Continuous ambulatory peritoneal dialysis in diabetic patients. The relationship of hypertension to retinopathy and cardiovascular complications.

The antimicrobial activity of serum and dialysate from patients on continuous ambulatory peritoneal dialysis (CAPD) was assessed by performing bactericidal assays on serum and both fresh and spent dialysate. Fresh dialysate, whether lactate or acetate based, displayed significant bactericidal activity, which could be abolished by the addition of serum or albumin but not urea. Most patients on CAPD lost that killing activity sometime during the course of their dialysis, but a few retained this capability. Serum bactericidal activity was decreased in CAPD patients when compared to that of normal controls or patients on hemodialysis. These studies suggest the need for further work to assess the relationship of such findings to the pathogenesis of peritonitis in patients on CAPD.

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Hematocrit and Residual Renal Creatinine Clearance in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686089001000406 ◽

1990 ◽

Vol 10 (4) ◽

pp. 279-282 ◽

Cited By ~ 4

Author(s):

K. D. Nolph ◽

B. F. Prowant ◽

H. L. Moore ◽

S. E. Reyad

Keyword(s):

Peritoneal Dialysis ◽

Creatinine Clearance ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Confidence Limits ◽

Males And Females ◽

Stage Renal Disease ◽

End Stage ◽

And Function ◽

Relationship Of ◽

The Relationship

In a recent report, the relationship between renal creatinine clearance and hematocrit in patients with renal creatinine clearances, ranging from 55 to 8 mL per min. per 1.73 square meters of body surface area, was analyzed (1). The authors of this study have performed a crosssectional analysis of the relationship of hematocrit to residual renal creatinine clearance in patients on continuous ambulatory peritoneal dialysis (CAPD). The authors of this study wanted to examine whether or not these hematocrits fall within extrapolations of the published 95% confidence limits for males and females with renal failure prior to end-stage renal disease and dialytic intervention. Authors also compare d regression intercepts at residual creatinine clearances of 0. Most of the CAPD patients had hematocrits within the upper half or above the extrapolated 95% confidence limits for the predialysis population. Within the CAPD population, there were no significant correlations of hematocrit with residual creatinine clearance at these lower ranges. The degree of scatter in the CAPD population for hematocrit values was similar to that in the predialysis population. Residual creatinine clearance appears to be a crude index of the increasing severity of multiple factors that may contribute to the anemia. CAPD appears to maintain or improve hematocrit as renal mass and function decline.

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Abstract 18907: Relationships Between Renal Haemodynamics With Cardiac and Aortic Haemodynamics in the Early Stages of Essential Hypertension

Circulation ◽

10.1161/circ.130.suppl_2.18907 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Konstantinos Kintis ◽

Costas Tsioufis ◽

Anastasia Mazaraki ◽

Evaggelia Koutra ◽

Lefki Nikolopoulou ◽

...

Keyword(s):

Essential Hypertension ◽

Augmentation Index ◽

Resistive Index ◽

Renal Haemodynamics ◽

Renal Resistive Index ◽

Diabetic Patients ◽

Diastolic Velocity ◽

Relationship Of ◽

The Relationship ◽

Cardiac Haemodynamics

Introduction: The relationship of renal haemodynamics with cardiac and aortic hameodynamics is still unclear. Hypothesis: We evaluated the relationship of increased renal resistive index (RRI) with Augmentation index (AIx) and cardiac haemodynamics by means of mitral annular early diastolic velocity (E/Ea) in untreated patients with essential hypertension. Methods: 76 newly diagnosed untreated non diabetic patients with stage I-II essential hypertension [35 males, aged 50 years, office blood pressure (BP) = 143/ 91 mm Hg], underwent ABPM, complete echocardiographic study for determination of E/Ea and blood sampling for assessment of metabolic profile. Moreover, data on renal resistive index (RRI), obtained by Doppler ultrasound sampling of the intrarenal arteries, as well as augmentation index (AIx), were retrospectively analyzed. Results: Based on the mean value of RRI (0.60), hypertensives were classified into those with high and low RRI. Hypertensives with high RRI values compared to those with low values were older (55.6±9.8 vs 44.4±11.6 years, p < 0.001), had lower 24-hour diastolic BP (77.5±7.7 vs 84.3±6.7 mmHg, p < 0.001), lower 24-hour HR (71.2±10.3 vs 76.2±9.2 bpm, p < 0.05), higher levels of AIx (27.2±8.2 vs 17.8±14.8 %, p < 0.01), and higher values of E/Ea (lateral) (7.7±1.8 vs 6.2±2.3, p < 0.05). In the total population, RRI was negatively related to 24-hour diastolic BP (r = -0.523, p < 0.001) and 24-hour HR (r = -0.281, p < 0.05), while it was positively associated with CRP (r = 0.335, p < 0.05), TChol (r = 0.296, p < 0.01), age (r = 0.443, r < 0.001), AIx (r = 0.413, p = 0.001) and E/Ea(lateral) (r = 0.465, p < 0.05). Multiple regression analysis revealed that 24-hour diastolic BP and E/Ea (lateral) were independent associated with RRI (R2 = 0.434, p < 0.05). Conclusions: Increased vascular resistance of intrarenal arteries is associated with impaired aortic and cardiac haemodynamics, as reflected by increased AIx and E/Ea (lateral) values. RRI may be considered a useful surrogate of haemodynamics in essential hypertension.

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The Relationship of Diastolic Dysfunction And Microalbuminuria in Type 2 Diabetic Patients

The Journal of Tepecik Education and Research Hospital ◽

10.5222/terh.1999.89587 ◽

1999 ◽

Vol 9 (2) ◽

pp. 92-97

Author(s):

Didem Dereli ◽

Harun Yenice ◽

Murat Akyurt ◽

Ebru Yüksel Özbal ◽

Ziya Günal

Keyword(s):

Diastolic Dysfunction ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Relationship Of ◽

The Relationship ◽

Type 2 Diabetic

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Gender, degree of obesity, and discrepancy between urea and creatinine clearance in peritoneal dialysis.

Journal of the American Society of Nephrology ◽

10.1681/asn.v93497 ◽

1998 ◽

Vol 9 (3) ◽

pp. 497-499

Author(s):

A H Tzamaloukas ◽

D Malhotra ◽

G H Murata

Keyword(s):

Peritoneal Dialysis ◽

Creatinine Clearance ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Ideal Weight ◽

Clearance Studies ◽

Obese Subjects ◽

The Difference ◽

The Relationship ◽

Linear Manner ◽

One Way Anova

The effect of gender and degree of obesity on the size indicators V, used to normalize urea clearance (Kt/Vur), and body surface area (BSA), used to normalize creatinine clearance (Ccr), in peritoneal dialysis was studied by: (1) mathematical comparison of the formulae used to estimate V (Watson and Hume) with the Dubois formula used to estimate BSA in peritoneal dialysis; and (2) comparison of percent deviation of BSA (delta BSA%) and V (delta V%) from ideal weight estimates in 933 clearance studies performed in actual patients (555 in men and 378 in women on continuous ambulatory peritoneal dialysis). V was estimated by the Watson formulae and BSA by the Dubois formula in these studies. delta BSA% and delta V% were stratified in 10% increments in deviation of body weight from ideal (delta W%) in these studies. Mathematically, the relationship between V and BSA is not linear. In the same subject, as obesity develops (delta W% increases) and BSA increases in a linear manner, V increases exponentially. In addition, there are substantial differences in the relationship between V and BSA caused by gender. For the same height and BSA, men have a larger V than women. In the clearance studies performed in actual continuous ambulatory peritoneal dialysis patients, the difference between delta V% and delta BSA% increased significantly (P < 0.0001) from the wasted to the obese subjects by one-way ANOVA in both men and women. Normalization of urea and creatinine clearances by different size indicators creates two types of mathematical distortion in the relationship between the two clearances. One distortion is caused by the degree of obesity. The second distortion is caused by gender. Use of the same size indicator to normalize both urea and creatinine clearances would eliminate these distortions.

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Acid–Base Disturbances

The Brigham Intensive Review of Internal Medicine ◽

10.1093/med/9780199358274.003.0059 ◽

2014 ◽

pp. 594-602

Author(s):

Julian L. Seifter

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

End Stage Renal Disease ◽

The United States ◽

Cardiovascular Complications ◽

Diabetic Patients ◽

Stage Renal Disease ◽

End Stage

According to projections from the United States Renal Data Service (USRDS), 〉600,000 individuals in the United States will have end-stage renal disease (ESRD) by 2010. The leading cause of ESRD in the United State is diabetes, followed by hypertension. As the care of diabetic patients has improved, particularly in the area of cardiovascular disease, they are living through their cardiovascular complications long enough to develop ESRD. As a consequence, since the inception of the Medicare ESRD program. the dialysis population has gradually become older with increasing numbers of comorbid conditions. Renal replacement therapy in the form of hemodialysis or peritoneal dialysis may serve as a bridge to the best form of renal replacement, renal transplantation. The demand for suitable kidneys for transplantation far exceeds the supply, leaving many patients on dialysis for extended periods of time.

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Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

Peritoneal Dialysis International ◽

10.1177/089686088000100504 ◽

1980 ◽

Vol 1 (5) ◽

pp. 54-58 ◽

Cited By ~ 10

Author(s):

Norbert H. Lameire ◽

Marc De Paepe ◽

Raymond Vanholder ◽

Johan Verbanck ◽

Severin Ringoir

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Average Rate ◽

Sodium Concentration ◽

Risk Category ◽

Diabetic Patients ◽

Serum Triglycerides ◽

Number Of Patients ◽

Stage Renal Disease ◽

End Stage

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

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The Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686088300301s06 ◽

1983 ◽

Vol 3 (1_suppl) ◽

pp. 16-20 ◽

Cited By ~ 5

Author(s):

C.T. Flynn

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Diabetic Patients ◽

Term Survival ◽

Basic Issue ◽

Insulin Dependent ◽

Intraperitoneal Insulin ◽

Insulin Dependent Diabetic

Insulin-dependent diabetics with renal failure have a relatively poor long-term survival. The basic issue, therefore, is quality of life. CAPD allows the patient to be independent. The procedure can be performed as well by the blind as by a sighted patient and thus is available to blind diabetics. Intraperitoneal insulin offers a safe, consistent and convenient control of the blood sugar. Our experience suggests that continuous ambulatory peritoneal dialysis is the dialytic treatment of choice for the majority of insulin-dependent diabetic patients.

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Cancer Antigen 1251S Locally Produced in the Peritoneal Cavity during Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686089401400207 ◽

1994 ◽

Vol 14 (2) ◽

pp. 132-136 ◽

Cited By ~ 38

Author(s):

Ger C.M. Koomen ◽

Michiel G.H. Betjes ◽

Oésirée Zemel ◽

Raymond T. Krediet ◽

Frans J. Hoek

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Mesothelial Cell ◽

Linear Increase ◽

Mesothelial Cells ◽

Ca 125 ◽

Cancer Antigen ◽

The Relationship

The local production of cancer antigen (CA) 125 in the peritoneal cavity of 14 continuous ambulatory peritoneal dialysis patients was studied. In addition, the relationship between the concentration of mesothelial cells and CA 125 in the peritoneal dialysate effluent was examined. The median results and ranges were as follows: plasma CA 125 14 U/mL (range 10 23), dialysate CA 125 18 U/mL (range 5.2 76), dialysate/plasma ratio 1. 9 (range 0.61 -5.4), and number of mesothelial cells 400/mL (range 10 5000). Peritoneal concentrations of mesothelial cellsand CA 125 were positively correlated (r = 0.50, p < 0.01). Using a monoclonal antibody, CA 125-positive cells were found in the cytospin preparations of the cells of dialysis effluents. All these CA 125 positive cells were also positive for cytokeratin used as a mesothelial cell marker. In vitro experiments using mesothelial cells in monolayers showed a linear increase in CA 125 concentration both in time and in relation to the number of mesothelial cells. From these experiments a production rate of 24 U/hour/1 06 cells could be calculated. It is therefore concluded that CA 125 is locally produced in the peritoneal cavity during CAPD and that the mesothelial cells are the major source of this CA 125.

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