The status of continuous ambulatory peritoneal dialysis

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (D PC), peritoneal glucose absorption (% GA), and drained dialysate volume ( VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month). There were no differences in the control (without NP) Curea, Ccr, D PC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and D PC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but D PC with NP was significantly lower in the long-term CAPD patients. The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.

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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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Disconnect during Continuous Ambulatory Peritoneal Dialysis (CAPD): Retrospective Experience with Three Different Systems

Peritoneal Dialysis International ◽

10.1177/089686088900900307 ◽

1989 ◽

Vol 9 (3) ◽

pp. 175-178 ◽

Cited By ~ 12

Author(s):

Richard Swartz ◽

Janice Reynolds ◽

Patricia Lees ◽

Leslie Rocher

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Sodium Hypochlorite ◽

Patient Preference ◽

Residual Effect ◽

Insufficient Data ◽

University Of Michigan ◽

Baxter Healthcare

Disadvantages of continuous ambulatory peritoneal dialysis (CAPD), such as inconvenience and bulkiness of the apparatus, inflexibility of infusion volume, and predictable peritonitis incidence may be altered by using systems which allow disconnection from the tubing and bag after each exchange. At University of Michigan we have followed 35 patients using the O set@ with sodium hypochlorite (Baxter Healthcare Corp.) for 15.5 ± 10 months, 16 patients using the Y configuration Ultraset® (Baxter Healthcare Corp.) for 8.1 ± 5 months, and 6 patients using a universal adapter (Delmed Corp.) for 14.3 ± 7 months. Failure occurred in 7 cases (18%) at 12 ± 8 months using the O set (3 elective, 3 related to peritonitis, 1 ultrafiltration difficulty), and 1 (7%) at 3 months using the Ultraset (related to peritonitis). Accidental sodium hypochlorite infusion occurred 8 times in 6 patients, 4 patients still on CAPD without residual effect and 2 in whom infusion contributed to failure but not to ultrafiltration difficulty. Cumulative per-patient-year (episode/ months) peritonitis rates of 0.75 (1/16.4), 0.65 (1/18.4) and 0.88 (1/14.3), respectively, compare favorably with the overall center experience of 0.96 (1/12.2) (NIH-CAPD Registry). Peritonitis rates did not differ during use of any of the disconnect systems between patients with prior CAPD experience compared to patients without prior CAPD experience. More important, however, in patients with prior CAPD experience, peritonitis rates after initiation of the disconnect system tended to be lower than rates before disconnect with both the O set, 0.66 (1/18.1) vs. 1.18 (1/10.2) (n = 16, p < 0.09) and Ultraset, 0.46 (1/26.1) vs. 1.54 (1/7.9) (n = 6, p < 0.03), with insufficient data (n = 2) for the universal set. In conclusion, disconnect systems favorably influence not only patient preference for CAPD and ability to vary CAPD infusion volume, but also the frequency of peritonitis during long term use.

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Longitudinal Study of Proteins in Plasma and Dialysate during Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686089001000402 ◽

1990 ◽

Vol 10 (4) ◽

pp. 257-261 ◽

Cited By ~ 6

Author(s):

Gerald A. Young ◽

Albert Taylor ◽

Steven Kendall ◽

Aleck M. Brownjohn

Keyword(s):

Peritoneal Dialysis ◽

Longitudinal Study ◽

Membrane Permeability ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Plasma Proteins ◽

Complement C3 ◽

Acid Glycoprotein ◽

Β2 Microglobulin ◽

Male Patients

The aim was to evaluate plasma proteins during continuous ambulatory peritoneal dialysis (CAPD) in relation to dialysis losses, membrane permeability, renal insufficiency, and time on CAPD. Ten male patients, established on CAPD for at least 14 months, were studied every 8 weeks for 56 weeks. Blood and dialysate from the morning exchange were analysed for urea, creatinine, and 7 proteins, and used to calculate dialysate to plasma concentration ratios (DIP). These ratios were not significantly changed suggesting that permeability remained constant. However, there was a trend for β2-microglobulin, creatinine, and urea to increase progressively. After 56 weeks, β2-microglobulin had increased from 27.9 to 31.3 mglL (p < 0.05) and creatinine 1006 to 1099 μmoLIL (p < 0.05) and both correlated with time on CAPD (p < 0.001). Plasma α1-acid glycoprotein, albumin, transferrin, IgG, IgA, and complement C3 were not significantly changed, although IgA and complement C3 were each negatively correlated with time on CAPD (r = −0.70 and −0.67, respectively), creatinine (r = 0.51 and −0.54), and urea (r = −0.61 and −0.61) (p < 0.001 for all). It is concluded that increases in β2-microglobulin, creatinine, and urea are not due to loss of membrane permeability but reflect a slight increase in uraemia. Long-term decreases in immunological proteins may be caused by uraemia or progressive depletion.

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Serum Albumin at Start of Peritoneal Dialysis Predicts Long-Term Outcomes in Anhui Han Patients on Continuous Ambulatory Peritoneal Dialysis: A Retrospective Cohort Study

Kidney Diseases ◽

10.1159/000492426 ◽

2018 ◽

Vol 4 (4) ◽

pp. 262-268 ◽

Cited By ~ 1

Author(s):

Jun Jiang ◽

Li-Hua Wang ◽

Yun-Yun Fei ◽

Xiao-Wan Zhou ◽

Li Peng ◽

...

Keyword(s):

Cohort Study ◽

Peritoneal Dialysis ◽

Serum Albumin ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Long Term Outcomes

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Overnight Mesothelial Cell Exfoliation: A Magic Tool for Predicting Future Ultrafiltration Failure in Patients on Continuous Ambulatory Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080802803s21 ◽

2008 ◽

Vol 28 (3_suppl) ◽

pp. 107-113

Author(s):

Talerngsak Kanjanabuch ◽

Monchai Siribamrungwong ◽

Rungrote Khunprakant ◽

Sirigul Kanjanabuch ◽

Piyathida Jeungsmarn ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Mesothelial Cell ◽

Mesothelial Cells ◽

Nutrition Status ◽

Continuous Exposure ◽

Peritoneal Membrane ◽

Dialysis Solution ◽

Ultrafiltration Failure

⋄ Background Continuous exposure of the peritoneal membrane to dialysis solutions during long-term dialysis results in mesothelial cell loss, peritoneal membrane damage, and thereby, ultrafiltration (UF) failure, a major determinant of mortality in patients on continuous ambulatory peritoneal dialysis (CAPD). Unfortunately, none of tests available today can predict long-term UF decline. Here, we propose a new tool to predict such a change. ⋄ Mesothelial cells from 8-hour overnight effluents (1.36% glucose dialysis solution) were harvested, co-stained with cytokeratin (a mesothelial marker) and TUNEL (an apoptotic marker), and were counted using flow cytometry in 48 patients recently started on CAPD. Adequacy of dialysis, UF, nutrition status, dialysate cancer antigen 125 (CA125), and a peritoneal equilibration test (3.86% glucose peritoneal dialysis solution) were simultaneously assessed and were reevaluated 1 year later. ⋄ Results The numbers of total and apoptotic mesothelial cells were 0.19 ± 0.19 million and 0.08 ± 0.12 million cells per bag, respectively. Both numbers correlated well with the levels of end dialysate–to–initial dialysate (D/D0) glucose, dialysate-to-plasma (D/P) creatinine, and sodium dipping. Notably, the counts of cells of both types in patients with diabetes or with high or high-average transport were significantly greater than the equivalent counts in nondiabetic patients or those with low or low-average transport. A cutoff of 0.06 million total mesothelial cells per bag had sensitivity of 1 and a specificity of 0.75 in predicting a further decline in D/D0 glucose and a sensitivity of 0.86 and a specificity of 0.63 to predict a further decline in UF over a 1-year period. In contrast, dialysate CA125 and other measured parameters had low predictive values. ⋄ Conclusions The greater the loss of exfoliated cells, the worse the expected decline in UF. The ability of a count of mesothelial cells to predict a future decline in UF warrants further investigation in clinical practice.

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