Peritoneal Kinetics and Mesothelial Markers in CCPD Using Icodextrin for Daytime Dwell for Two Years

Objective To evaluate the safety, efficacy, and biocompatibility of icodextrin (Ico), continuous cycling peritoneal dialysis (CCPD) patients were treated for 2 years with either Ico- or glucose (Glu)-containing dialysis fluid for their daytime dwell (14 – 15 hours). Prior to entry into the study, all patients used standard Glu solutions (Dianeal, Baxter BV, Utrecht, The Netherlands). Design Open, randomized, prospective two-center study. Setting University hospital and teaching hospital. Patients Both established patients and patients new to CCPD were included. A life expectancy of more than 2 years, a stable clinical condition, and written informed consent were necessary before entry. Patients aged under 18 years or with peritonitis in the previous month, and women of childbearing potential unless taking adequate contraceptive precautions, were excluded. Thirty-eight patients entered the study (19 Glu, 19 Ico). Main Outcome Measures Daytime dwell peritoneal effluents were collected every 3 months in combination with other study variables (clinical data, laboratory measurements, dialysis-related data, and urine collection). Peritoneal transport studies were carried out every 6 months. Results In Glu- and Ico-treated patients, peritoneal transport of low molecular weight solutes and protein clearances neither changed during follow-up nor differed between the two groups. Peritoneal membrane markers (CA125, interleukin-8, carboxyterminal propeptide of type I procollagen, and aminoterminal propeptide of type III procollagen) measured in effluents did not differ between the groups and did not change over time. All these markers showed a dialysate/plasma ratio of more than 1, suggesting local production. Residual renal function remained stable during follow-up and adverse clinical effects were not observed. Conclusions Peritoneal membrane transport kinetics and markers remained stable in both groups over a 2-year follow-up period. Membrane markers were higher in effluents than in serum, suggesting local production. No clinical side effects were demonstrated. Icodextrin was a well-tolerated effective treatment.

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Determination of peritoneal transport characteristics with 24-hour dialysate collections: dialysis adequacy and transport test.

Journal of the American Society of Nephrology ◽

10.1681/asn.v561333 ◽

1994 ◽

Vol 5 (6) ◽

pp. 1333-1338

Author(s):

M V Rocco ◽

J R Jordan ◽

J M Burkart

Keyword(s):

Membrane Transport ◽

Cost Savings ◽

Correlation Coefficients ◽

Peritoneal Membrane ◽

Dialysis Adequacy ◽

Peritoneal Transport ◽

Data Rates ◽

The Mean

Although the 24-hour collection of dialysate provides a very accurate measure of the adequacy of dialysis, it is not known if it can also determine peritoneal membrane transport characteristics. In this prospective study, 101 24-hour dialysate collections were immediately followed by a standard peritoneal equilibration test (PET). Four- and 24-h dialysate-to-plasma (D/P) ratios were determined for creatinine and urea. The correlation coefficients between these two tests were 0.86 for the adjusted D/P creatinine and 0.71 for the D/P urea, whereas the standard errors of estimate were 0.054 and 0.060, respectively. Patients were classified into one of four transport groups on the basis of the mean and standard deviation of the adjusted D/P creatinine values, and these values were similar to those generated from the PET data. Rates of ultrafiltration were also defined for patients undergoing 2.0- and 2.5-L dwells. A survey of a subset of these patients demonstrated that the 24-h collection was preferred to the PET for determining transport characteristics. Therefore, the 24-h dialysate collection can be used to monitor both peritoneal membrane transport characteristics and adequacy. This technique, which has been named the "dialysis adequacy and transport test," has the potential for significant cost savings when it is used for the routine follow-up of both peritoneal transport and adequacy of dialysis.

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MO688CALCIUM PHOSPHATE PRODUCT IN PERITONEAL DIALYSIS: A RISK FACTOR FOR TYPE I MEMBRANE FAILURE?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0010 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Berfu Korucu ◽

Omer Faruk Akcay ◽

Galip Guz

Keyword(s):

Risk Factor ◽

Peritoneal Dialysis ◽

High Glucose ◽

Cox Regression ◽

Residual Renal Function ◽

Study Endpoint ◽

Type I ◽

Cox Regression Analysis ◽

Increased Risk

Abstract Background and Aims Type I membrane failure (T1MF), increased transport status with ultrafiltration, and solute removal inadequacy are among the most challenging issues in peritoneal dialysis (PD) continuity. Although quite common, the causes of T1MF are not fully understood. This study aims to identify risk factors associated with T1MF. Method This is a retrospective, single site, cohort study of incident adult peritoneal dialysis patients sampled between January 2000 and January 2020. Patients were classified as “increased transporters” who had two or more categories of a rise in peritoneal equilibration test (PET), and “stable transporters” who had had a rise of 1 or no categories from their baseline during follow-up. The four-hour dialysate/plasma creatinine ratio was used to classify PET categories. The study endpoint was five years for stable transporters, and at the time of two category rise in the PET test for increased transporters. Results Baseline demographics, diabetes frequency, residual renal function (RRF), non-phosphate baseline laboratory, parathormone levels, and PD modalities were similar between the increased transporters (n=48) and the stable transporters (n=93). Significantly more patients were using renin-angiotensin-aldosterone system (RAAS) blockers in stable transporters and high-glucose dialysates in increased transporters (p=0.03 and p<0.01). Icodextrin, calcitriol, calcium-based phosphate binder use, and the number of peritonitis episodes were similar between the groups. Increased transporters reached the endpoint in 3.9(±0.7) years. Increased transporters had a higher baseline phosphate than stable transporters (p=0.02). The frequency of patients with an RRF and groups’ mean RRF in ml were similar at the endpoint (p=0.37, p=0.13). Increased transporters had a significantly higher baseline and endpoint CaXP than stable transporters (p<0.01 and p=0.02). Baseline weekly peritoneal Kt/V and peritoneal creatinine clearance (PCrCl) were similar at baseline. Increased transporters had significantly lower endpoint peritoneal Kt/V and insignificantly lower endpoint PCrCl than stable transporters (p<0.01 and p=0.05). ΔUF was negative for increased transporters and positive for stable transporters. Age, diabetes, peritonitis episodes, RAAS blocker use, and PD modality were insignificant in Cox regression analysis. A CaXP of >55 was related to 2.51-fold, and high-glucose dialysates were associated with a 2.93-fold increased risk for a rise in transport status (p=0.01 and p<0.01). Mean follow-up was 7.0 (±3.9) years for stable transporters and 5.6 (±2.0) years for increased transporters. Technical survival was significantly higher in stable transporters (p=0.03). Conclusion Our study revealed a CaXP of >55 is a risk factor for a significant increase in transport status, presumably due to peritoneal calcification. The peritoneal Kt/V, PCrCl, and UF rates declined accordingly. The high-glucose dialysates are associated with a high risk in analyses. However, it is not possible to determine whether these solutions are the cause or the result of Type I membrane failure.

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Laryngeal cleft type I in neonate: case report

CoDAS ◽

10.1590/2317-1782/20142013071 ◽

2014 ◽

Vol 26 (5) ◽

pp. 421-424 ◽

Cited By ~ 1

Author(s):

Mirella Spinoso Rossi ◽

Karina Elena Bernardis Buhler ◽

Gabriel Alberto Brasil Ventura ◽

José Pinhata Otoch ◽

Suelly Cecilia Olivan Limongi

Keyword(s):

University Hospital ◽

Type I ◽

Speech Language Pathologist ◽

Thickened Liquid ◽

Laryngeal Cleft ◽

The University ◽

Thin Liquids ◽

General Diet ◽

Oral Diet

Laryngeal cleft (LC) is a congenital malformation that leads to the unusual communication between the esophagus and the laryngotracheal complex. It is a rare disease, mostly prevalent among male individuals. The goal of this study was to describe the evaluation and intervention by the speech language pathologist of a female newborn diagnosed with LC type I, admitted on the University Hospital of Universidade de São Paulo, in her second hospitalization due to small weight gain and pneumonia. She was submitted to a bedside clinical evaluation of the swallowing and the most important occurrence was frequent gagging. The videofluoroscopy swallowing study showed laryngotracheal aspiration level 8 for thin liquid and level 1 for thickened liquid, according to the Penetration-Aspiration Scale. The newborn was submitted to a microlaryngoscopy, in which the presence of LC type I was found. After the diagnosis, the speech language pathologist offered thickened liquid at 6% and, in 8 days, the newborn was discharged with exclusive oral diet without gagging. Eight outpatient consultations were carried out for 11 months, with emphasis on reintroduction of thin liquids. The treatment was discontinued and the patient was put on general diet for the age without modifications. Throughout follow-up, the patient remained asymptomatic and showed no respiratory complications.

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The Clinical Usefulness of Peritoneal Dialysis Fluids with Neutral pH and Low Glucose Degradation Product Concentration: An Open Randomized Prospective Trial

Peritoneal Dialysis International ◽

10.1177/089686080802800214 ◽

2008 ◽

Vol 28 (2) ◽

pp. 174-182 ◽

Cited By ~ 57

Author(s):

Hoon Young Choi ◽

Dong Ki Kim ◽

Tae Hee Lee ◽

Sung Jin Moon ◽

Seung Hyeok Han ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Prospective Trial ◽

Residual Renal Function ◽

Peritoneal Membrane ◽

Low Concentration ◽

Neutral Ph ◽

Randomized Prospective Trial ◽

Dialysis Fluids

Background Long-term peritoneal dialysis (PD) is associated with the development of various structural and functional changes to the peritoneal membrane when bioincompatible conventional peritoneal dialysis fluids (PDFs) are used. In this study, we looked at patients that were treated with conventional PDFs and then changed to novel biocompatible PDFs with a neutral pH and a low concentration of glucose degradation products (GDPs) to investigate whether this change could result in the arrest or reversal of peritoneal membrane deterioration. Methods In an open label, randomized prospective trial, the clinical effects of conventional PDFs and biocompatible PDFs with neutral pH and very low concentration of GDPs were compared in 104 patients equally divided between both study PDFs. Blood and effluent dialysate samples, peritoneal equilibration tests, and adequacy evaluation were undertaken at baseline, 4, 8, and 12 months. The target variables were the ratio of dialysate-to-plasma (D/P) creatinine, peritoneal ultrafiltration, residual renal function, dialysis adequacy indices, and effluent cancer antigen 125 (CA125). Results D/P creatinine values were not different in the two groups. Peritoneal ultrafiltration was significantly higher in the low-GDP PDF group than in the conventional PDF group at all follow-up times (4 months: 9.1 ± 4.3 vs 6.0 ± 3.0; 8 months: 8.3 ± 3.4 vs 6.0 ± 3.0; 12 months: 8.9 ± 3.3 vs 6.1 ± 3.3 mL/g dextrose/day; p < 0.05). Peritoneal Kt/V urea values and total weekly Kt/V urea values at 4 months were significantly higher in the low-GDP PDF group than in the conventional PDF group. Residual renal function was not statistically significant. Effluent CA125 levels were significantly higher in the low-GDP PDF group at all follow-up visits (4 months: 37.8 ± 20.8 vs 22.0 ± 9.5; 8 months: 41.2 ± 20.3 vs 25.9 ± 11.3; 12 months: 40.4 ± 21.4 vs 28.6 ± 13.0 U/mL; p < 0.05). Among anuric patients, peritoneal ultrafiltration at 4, 8, and 12 months, total weekly Kt/V at 4 and 8 months, and CA125 levels at all follow-up visits were significantly higher in patients treated with low-GDP PDF than those treated with conventional PDF. However, among anuric patients, D/P creatinine showed no significant differences between the low-GDP PDF group and the conventional PDF group. Conclusion The use of biocompatible PDFs with neutral pH and low GDP concentration can contribute to improvement of peritoneal ultrafiltration and peritoneal effluent CA125 level, an indicator of peritoneal membrane integrity in PD patients.

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Previous Renal Replacement Therapy Time at Start of Peritoneal Dialysis Independently Impact on Peritoneal Membrane Ultrafiltration Failure

International Journal of Nephrology ◽

10.4061/2011/685457 ◽

2011 ◽

Vol 2011 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Luís Oliveira ◽

Anabela Rodrigues

Keyword(s):

Peritoneal Dialysis ◽

Renal Replacement Therapy ◽

Replacement Therapy ◽

Time Course ◽

Residual Renal Function ◽

Type I ◽

Peritoneal Membrane ◽

Transport Parameters ◽

Free Survival ◽

Ultrafiltration Failure

Background. Peritoneal membrane changes are induced by uraemia per se. We hypothesise that previous renal replacement therapy (RRT) time and residual renal function (RRF) at start of peritoneal dialysis impact on ultrafiltration failure (UFF).Methods. The time course of PET parameters from 123 incident patients, followed for median 26 (4–105) months, was evaluated by mixed linear model. Glucose 3.86% solutions were not used in their standard therapy. Sex, age, diabetes, previous RRT time, RRF, comorbidity score, PD modality and peritonitis episodes were investigated as possible determinants of UFF-free survival.Results. PET parameters remained stable during follow up. CA125 decreased significantly. Inherent UFF was diagnosed in 8 patients, 5 spontaneously recovering. Acquired UFF group presented type I UFF profile with compromised sodium sieving. At baseline they had lower RRF and longer previous time of RRT which remained significantly associated with UFF-free survival by Cox multivariate analysis (HR 0.648 (0.428–0.980),P=0.04) and (HR 1.016 (1.004–1.028),P=0.009, resp.). UFF free survival was 97%, 87% and 83% at 1, 3 and 5 years, respectively.Conclusions. Inherent UFF is often unpredictable but transitory. On the other hand baseline lower RRF and previous RRT time independently impact on ultrafiltration failure free survival. In spite of these detrimental factors generally stable long-term peritoneal transport parameters is achievable with a 5-year cumulative UFF free survival of 83%. This study adds a further argument for a PD-first policy.

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Cystic dilation of the ventriculus terminalis

Journal of Neurosurgery Spine ◽

10.3171/2012.4.spine11504 ◽

2012 ◽

Vol 17 (1) ◽

pp. 86-92 ◽

Cited By ~ 17

Author(s):

Mario Ganau ◽

Andrea Talacchi ◽

Paolo C. Cecchi ◽

Claudio Ghimenton ◽

Massimo Gerosa ◽

...

Keyword(s):

Surgical Treatment ◽

Clinical Status ◽

Relevant Literature ◽

University Hospital ◽

Neurological Deficits ◽

Herniated Disc ◽

Treatment Modalities ◽

Consecutive Series ◽

Type I

Object The ventriculus terminalis, an embryological remnant consisting of the ependymal-lined space of the conus medullaris, can occasionally become symptomatic after cystic dilation. In the existing literature, consisting of 32 cases, the preferred type of management (conservative vs surgical) is still debated. The object of this study was to report the surgical results in a consecutive series of 10 adult patients with cystic dilation of the ventriculus terminalis (CDVT), to match them with data retrieved from the relevant literature, and specifically to validate a new recent clinical classification. Methods The authors reported 13 new cases of CDVT treated in the Department of Neurosurgery at University Hospital in Verona, Italy. Treatment modalities and clinical and radiological outcomes, both early and at follow-up, were analyzed and compared with a preoperative classification of clinical presentation, as established by de Moura Batista and colleagues (2008). Results Surgical treatment seemed to guarantee the resolution of CDVT. Dorsolumbar laminotomy, myelotomy, and cystic drainage were performed in 10 patients. Patients with Type I symptoms (nonspecific complaints) often presented with comorbidities (herniated disc or facet hypertrophy) confusing their clinical status. The surgical treatment of patients with Type I symptoms promoted good results only if the diagnosis of CDVT was definitive and symptoms had rapidly evolved. In patients with Type II (focal neurological deficits) and III (sphincter disturbances) symptoms, surgical treatment sustained improvement even at the late follow-up. Conclusions While confirming the usefulness of de Moura Batista and colleagues' classification in its impact on prognosis, the authors propose a revision of the classification with subgroups Type Ia (nonspecific symptoms without clear relation to CDVT), which is best treated conservatively, and Type Ib (rapid onset and invalidating unspecific complaints without comorbidities), which may benefit from surgical evacuation.

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Management of Pediatric Nasoorbitoethmoid Complex Fractures at a Level 1 Trauma Center

The American Surgeon ◽

10.1177/0003134821998682 ◽

2021 ◽

pp. 000313482199868

Author(s):

Margaret M. Luthringer ◽

Nicholas C. Oleck ◽

Thayer J. Mukherjee ◽

Jordan N. Halsey ◽

Mark S. Granick

Keyword(s):

Trauma Center ◽

Surgical Intervention ◽

Plate Fixation ◽

Treatment Algorithm ◽

Retrospective Chart Review ◽

University Hospital ◽

Type I ◽

Level 1 ◽

Level 1 Trauma Center

Purpose A universally accepted treatment algorithm for rare pediatric nasoorbitoethmoid (NOE) fractures has yet to be established. In this study, the authors examine how severity of pediatric NOE fractures interplays with patient characteristics, management choices, and complications from injury and surgical intervention at our institution. Methods A retrospective chart review was performed for all cases of pediatric NOE fracture at a level 1 trauma center (University Hospital in Newark, New Jersey) between 2002 and 2014. Results Fifteen of 1922 patients met our inclusion criteria. Ten (66.7%) demonstrated Markowitz type I injuries, 2 (13.3%) had type II NOEs, and 3 (20%) sustained type III fractures. Five (33.3%) of our patients were only monitored. Six (40.0%) were treated with plate fixation. One patient (6.7%) required enucleation alone, while 1 (6.7%) warranted enucleation with medial canthoplasty and plate fixation. Transnasal canthopexy was performed for 1 patient (6.7%). Zero patients managed without surgery had complications at 1-year follow-up. Surgical intervention was associated with complications in 4 of 15 patients. Both nonoperative treatment and plate fixation were associated with a higher rate of complications from initial injury or subsequent therapy when than other mentioned forms of treatment ( P = .004). Conclusion Nonoperative management for nondisplaced fractures is associated with zero complications at 1-year follow-up in our data; plate fixation and watchful waiting yield significantly fewer postoperative complications and injury sequelae than surgical intervention for medial canthal tendon and globe injuries.

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The Longitudinal Effect of a Single Peritonitis Episode on Peritoneal Membrane Transport in CAPD Patients

Peritoneal Dialysis International ◽

10.1177/089686080002000210 ◽

2000 ◽

Vol 20 (2) ◽

pp. 220-226 ◽

Cited By ~ 20

Author(s):

Kenan Ates ◽

Rafet Koç ◽

Gökhan Nergizoglu ◽

Sehsuvar Ertürk ◽

Kenan Keven ◽

...

Keyword(s):

Solute Transport ◽

Membrane Transport ◽

Regression Line ◽

University Hospital ◽

Logarithmic Scale ◽

Peritoneal Membrane ◽

Prospective Longitudinal Study ◽

Glucose Ratio ◽

Prospective Longitudinal

Objective To evaluate the longitudinal effect of a single peritonitis episode on peritoneal membrane transport. Design A prospective longitudinal study. Setting Department of nephrology in a university hospital. Patients Eighteen continuous ambulatory peritoneal dialysis patients with peritonitis. Methods Peritoneal transport for low, middle, and high molecular weight (MW) solutes was evaluated by peritoneal equilibration test (PET). The first PET was performed on the day following the diagnosis of peritonitis. The test was repeated at weeks 1, 2, 4, 12, and 24 and the results were compared to baseline PET data obtained before peritonitis. In addition, dialysate CA125 concentration and leukocyte count were measured. Results During peritonitis there were significant increases in dialysate-to-plasma (D/P) ratios for all low, middle, and high MW solutes except potassium, and decreases in D4/D0 glucose ratio and ultrafiltration (UF) volume. Over the subsequent 2 weeks, solute transport gradually decreased to the baseline values then remained unchanged during follow-up. Although net UF volume demonstrated a similar course during the study, it did not completely return to the baseline value. No decrease in D/P sodium ratio was found at 60 minutes during the PET performed 24 weeks after peritonitis. The percent change in solute transport during peritonitis compared to baseline value was significantly correlated with a solute's MW ( r = 0.776, p = 0.014). The slope of the regression line for D/P ratios versus MW, in double logarithmic scale, before peritonitis (-0.73 ± 0.09) was steeper than the slope during peritonitis (-0.59 ± 0.08). Conclusions These findings indicate that a single peritonitis episode does not permanently affect peritoneal solute transport. However, the loss of net UF that accompanies peritonitis is not completely recovered, probably due to impairment of transcellular water transport. The transport changes associated with peritonitis may be due to the combined effect of increased effective peritoneal surface area and intrinsic permeability. Our findings suggest that the latter mechanism seems to be more important.

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