The Management of Hydrothorax in Continuous Ambulatory Peritoneal Dialysis (CAPD)

1990 ◽  
Vol 10 (4) ◽  
pp. 271-274 ◽  
Author(s):  
Andrew Green ◽  
Mark Logan ◽  
Walid Medawar ◽  
Francis McGrath ◽  
Francis Keeling ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Blood Sugar ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
High Glucose ◽  
Definitive Diagnosis ◽  
The Other ◽  
Pleural Effusions ◽  
Glucose Content ◽  
Maintenance Haemodialysis ◽  
Glucose Estimation

Four patients on continuous ambulatory peritoneal dialysis (CAPD) developed large, symptomatic pleural effusions after commencing peritoneal dialysis. Pleuroperitoneal fistula in each case was diagnosed by the presence of a high glucose content in pleural fluid, with a normal corresponding blood sugar, and was confirmed by isotope or contrast peritoneography. Two patients had their effusions drained percutaneously, and then underwent pleural sclerosis with intracavitary tetracycline. Two patients had a thoracotomy performed, of which no fistula was identified in one case, and the other patient underwent pleurectomy. All four patients successfully recommenced CAPD several weeks after therapy, without recurrence of effusions. We conclude that pleuroperitoneal connections associated with CAPD do not mandate cessation of peritoneal dialysis and conversion to maintenance haemodialysis. Definitive diagnosis requires aspiration of pleural effusions for glucose estimation. Contrast or isotopic peritoneography is helpful in localising the fistula, but in our experience did not alter management. Simple sclerotherapy is effective and avoids the need for a formal thoracotomy.

P1133XYLITOL-BASED PERITONEAL DIALYSIS SOLUTIONS MITIGATED IN VITRO MESOTHELIAL AND ENDOTHELIAL TO MESENCHYMAL TRANSITION

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Valentina Masola ◽  
Arduino Arduini ◽  
Mario Bonomini ◽  
Giovanni Gambaro ◽  
Gianluigi Zaza
Keyword(s):  
Gene Expression ◽  
Endothelial Cells ◽  
Peritoneal Dialysis ◽  
High Glucose ◽  
Zinc Finger Protein ◽  
Mesothelial Cell ◽  
In Vivo Studies ◽  
Glucose Content ◽  
Mesenchymal Transition

Abstract Background and Aims Fibrosis, angiogenesis and microvascular alteration are main pathogenetic mechanisms involved in the progressive loss of the peritoneal ultrafiltration capacity in patients undergoing peritoneal dialysis (PD). Main cause of this condition is the continuous peritoneal exposure to hyperosmotic and hyperglycaemic agents. High glucose level activates the Mesothelial to Mesenchymal Transition (MMT) and the Endothelial-to-Mesenchymal (EndMT) program, which are responsible for the development of fibrosis/chronic peritoneal damage. Moreover, the high glucose content of PD solution may induce the VEGF production with consequent neo-angiogenesis. Therefore, the introduction of more biocompatible solutions in clinical practice is necessary for preserving the long-term peritoneal membrane. To this purpose we tested the in vitro effects of a new commercially available PD solutions containing xylitol, carnitine and reduced glucose, at comparable osmotic strength (XyloCore). Method Human vein microvascular endothelial cells (HMVEC) were cultured in EGM™-2MV medium (Lonza) and Human peritoneal mesothelial cell line (HMrSV5) were cultured in Dulbecco's Modified Eagle Medium (DMEM; Gibco) containing 10% fetal bovine serum. Cells were cultured to confluence and then treated for 3 hours with serum free medium, XyloCore 0.7 (0.5% Glucose, 0.7% Xylitol and 0.02% L-carnitine), XyloCore 1.5 (0.5% Glucose, 1.5% Xylitol and 0.02% L-carnitine) and commercially available glucose-based solutions (Fixioneal) 1.36% and 2.27% Glucose. Gene expression of MMT/EndMT, apoptosis, inflammation, extracellular remodeling and angiogenesis markers was evaluated by real-time PCR. Cell viability was assayed by MTS assay. Results Our in vitro results demonstrated that XyloCore solutions, by influencing only partially the mesothelial and endothelial cells viability, demonstrated a good biocompatible profile. Then, gene expression analysis of HMVEC and HMrSV5 treated with XyloCore solutions revealed a significant down-regulation of transcripts encoding for MMT and EndMT biomarkers (Zinc finger protein SNAI1, TGF-beta, alpha-SMA and vimentin), and pivotal biological elements involved in apoptosis (Bcl-2), extracellular matrix remodeling (matrix metallopeptidases), inflammation (IL-1beta, IL-6) and angiogenesis (Vascular endothelial growth factor) compared to glucose-based solutions with comparable osmotic strength. Conclusion These in vitro results demonstrated, for the first time, that XyloCore solutions have a better biocompatible impact and less pro-fibrotic potentials compared to conventional glucose-based solutions. These effects, if confirmed in in vivo studies, could have interesting clinical potentials.

Lipoprotein (a) Levels in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 236-241 ◽  
Author(s):  
Carmen Guindeo ◽  
Nicanor Vega ◽  
Ana M. Fernandez ◽  
Leocadia Palop ◽  
Jose A. Aguilar ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Treatment Group ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
The Other ◽  
Control Group ◽  
Protein Loss ◽  
Significant Relation ◽  
Dialysis Treatment ◽  
Lipoprotein A ◽  
Group I

Most researchers have found increases of lipoprotein (a) [Lp(a)] in uremic patients, as well as in those undergo ng hemodialysis (HD) or continuous ambulatory peritoneal dialysis (CAPD). The mechanisms for this increase remain unclear. We studied 71 patients undergoing CAPD, 48 me n and 23 women. According to the time spent on CAPD, the patients were divided into three groups: group 0: 29 patients at the starting off point of dialysis treatment; group I: 22 patients with an average stay of 15.2 months; group II: 20 patients with an average stay of 69.3 months on CAPD. We have only observed significant increases of Lp(a) levels in those patients initiating the dialysis, but no significant differences are found in the other groups undergoing CAPD for longer periods when compared to the control group. We found no significant relation between Lp(a) levels and peritoneal protein loss, and not with absorption of glucose from the dialysate either. We have found a positive and significant correlation between Lp(a) levels and urinary protein loss (r = 0.41; p < 0.001). It is possible that an element associated with proteinuria might have an effect on the metabolism of Lp(a) in CAPD patients.

scholarly journals Pleuroperitoneal Leak: An Unusual Cause of Acute Shortness of Breath in a Peritoneal Dialysis Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
D. P. Ramaema ◽  
P. Mpikashe
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Dialysis Patient ◽  
Peritoneal Dialysis Patient ◽  
Shortness Of Breath ◽  
Pleural Effusions ◽  
Dialysis Patients ◽  
Case Presentation ◽  
Peritoneal Scintigraphy ◽  
Uncommon Complication

Introduction. Pleuroperitoneal leak is an uncommon complication of continuous ambulatory peritoneal dialysis (CAPD), with an estimated incidence of 1.6%. It should be suspected in these patients when they present with recurrent unilateral pleural effusions and/or acute shortness of breath following dialysate infusion.Case Presentation. We present the case of a 25-year-old female patient who had acute hydrothorax as a result of pleuroperitoneal leak complicating continuous ambulatory peritoneal dialysis (CAPD), which was confirmed on peritoneal scintigraphy.Conclusion. Continuous ambulatory peritoneal dialysis patients presenting with acute shortness of breath and/or recurrent unilateral pleural effusion should be investigated with peritoneal scintigraphy to exclude pleuroperitoneal leak.

The pituitary-testicular axis of uraemic subjects on haemodialysis and continuous ambulatory peritoneal dialysis

1982 ◽  
Vol 101 (3) ◽  
pp. 464-467 ◽  
Author(s):  
C. G. Semple ◽  
G. H. Beastall ◽  
I. S. Henderson ◽  
J. A. Thomson ◽  
A. C. Kennedy
Keyword(s):  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Free Testosterone ◽  
Control Group ◽  
Total Testosterone ◽  
Testicular Function ◽  
Maintenance Haemodialysis ◽  
Significant Difference ◽  
Group Serum

Abstract. Pituitary-testicular function was evaluated in 18 patients with chronic renal failure, 9 treated by maintenance haemodialysis (HD) and 9 by continuous ambulatory peritoneal dialysis (CAPD), and compared with a non-uraemic control group. Serum total testosterone and the free testosterone index were significantly low in both dialysis groups. Basal FSH and LH levels were elevated but this reached significance only with regard to LH. The responses of both FSH and LH to the iv administration of LRH were normal. There was no significant difference between the CAPD and HD groups in any of the hormonal parameters estimated. While CAPD may improve control of some metabolic parameters when compared with HD, it does not improve the function of the pituitary-testicular axis.

Computerized Tomography CT in the Diagnosis of Subcutaneous Leak Sites during Continuous Ambulatory Peritoneal Dialysis (CAPD)

1984 ◽  
Vol 4 (3) ◽  
pp. 163-166 ◽  
Author(s):  
Zbylut J. Twardowski ◽  
Richard J. Tully ◽  
W. Kirt Nichols ◽  
Sobha Sunderrajan
Keyword(s):  
Peritoneal Dialysis ◽  
Inguinal Hernia ◽  
Ct Scan ◽  
Computerized Tomography ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Supine Position ◽  
The Other ◽  
Contrast Injection ◽  
Peritoneal Catheter ◽  
Fluid Leakage

Two patients receiving continuous ambulatory peritoneal dialysis (CAPD) presented with abdominal, and scrotal or vulvar edema. In both we suspected a dialysate leak, but the leak site could not be defined clinically. In one patient, a plain CT scan (without contrast in dialysate) revealed a small inguinal hernia and ruled out a pericatheter leak. In the other patient the route of fluid leakage could not be detected on a plain CT scan, or when images were taken immediately after contrast injection into dialysate, while the patient remained in the supine position on the CT table. Images taken two hours after contrast injection, with the patient ambulatory in the meantime, disclosed a leak through the tunnel of a previous peritoneal catheter. The diagnosis was confirmed at operation in both patients. Our experience suggests that when the diagnosis cannot be established clinically, CT scan may be useful to delineate a leak site.

Hydrothorax as a Complication of Pediatric Peritoneal Dialysis

1987 ◽  
Vol 7 (4) ◽  
pp. 237-239 ◽  
Author(s):  
Timothy E. Bunchman ◽  
Ellen G. Wood ◽  
Robert E. Lynch
Keyword(s):  
Peritoneal Dialysis ◽  
Respiratory Symptoms ◽  
Pediatric Patients ◽  
Common Factors ◽  
The Other ◽  
Surgical Trauma ◽  
Pleural Effusions ◽  
Short Period ◽  
Causative Agents ◽  
Technical Factors

Hydrothorax is a known complication of peritoneal dialysis (PD) but there is very little in the pediatric literature concerning this complication. From 1982 to 1984 seven of 29 of our patients who underwent peritoneal dialysis, developed pleural effusions as a complication of PD. These patients varied in respect to age, technique and duration of PD. Four of the seven developed respiratory symptoms at the time when effusions were discovered, while the other three were recognized during evaluation of loss of ultrafiltration. Five of the seven had right-sided effusions, one had a left-sided effusion, and one had bilateral effusions. No technical factors could be identified as causative agents. We have concluded that pediatric patients may be particularly likely to develop hydrothorax as a complication of peritoneal dialysis. This may present as a pulmonary emergency or as a subtle loss of ultrafiltration ability. The possibility of congenital potential communicating pathways seems more likely than any other single explanation for this phenomena. Hydrothorax as a complication of peritoneal dialysis (PD) is reported chiefly in the adult PD literature. The first reports were associated with trauma but in most subsequent cases, there was no explanation. We are aware of only two accounts of this complication in children covering a total of eight cases. Several of these may have been related to surgical trauma (1). However, in our own patient population, we observed seven who developed hydrothorax while on various forms of PD. Review of individual cases did not demonstrate common factors which would explain the hydrothorax. Thus, hydrothorax developed during PD in a significant number of infants over a short period and under a variety of clinical circumstances. This suggests the existence of potential anatomical channels which may open under a variety of circumstances.

Comparison of Serum Calcium Fractions during Haemodialysis and Peritoneal Dialysis

1987 ◽  
Vol 24 (6) ◽  
pp. 585-590 ◽  
Author(s):  
P M Kelly ◽  
M R Bending ◽  
J L Barron
Keyword(s):  
Peritoneal Dialysis ◽  
Healthy Volunteers ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Serum Calcium ◽  
Reference Group ◽  
The Other ◽  
Total Calcium ◽  
Ionised Calcium ◽  
Before And After ◽  
Active Calcium

Total, ultrafiltrable and ionised calcium concentrations were determined in anaerobic serum from healthy volunteers, patients immediately before and after haemodialysis and patients on continuous ambulatory peritoneal dialysis (CAPD). Protein-bound, complexed and albumin-corrected total calcium concentrations were calculated from the results. During haemodialysis, complexed calcium did not change, whereas the other fractions increased. For patients on CAPD, the total, ionised and protein-bound calcium results were frequently lower than the reference group, whereas the ultrafiltrable and albumin-corrected total calcium results were within or higher than the reference group. Albumin-corrected total calcium for all subjects correlated better with ultrafiltrable calcium than with ionised calcium. It was concluded that low ionised calcium concentrations found in CAPD patients may be related to low albumin concentrations, and the concentration of physiologically active calcium may be normal in these patients.

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