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Biomedical subjects

D G Struijk

Publications and source records attributed to D G Struijk.

At least 73 records · Page 4Linked to original sources
PubMed1994

The effect of serum albumin at the start of continuous ambulatory peritoneal dialysis treatment on patient survival.

OBJECTIVE: To analyze the effect of serum albumin using immunoturbidimetry, demographic, biochemical, and kinetic factors on survival of continuous ambulatory peritoneal dialysis (CAPD) patients. DESIGN: A review of prospectively collected data in a 2-year follow-up study of peritoneal transport kinetics. SETTING: University medical center. PARTICIPANTS: Sixty-one patients, evaluated within 3 months after the start of CAPD. MAIN OUTCOME MEASURES: Covariables used in the survival analysis were plasma urea, and creatinine, albumin, hemoglobin, mass transfer area coefficient of creatinine, peritoneal albumin clearance, 4-hour peritoneal albumin loss, net ultrafiltration, age, blood pressure, body mass index, difference between actual and ideal bodyweight, and presence or absence of systemic disease. RESULTS: Overall survival was 64% at 2 years. Median serum albumin was 30.9 g/L, range 18.1-43.9 g/L. Patients with a serum albumin below the median had a lower survival rate than those higher than the median (2-year survival 49% vs 79%, p = 0.01). Using the Cox model, survival was related to systemic disease (p = 0.004), age (p = 0.02), hemoglobin (p = 0.03), and serum albumin (p = 0.1). CONCLUSIONS: The results confirm the strength of serum albumin as predictor of survival. However, in this study serum albumin merely reflected the presence of a systemic disease, which was the most important risk factor for patient survival.

Comorbidity↗
PubMed1993

Effect of dialysate osmolarity on the transport of low-molecular weight solutes and proteins during CAPD.

Osmotic-induced fluid and solute transport was studied in ten stable CAPD patients, who were examined twice within one week, using dialysate with 1.36% glucose on the first and 3.86% glucose on the second day. Peritoneal fluid kinetics were determined using intraperitoneally administered dextran 70 as a volume marker. After a four-hour dwell period, an increase in mean transcapillary ultrafiltration rate (TCUFR) with 3.86% glucose compared to 1.36% glucose was found (3.40 +/- 0.62 ml/min vs. 1.20 +/- 0.57, P < 0.001), but the lymphatic absorption was unchanged (1.32 +/- 0.10 ml/min vs. 1.42 +/- 0.15). The increased TCUFR resulted in a higher clearance of beta 2-microglobulin, but no differences were present in the clearances of albumin, transferrin, IgG, IgA and alpha 2-macroglobulin. This is consistent with the two pore theory for transcapillary transport with a small pore size of less than 40 A. The contribution of osmotic induced convection to the total transport of beta 2-microglobulin was small (6% during 1.36% glucose, 16% during 3.86% glucose), suggesting that macromolecules are mainly transported by diffusion or hydrostatic convection. The peritoneal restriction coefficient was 2.37 +/- 0.04, indicating restricted diffusion for macromolecules. In contrast, the restriction coefficient for low-molecular weight solutes was 1.24 +/- 0.03, in accordance with a process of mainly unrestricted diffusion for solutes smaller than 16 A. Higher values of protein clearances were found during the first hour of dialysis compared with the subsequent hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Effect of an increased intraperitoneal pressure on fluid and solute transport during CAPD.

The effect of an increased intraperitoneal pressure on fluid and solute transport was studied in eight stable CAPD patients. Two permeability tests of two hours each with continuous registration of the intraperitoneal pressure were performed while patients were in supine position. The intra-abdominal pressure was raised by means of a tightening girdle with inflatable cuffs in one of the experiments. Intraperitoneally administered dextran 70 was used as a volume marker in order to determine the peritoneal fluid kinetics. The increment in the intra-abdominal pressure of 10.0 +/- 1.0 mm Hg caused a decline in the net ultrafiltration. This was mainly determined by an increase in the lymphatic absorption: 1.07 +/- 0.18 ml/min (without compression) versus 1.86 +/- 0.25 ml/min (with compression; P < 0.01), whereas the transcapillary ultrafiltration rate tended to decrease: 2.02 +/- 0.23 versus 1.73 +/- 0.27 ml/min (P = 0.08). External compression also diminished solute transport from the circulation to the peritoneal cavity. The decline in the mass transfer area coefficient of urea, creatinine, urate and beta 2-microglobulin was 13%, indicating a smaller effective peritoneal surface area caused by external compression probably due to a decrease in the number of the perfused peritoneal capillaries. The fall in the peritoneal protein clearances was more pronounced the higher the molecular weight of the protein, consistent with a decline in the intrinsic permeability of the peritoneum. Kinetic modeling using computer simulations was used to analyse these effects in terms of the pore theory, using a convection model (large pore radius 184 +/- 14 A) and a diffusion model (large pore radius 1028 +/- 218 A) for the transport of macromolecules.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Immuno-effector characteristics of peritoneal cells during CAPD treatment: a longitudinal study.

Peritoneal cells (PC) from 75 patients were immuno-phenotypically and functionally characterized during the first year of CAPD treatment (PCcapd) and compared to PC obtained by laparoscopy of healthy women (control peritoneal cells). Patients were divided, according to their peritonitis incidence (PI), into a high PI (HPI) and a low PI group (LPI). The yield of PCcapd decreased significantly over the year. The differential cell count and immunophenotype of PCcapd remained unchanged in the LPI group, but the percentage of macrophages decreased over the year in the HPI group. Macrophages in the PCcapd, when compared to control peritoneal cells, had a less mature phenotype as measured by RFD7 expression but a higher Fc-receptor expression. The PCcapd showed a higher percentage of B cells, CD4 positive T cells and activated T cells bearing HLA-DR/DQ when compared to the control peritoneal cells. Over the year a decrease in chemotactic activity of the PCcapd towards 10(-8) M N-formylmethionyl-leucyl-phenylalanine and dialysis effluent was observed in LPI patients but not in HPI patients. After one year of treatment, a significantly higher percentage of phagocytosing macrophages in the PCcapd of HPI patients was found when compared to LPI patients. During the year there was an increase of immunophagocytosis of PCcapd independent of PI. In conclusion, the CAPD peritoneal cellular immune system showed signs of both immaturity and activation. The decrease in the yield and in the chemotactic activity of PCcapd suggests an adaptation to the chronic stimulus of the dialysis fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Interleukin-8 production by human peritoneal mesothelial cells in response to tumor necrosis factor-alpha, interleukin-1, and medium conditioned by macrophages cocultured with Staphylococcus epidermidis.

Patients treated with continuous ambulatory peritoneal dialysis (CAPD) may suffer from recurrent peritonitis episodes caused by Staphylococcus epidermidis. Early recruitment of granulocytes from the peripheral blood is important for the peritoneal antibacterial defense of CAPD patients. In this study, human peritoneal mesothelial cells were shown to produce high levels of interleukin-8 (IL-8) in response to IL-1 beta and tumor necrosis factor-alpha (TNF alpha) but not lipopolysaccharide or S. epidermidis. Coculture of peritoneal macrophages with S. epidermidis induced high levels of IL-1 alpha, IL-1 beta, and TNF alpha in 24-h-conditioned medium. Preincubation of this medium with anti-TNF alpha, anti-IL-1 alpha, or anti-IL-1 beta partially blocked stimulation of IL-8 production by mesothelial cells. Added together, these antibodies abolished IL-8 production to a level just above background. Migration of granulocytes to the stimulated mesothelial cell-conditioned medium could be totally blocked with rabbit polyclonal anti-IL-8 antibody. Thus, mesothelial cells are important for the recruitment of granulocytes into the peritoneal cavity.

Cells, Cultured↗
PubMed1993

Antigen-presenting capacity of macrophages and dendritic cells in the peritoneal cavity of patients treated with peritoneal dialysis.

In this study the antigen-presenting capacity of human peritoneal cells and the influence of continuous ambulant peritoneal dialysis (CAPD) were studied. On average 6% of the peritoneal cells were dendritic cells (DC), with no difference between CAPD and control peritoneal cells. DC were enriched by selecting for non-adherent, Fc receptor-negative, low density cells. A typical spot-like CD68 positivity was seen in DC, in contrast to the pancytoplasmic staining pattern in macrophages. Peritoneal DC morphologically and functionally showed features of cells belonging to the DC lineage. Peritoneal DC were superior antigen-presenting cells for both allo-antigen, and Candida albicans antigen or purified protein derivative. CAPD peritoneal macrophages were two- to three-fold better stimulator cells for allogeneic T cells compared with control macrophages. The level of integrins/adhesins or MHC class I or II, as measured semi-quantitatively on the FACS, could not account for this phenomenon. In addition, a double chamber system showed that dialysate-activated macrophages produced soluble factors that could enhance DC-induced allogeneic T cell proliferation. In conclusion, human peritoneal cells contain a relatively high percentage of classical DC. CAPD treatment does not impair the antigen-presenting capacity of peritoneal cells, but instead upregulates the allo-antigen-presenting capacity of peritoneal macrophages.

Antigen-Presenting Cells↗
PubMed1993

Fibronectin during CAPD-related peritonitis: no indications for intraperitoneal production.

Fibronectin is a 440-kD MW glycoprotein involved in opsonization and adhesion of cells to collagen. We examined 13 episodes of peritonitis on 8 consecutive days from the start and once after recovery (control). Fibronectin clearance was compared to that of marker proteins for peritoneal transport. Increased dialysate fibronectin levels were observed on the first peritonitis day. They declined during recovery. Serum levels were stable during peritonitis. All protein clearances, including fibronectin, were increased during the acute phase and decreased during recovery. The clearance of fibronectin showed a time course similar to that of the marker proteins. It was in the range between IgG (150 kD) and alpha 2-macroglobulin (820 kD), thus as expected on the basis of its molecular weight. We conclude that elevated dialysate fibronectin levels observed during peritonitis are due to increased transperitoneal transport and not to local synthesis. This augmented transport results from increments in both effective surface area and intrinsic permeability of the peritoneum.

Adult↗
PubMed1993

The effect of amphotericin B on fluid kinetics and solute transport in CAPD patients.

Loss of net ultrafiltration capacity is an important complication in long-term continuous ambulatory peritoneal dialysis (CAPD). It has been reported in animal studies that the drained volumes after a dwell period were larger when amphotericin B had been given intraperitoneally. In this study the effect of intraperitoneally administered amphotericin B on fluid kinetics was evaluated in 3 CAPD patients. The first patient lost 2.5 kg body weight during the first 4 days of treatment, whereas the net ultrafiltration in the second patient was higher in the treatment period compared with the nontreatment period (750 +/- 38 mL/day vs 438 +/- 34 mL/day (mean +/- SEM), p < 0.0001). In the last patient it can be demonstrated that the increase in the net ultrafiltration was caused by an increase in the transcapillary ultrafiltration (570 vs 454 mL/4 hours), but that lymphatic absorption was not different (251 vs 265 mL/4 hours). The higher transcapillary ultrafiltration capacity is probably caused by an increase in the hydraulic permeability. It is likely that this phenomenon is governed by the interaction of amphotericin B with membrane-bound cholesterol leading to the formation of transcellular pores. However, the administration of amphotericin B caused a chemical peritonitis, probably due to its solvent, sodium desoxycholate. Therefore, before amphotericin B can be used for the treatment of CAPD patients with ultrafiltration failure, further investigations are necessary to obtain a solvent for amphotericin B that is nontoxic and causes no chemical peritonitis.

Amphotericin B↗
PubMed1993

Relationship of TNF-alpha, interleukin-6, and prostaglandins to peritoneal permeability for macromolecules during longitudinal follow-up of peritonitis in continuous ambulatory peritoneal dialysis.

Infectious reactions are known to comprise changes in vasopermeability and inflammatory mediators. We used peritonitis that complicated continuous ambulatory peritoneal dialysis (CAPD) as an in vivo inflammation model to study the time courses of peritoneal permeability characteristics and mediators in dialysate. Sixteen episodes of peritonitis were prospectively followed on eight consecutive days from the onset of the infection and once after recovery (control). Dialysate night dwells were examined for marker proteins of peritoneal permeability, cytokines (tumor necrosis factor-alpha [TNF-alpha], interleukin-6 [IL-6] and prostaglandins (PGE2, 6-keto-PGF1 alpha, and thromboxane B2 [TxB2]). The clearance of beta 2-microglobulin was used as indicator of the effective peritoneal surface area. The intrinsic permeability was characterized functionally by the peritoneal restriction coefficient. All protein clearances were increased during the acute phase of peritonitis and subsequently decreased to control. Likewise, the intrinsic peritoneal permeability was elevated, as demonstrated by a decrease of the peritoneal restriction coefficient. Peritoneal appearance rates of TNF-alpha, IL-6, and prostaglandins were also increased during the acute phase. Peak values were reached on day 1. The largest increase was observed for IL-6 (median 854-fold), followed by TNF-alpha (35-fold). The vasodilating PGE2 and 6-keto-PGF1 alpha were increased 12-fold and the vasoconstricting TxB2 was increased threefold. Evidence was obtained for local intraperitoneal synthesis of IL-6 and prostaglandins. TNF-alpha production appeared to be present only during the early acute inflammatory response. Analysis of variance for repeated measurements revealed that changes in the clearance of beta 2-microglobulin were related to those in IL-6 and marginally also to TNF-alpha in dialysate. Changes in the peritoneal restriction coefficient were also related to IL-6, but were more closely related to alterations in dialysate PGE2. These findings suggest that TNF-alpha, IL-6, and PGE2 are involved in the changes in permeability characteristics during CAPD-related peritonitis.

6-Ketoprostaglandin F1 alpha↗
PubMed1993

The initial decrease in effective peritoneal surface area is not caused by an increase in hematocrit.

The possible relationship between initial changes in functional characteristics of the peritoneal membrane in time and hemoglobin (Hb) or hematocrit (Ht) was analyzed as part of a prospective longitudinal study. The patients were investigated twice: the first time within 3 months after the start of continuous ambulatory peritoneal dialysis (CAPD), and again 4 months later. Mass transfer area coefficients (MTC) for low molecular weight solutes and net fluid removal were calculated during a 4-hour dwell, glucose 1.36%. Thirty-four patients were analyzed. MTC (mean +/- SD, mL/min/1.73 m2), were higher during the first examination: urea 22.6 versus 19.9, p < 0.05; lactate 15.6 versus 13.8, p < 0.001; creatinine 10.5 versus 9.3, p < 0.05; glucose 9.4 versus 7.9, p < 0.001. Net fluid removal was lower during the first examination: 28 versus 99 mL/min/1.73 m2, p < 0.05. Hb and Ht increased between the two examinations (Hb: 5.4 vs 6.1 mmol/L, p < 0.001: Ht: 0.26 vs 0.29, p < 0.001). No relation was found between the absolute or relative change in Hb or Ht and the absolute or relative change in solute and fluid transport between the same examinations. In conclusion, Hb and Ht increased between the first and second examinations. The simultaneously observed changes in peritoneal transport kinetics could not be attributed to changes in Hb or Ht. Therefore, the changes in transport kinetics during the first months on CAPD are probably due to the recent start of the treatment, possibly by an increase in peritoneal surface area. Local irritation by the dialysate may be the causative mechanism.

Adult↗
PubMed1992

Indirect measurement of lymphatic absorption in CAPD patients is not influenced by trapping.

The disappearance rate of intraperitoneally administered macromolecules is often used to calculate lymphatic absorption during CAPD. The possible contribution of local accumulation (trapping) of such solutes in the tissues surrounding the peritoneal cavity, leading to overestimation of lymphatic flow, was investigated in eight CAPD patients. They were studied twice during a four hour dwell, glucose 1.36%, to which polydisperse neutral dextran 70 1 g/liter had been added for measurement of lymphatic flow. After the test on day 1 dextran 130 mg/kg was given intravenously and also dextran 1 g/liter was added to every following dialysis bag until the second test on day 3. This was done to saturate the tissues surrounding the peritoneal cavity and thereby to create a steady state condition. In one patient the dextran administration was continued until a third study was done on day 5. Dextran in serum during day 3 was 1.3 +/- 0.5 g/liter (mean +/- SD). No difference in peritoneal clearance of dextran was found between day 1 and day 3 (1.11 +/- 0.56 versus 0.97 +/- 0.41 ml/min). Also no difference was found between day 1 (0.32), day 3 (0.62), and day 5 (0.42 ml/min). Trapping would have influenced the first but not the second test, as the second time all tissues were saturated with dextran. As the dextran absorption rate remained the same, this indicates that trapping is of no importance and that lymphatic absorption can be measured by the disappearance of a macromolecular marker.

Absorption↗
PubMed1992

Effects of tracer, volume, osmolarity and infection on fluid kinetics during CAPD.

A review is given on various aspects of using the disappearance rate of intraperitoneally administered macromolecules for the determination of fluid kinetics in CAPD patients. The rationale and mathematics for the calculation of transcapillary ultrafiltration and of indirect measurement of lymphatic absorption are described. A comparison is made between autologous haemoglobin, human albumin and dextran 70. Dextran 70 appeared most useful; one brand of human albumin increased solute transport. Lymphatic absorption was higher after the installation of a 3-litre dialysate volume than after a 2-litre one, and also higher during peritonitis than after recovery from infection. A gradual increase in intraperitoneal volume, as obtained with glucose 3.86% dialysate, had no apparent effect on the disappearance rate of dextran 70. It is concluded that intraperitoneally administered dextran 70 is a clinically useful marker for the description of fluid kinetics in CAPD patients under various conditions.

Ascitic Fluid↗
PubMed1992

Use of the disappearance rate for the estimation of lymphatic absorption during CAPD.

Several studies are discussed which investigated the usefulness of the disappearance rate of macromolecules from the peritoneal cavity for estimating convective fluid loss from the peritoneal cavity into the peritoneal lymphatic system. It is shown that dextrans are removed from the peritoneal cavity by a size-independent process at a mean rate of 1.37 +/- 0.15 ml/min, whereas the clearance from blood to dialysate of dextrans is size-dependent. The fluid removal rate estimated by the difference in bidirectional transport of inulin (1.79 +/- 0.38 ml/min; p < 0.0005) was of the same order of magnitude as has been found using the removal rate of macromolecules from the peritoneal cavity. Also, the role of local accumulation of macromolecules was studied during continuous administration of dextrans. No differences were found in the dextran disappearance rate before and after saturation of the peritoneal interstitium with dextran (1.1 +/- 0.6 vs. 1.0 +/- 0.4 ml/min). During a study using a hypoosmotic solution we calculated a net transcapillary backfiltration of fluid, whereas the dextran removal rate was in the same order of magnitude as found using commercially available dialysate. In our opinion, the disappearance rate of macromolecules is an estimate of convective fluid loss from the peritoneal cavity into the peritoneal lymphatic system.

Absorption↗
PubMed1992

Residual volume measurements in CAPD patients with exogenous and endogenous solutes.

Accurate residual volume (RV) measurements are needed in studies on fluid kinetics during CAPD. In this study 10 stable CAPD patients were examined twice within 1 week. On both occasions RV after drainage was calculated by the indicator dilution method. Exogenous (dextran 70, inulin) and endogenous (albumin, IgG, urea, creatinine) solutes were used as markers. RV calculated with endogenous solutes (mean +/- SD) were significantly higher than those calculated with dextran (232 +/- 77 mL) and inulin (223 +/- 73): albumin (389 +/- 123), IgG (497 +/- 180), urea (465 +/- 129) and creatinine (429 +/- 109). The relationship between RV calculated with exogenous solutes was much better than between those calculated with endogenous solutes: dextran vs inulin (r = 0.91), albumin vs IgG (r = 0.69) and urea vs creatinine (r = 0.63). Since mass transport of endogenous solutes during rinsing time exceeds mass transport of dextran and inulin, RV was also calculated after corrections had been made for diffusive mass transport of endogenous solutes during the rinsing procedure. After this correction only albumin was similar to exogenous solutes (244 +/- 111 mL) and had an acceptable confidence interval when compared to dextran. No correlation was found between RV on the first and second day, suggesting large intra-individual variability. We conclude that RV should be calculated with dextran or inulin. When no exogenous solutes are used, albumin is the best alternative. However, only rough estimations are obtained when no correction for diffusion is applied.

Adult↗
PubMed1992

Adherence of Staphylococci to plastic, mesothelial cells and mesothelial extracellular matrix.

In this study we have investigated whether mesothelial cells (MC) and mesothelial extracellular matrix (ECM) are suitable substrates for the adherence of Staphylococci. Mesothelial cells were isolated from the peritoneal dialysis effluent by making use of their lack of Fc-receptors and capacity to attach firmly to plastic. After 10 days post-confluency the MC monolayer was removed with 0.1% Triton-X100 and the presence of an ECM shown by enzyme linked immunosorbent assay (ELISA). The ELISA showed the presence of fibronectin and laminin but not of type IV collagen and vitronectin. Bacterial adherence assays with Staphylococcus aureus (N:3 isolates) adhered well to both ECM (33.4%) and MC monolayers (40.2%; ECM vs. MC monolayers p < 0.03). Staphylococcus aureus adhered significantly better to both ECM (p < 0.05) and MC monolayers (p < 0.05) when compared to plastic. Staphylococcus epidermidis (N:3 isolates) showed similar adherence for plastic (22.1%) and MC monolayers (23.5%); mesothelial ECM was a relatively poor substrate for adherence (6.8%, p < 0.03). In conclusion, results obtained sofar do not indicate an increased risk for adherence of Staphylococci when the mesothelial ECM is exposed.

Bacterial Adhesion↗