Patent•
15 Feb 1985
TL;DR: In this paper, a peritoneal dialysis composition containing an osmotic agent comprising a glucose polymer mixture, said mixture including at least 15% by weight of glucose polymers having a D.P. (degree of polymerization) greater than 12.
Abstract: A peritoneal dialysis composition containing an osmotic agent comprising a glucose polymer mixture, said mixture including at least 15% by weight of glucose polymers having a D.P. (degree of polymerization) greater than 12. A method is provided for preparing the glucose polymers and a defined sterile aqueous solution of the same for use in peritoneal dialysis by introduction into the abdominal cavity. Also disclosed are methods of treating toxaemia caused by toxins arising from internal disorders of the body, such as hepatic encephalopathy, or which arise from external sources such as poisoning by overdoses of drugs or industrial and agricultural chemicals, e.g., paraquat.
TL;DR: On the basis of the findings the following procedures are recommended: placement of the catheter in the operating room, use of a paramedian incision, closure of the fascia with a running nonabsorbable suture, and early operation if there is any doubt of an intraabdominal catastrophe.
Abstract: Peritoneal catheters are relatively easy to insert but are associated with specific complications. Proper placement and appropriate management reduce the problems associated with these complications, reduce morbidity and mortality, and increase catheter survival. On the basis of our findings the following procedures are recommended: placement of the catheter in the operating room, use of a paramedian incision, closure of the fascia with a running nonabsorbable suture, use of small exchanges initially to allow for healing, cessation of peritoneal dialysis for a limited time when leaks occur, performance of omentectomy when necessary, repair of abdominal wall hernias preoperatively or whenever they occur, maintenance of meticulous asepsis, removal of the catheter after fungal peritonitis or multiple episodes of peritonitis with the same organism, and early operation if there is any doubt of an intraabdominal catastrophe.
TL;DR: The fast and accurate etiological diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis is essential and the use of anaerobic culture media is justified if fecal organisms are suspected as the cause of the infection.
Abstract: The fast and accurate etiological diagnosis of peritonitis in patients on continuous ambulatory peritoneal dialysis is essential. The concentration of larger volumes of peritoneal fluids may yield more isolates than conventional methods. The removal of antibiotics present in the fluids as a consequence of therapy by washing or using antibiotic-removing resins increases the yield considerably. The use of anaerobic culture media is justified if fecal organisms are suspected as the cause of the infection.
Journal Article•
TL;DR: Systemic delivery of the study drug was not shown to be compromised by intraperitoneal administration of 5-fluorouracil, an agent that has advantageous activity for ovarian cancer therapy, although it has not yet been extensively studied.
Journal Article•
TL;DR: Improved peritoneal dialysis can be undertaken with less morbidity to the patient with these guidelines, and management of infective complications should include continued antibiotic dialysis and catheter replacement only if persistent peritonitis or fungalperitonitis occur.
Abstract: A 3-year retrospective review of 110 consecutive Tenckhoff catheter placements was undertaken. Major complications were found in 3.6 per cent of cases and minor complications occurred in 30 per cent. Analysis of cases in which catheters failed revealed that obesity and prior abdominal surgery occurred in 75 per cent of these patients. Attention to these factors and the use of appropriate techniques of placement and, in special situations, the use of endoscopy and fluoroscopy have reduced the failure rate of these high-risk situations. Management of infective complications are outlined and should include continued antibiotic dialysis and catheter replacement only if persistent peritonitis or fungal peritonitis occur. With these guidelines, improved peritoneal dialysis can be undertaken with less morbidity to the patient.