Nutrition in diabetic patients undergoing continuous ambulatory peritoneal dialysis.
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Diabetic Nephropathies↗
Biomedical subjects
E Thodis
Publications and source records attributed to E Thodis.
Recommendations for glucose control in diabetics on CAPD.
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Blood Glucose↗
Evaluation of changes in serum and dialysate levels of cancer antigen 125 in stable continuous ambulatory peritoneal dialysis patients.
To estimate the relationship between changes in the concentration of cancer antigen 125 (CA125) and peritoneal membrane kinetics, the permeability characteristics of 44 continuous ambulatory peritoneal dialysis (CAPD) patients who had been treated with peritoneal dialysis for at least six months were prospectively evaluated. Twenty-seven males (age 66 +/- 6 years, duration of CAPD 35.5 +/- 29 months) and seventeen females (age 63.7 +/- 9 years, duration of CAPD 47.7 +/- 32 months) were evaluated. Peritoneal equilibration test (PET) data and Adequest (Baxter Healthcare Corporation, Deerfield, Illinois, U.S.A.) data were analyzed in all patients over a 12-month period, while CA125 levels were measured in blood and dialysate samples. No statistically significant correlations were seen between the patients' age, sex, or peritonitis incidence rates, and serum and dialysate levels of CA125. Dialysate-to-plasma ratio (D/P) of small solutes at 0 and 240 minutes also showed no statistical correlation. Statistical analysis revealed a statistically significant negative correlation (r = -0.33, p = 0.035) between dialysate CA125 and duration of CAPD. The statistically significant difference found between dialysate CA125 concentrations at 0 minutes and 240 minutes (2.32 +/- 1.3 U/mL vs 9.08 +/- 6.8 U/mL, p < 0.0001), means that CA125 concentration increases with longer dwell time. These results suggest that the duration of CAPD clearly affects dialysate CA125 concentrations. CA125 may therefore be used as a useful marker to evaluate the mesothelial cell mass in longitudinal follow-up.
Aged↗
Nonsurgical implantation of Tenckhoff peritoneal catheters in patients on continuous ambulatory peritoneal dialysis.
From 1994 to 1998, 54 Tenckhoff peritoneal catheters were implanted in 49 patients undergoing continuous ambulatory peritoneal dialysis. The implantation technique included bedside insertion of peritoneal catheters via trocar under local anesthesia. Early and late complications of this technique were comparable with surgical techniques. Cumulative survival of all catheters was 91% after one year, 78% after two years, 71% after three years, and 68% after four years. Our results suggest that the percutaneous technique for insertion of peritoneal catheters remains an easy, safe, and useful technique in the management of end-stage renal disease patients.
Catheters, Indwelling↗
Bioelectrical impedance analysis in the evaluation of the nutritional status of continuous ambulatory peritoneal dialysis patients.
The authors evaluated the nutritional status of 47 continuous ambulatory peritoneal dialysis (CAPD) patients, 26 men (age 58.9 +/- 14.6 years, duration on CAPD 27.3 +/- 18.3 months) and 21 women (age 56.2 +/- 14.9 years, duration on CAPD 34.5 +/- 23.4 months), using subjective global assessment (SGA), an established method for the nutritional assessment of dialysis patients, and bioelectrical impedance analysis (BIA: body cell mass, fat mass, and phase angle). Of the studied patients, 19 were diabetic (age 59.7 +/- 13.8 years, duration on CAPD 29.2 +/- 19.7 months) and 28 were non diabetic (age 53.9 +/- 14.3 years, duration on CAPD 31.5 +/- 21.8 months. According to SGA, 24 patients were scored as well nourished (Group I), 18 as mildly malnourished (Group II), and 5 as moderately malnourished (Group III). No patient scored as severely malnourished (Group IV). Analysis of the main nutritional parameters for the subgroups revealed a proportional decrease in phase angle, with a statistically significant correlation (p < 0.009) between phase angle and SGA. No significant difference was seen in serum albumin levels between patients in Group I and Group II, but the mean level was significantly lower in patients in Group III compared to Group I. The nutritional and biochemical data in diabetic patients and non diabetic patients were not significantly different. BIA phase angle seems to be a simple and reliable method for the routine assessment of nutritional status in CAPD patients.
Diabetes Complications↗
Failure of icodextrin to provide adequate ultrafiltration in continuous ambulatory peritoneal dialysis patients.
Icodextrin, a starch-derived glucose polymer with an average molecular weight of 20,000 D, has been developed partly as a response to some of the disadvantages of dextrose. It has been suggested that icodextrin solutions are able to provide sustained ultrafiltration (UF) over long dwell times of 8-12 hours in continuous ambulatory peritoneal dialysis (CAPD). In this paper we describe three patients on CAPD: 2 males and 1 female aged 60, 67, and 58 years respectively, duration on CAPD 47, 60, and 15 months respectively. All of these patients, who were categorized as high transporters according to peritoneal equilibration test (PET) results, presented early signs of ultrafiltration loss with no evidence of peritoneal inflammation. Icodextrin solution was used in a single nightly exchange with 10-12 hours' dwell, for a period of 5-30 days. In all of these cases, icodextrin solution failed to provide adequate ultrafiltration and the patients returned to the previously used regime of five daily hypertonic exchanges of 3.86% glucose concentration. Although these negative results were not clearly explained, we report these three cases because they exemplify some limitations of icodextrin solution to provide adequate ultrafiltration, at least in a small number of CAPD patients.
Aged↗
Early peritoneal catheter removal may be life saving in fungal peritonitis.
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Antifungal Agents↗
Evaluation of bone mineral density in CAPD patients with dual energy X-ray absorptiometry.
In this study bone mineralization was evaluated using dual energy x-ray absorptiometry (DEXA), which measured regional bone mineral density [BMD (g/cm2)] at two skeletal sites, the lumbar spine and the femur, in 33 patients (15 male, 18 female) undergoing continuous ambulatory peritoneal dialysis (CAPD) with no history of chronic disease or medications affecting bone. The biochemical profile included measurements of plasma levels of calcium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (iPTH). We did not find any statistically significant difference or correlation between BMD and the examined parameters, except for the lower BMD values in the female population. Because of the reported findings of significantly lower PTH levels in CAPD patients with low turnover bone disease (adynamic bone disease) and the higher prevalence in CAPD than in hemodialysis patients, we tried to evaluate any correlation between BMD and iPTH levels in CAPD patients that were separated into two groups: group A (iPTH < 200 pg/mL), 13 patients, and group B (iPTH > 200 pg/mL), 20 patients. Data analysis revealed a negative correlation between PTH levels and BMD values (r = -0.66, p = 0.014) as PTH and serum calcium (r = -0.77, p = 0.002) only in group A. No other statistically significant changes were observed. These findings suggest that there is a favorable influence of CAPD modality on bone mineralization, while no special DEXA findings are representative of the possible appearance of adynamic bone disease.
Absorptiometry, Photon↗
The identification of bone mineral density in CAPD in comparison with HD patients.
Renal osteodystrophy is a virtually universal complication of chronic renal failure (CRF). Varying degrees of calcium-phosphate metabolism derangement and different types of skeletal damage are observed in CRF for many reasons while the use of dialysis for the management of end-stage renal failure further affects these complications. This study was designed to evaluate the bone mineral density (BMD) that is measured by dual-energy x-ray in three groups of patients: A, 10 patients on continuous ambulatory peritoneal dialysis (CAPD); B, 10 patients on hemodialysis (HD); and C, 10 predialytic patients with advanced CRF. All patients were matched for age, sex, duration of dialysis (> 3 years), and the use of phosphate binders. Biochemical (serum iPTH levels, SAP, Ca, P) and radiological bone studies were compared in the three groups. The majority of predialytic patients had BMD values within the normal range, while the BMD values in PD patients were higher (0.985 g/cm2) in comparison with HD patients (0.949 g/cm2). Some patients, especially in the HD population, showed an increase in BMD with time on dialysis. From all other comparisons, radiological signs of high turnover bone disease and osteopenia were the only variables that were correlated with BMD. All these findings suggest that dialysis affects the bone status and that CAPD patients have better bone mineral metabolism as shown mainly with the use of BMD measurements.
Absorptiometry, Photon↗
Treatment and prevention of relapses of CAPD Pseudomonas peritonitis.
Pseudomonas peritonitis in continuous ambulatory peritoneal dialysis (CAPD) can be difficult to eradicate, because it is frequently resistant to common antibiotics, inducing the loss of the peritoneal cavity in some cases. A total of 14 episodes of Pseudomonas peritonitis in 12 patients (6 male, 6 female) were treated with intraperitoneal (IP) administration of a combination of ceftazidime and tobramycin. All patients were hospitalized. The loading doses were 1000 mg/2 L of ceftazidime and 1.7 mg/kg of tobramycin, and the maintenance IP doses were 250 mg/2 L of ceftazidime and 16 mg/2 L of tobramycin. The therapy duration was 14 days. In 7 episodes (group A) no other antibiotic regimen was provided, while in the remaining 7 episodes (group B) therapy was continued with 500 mg b.i.d. of oral ciprofloxacin for the next 14 days. Pseudomonas species isolated in group A were P. alcaligenis (1), P. putida (1), P. maltophilia (1), R. cepacia (1), and unidentified (3). In group B the following Pseudomonas species were isolated: P. aeruginosa (4), P. diminuta (1), P. stutszeri (1), and unidentified (1). Recurrence of peritonitis was seen in 4 episodes of group A with 2 catheter removals, while all episodes were cured in group B. These results suggest that IP ceftazidime and tobramycin with the additional use of oral ciprofloxacin is successful in the treatment and prevention of relapses of Pseudomonas peritonitis.
Ceftazidime↗
Evaluation of CNS-function in CAPD patients using magnetoencephalography (MEG): comparison with hemodialysis patients.
In order to evaluate the CNS-function of uremic patients, the magnetic activity emitted from the brain of 20 pts (10 pts on CAPD and 10 on HD) was measured. MEG consisted of taking 32 consecutive records from the 32 equally spaced points chosen on the skull in uremic pts around our reference points T3, T4, P4, F3, F4 of the international 10-20 electrode placement point system. MEG data were converted using an AD-converter with sampling frequency 256 Hz and stored in a P/C. Our results showed significant differences between the two groups. In all HD pts there was abnormal magnetic brain activity with high spectral amplitudes (in the band 2-7 Hz) which was more prominent in pts in hemo for more than 4 years. The magnetic activity was within normal ranges in all CAPD pts. We conclude that: 1) There is high magnetic brain activity in HD pts, which in accordance with the EEG findings are signs of diffuse encephalopathy. 2) CAPD pts show a very low magnetic brain activity which must be interpreted as normal brain function, and 3) MEG can be useful in further measurement of adequacy of dialysis.
Adult↗
Treatment of CAPD peritonitis with clavulanate potentiated ticarcillin.
A total of 16 episodes of peritonitis in 14 patients (9 males, 5 females), were treated with Clavulanate potentiated ticarcillin (TC), a -lactamase stable parenteral penicillin. All the pts were hospitalized and received initial loading dose of 3.2 gr intraperitoneally (i.p.) in a 6-hour 1 L exchange, which was followed by four 1 L exchanges with 320 mg/LTC. The therapy was continued for ten days. The bacteria isolated were: Staph. epid. (4), Staph. aureus (2), Strept. viridans (1), Enterococcus (1), Klebsiella Pneum. (1), Serratia (1), Enterobacter (1), Pseudomonas species: stutszeri (2), cepacia (1), fluorescens (1), negative cultures (1). Recurrence of peritonitis was seen in three patients with Pseudomonas (stutszeri (2), fluorescens (1)) peritonitis, 10-16 days after cessation of therapy. No clinical or biological side effects were seen in any patient during and/or after the therapy. These results suggest that, i.p. monotherapy of TC is effective in the treatment of CAPD peritonitis, while in cases of Pseudomonas peritonitis more specific regimens should be used.
Anti-Bacterial Agents↗
Efficacy of vancomycin plus tobramycin as antiperitonitis regimen for patients on CAPD.
From October 1985 to August 1989, 55 episodes of peritonitis were treated with intraperitoneal (i.p.) use of Vancomycin (V) and Tobramycin (T), in 35 patients (18 males, 17 females). After three rapid IL peritoneal exchanges, the pts received i.p. loading dose of V500 mg/L and an intramuscular dose of T 1.7 mg/Kg, followed by four IL exchanges, with addition of V15 mg/L and T8 mg/L. The length of treatment was 10 days for all pts. The continued administration of V or T as the simple antibiotic regimen was based on the antibiogram, while the combination of both antibiotics was used in negative cultures. Recurrence of peritonitis was seen in 3 episodes (5.4%). No side effects were seen during the therapy. These results indicate that the i.p. use of Vancomycin plus Tobramycin are an appropriate antiperitonitis regimen in the treatment of CAPD peritonitis.
Drug Therapy, Combination↗
Effect of a calcium antagonist (verapamil) on the permeability of the peritoneal membrane in patients on continuous ambulatory peritoneal dialysis.
Peritoneal clearances of small solutes, mass transfer, ultrafiltration, and the mass transfer area coefficient were measured in order to evaluate the effect of calcium antagonists on the permeability of the peritoneal membrane in patients on continuous ambulatory peritoneal dialysis. We studied 10 patients before and after the instillation of 10 mg (5 mg/l) of verapamil into the peritoneal cavity. Our results showed a significant increase of urea, creatinine, and uric acid clearances. A significant increase in ultrafiltration and mass transfer coefficient area was also observed (p less than 0.05), while the mass transfer of K+, Na+, and Ca2+ was essentially unchanged. These findings indicate that the intraperitoneal use of verapamil may induce an increase in the peritoneal permeability in patients on continuous ambulatory peritoneal dialysis.
Adult↗
The effect of calcium antagonists on the peritoneal membrane in patients on CAPD.
In order to evaluate the effect of Calcium Antagonists on the permeability of the peritoneal membrane in patients on CAPD, the peritoneal clearances, the mass transfer, the ultrafiltration and the mass transfer area coefficient (MTAC) were measured. We studied 10 patients before and after the instillation of 10 mg (5 mg/L) of Verapamil into the peritoneal cavity. Our results showed a significant (p less than 0.05) increase of urea, creatinine and uric acid clearances. A significant increase (p less than 0.05) in the ultrafiltration and MTAC was also observed, while the mass transfer of electrolytes K+, Na+ and Ca++ was unchanged. These findings indicate that the intraperitoneal use of verapamil may induce an increase in the peritoneal permeability in patients on CAPD.
Adult↗
The effect of small solute clearances on survival of anuric peritoneal dialysis patients.
OBJECTIVE: Primarily, to determine whether peritoneal small solute clearance is related to patient and technique survival among anuric peritoneal dialysis [continuous ambulatory (CAPD) and automated peritoneal dialysis (APD)] patients. A secondary goal was to describe the ability to attain Dialysis Outcomes Quality Initiative (DOQI) targets among anuric patients on peritoneal dialysis. DESIGN: Retrospective cohort study via chart reviews. SETTING: Peritoneal Dialysis Unit of Toronto Hospital (Western Division). PATIENTS: The study included 122 CAPD and APD patients between January 1992 and September 1997, with 24-hour urine volume less than 100 mL, or renal creatinine clearance (CCr) less than 1 mL/minute. Adequacy data were available for 115 patients. OUTCOME MEASURES: Mortality and technique failure (TF). Regression analysis was used to estimate the mortality and TF rate ratios (RR) for peritoneal Kt/V urea (pKt/V) and pCCr, adjusting for age, gender, diabetes, months of follow-up prior to anuria, albumin, transport status, coronary artery disease, cardiovascular disease, and peripheral vascular disease. RESULTS: Fifty seven per cent (51/89) of patients on CAPD and 81% (21/26) on APD had a weekly pKt/V > or = 2 and > or = 2.2, respectively (DOQI targets); whereas only 35% on CAPD (31/89) and 35% (9/26) on APD had a weekly pCCr > or = 60 U1.73 m2 and 66 L/1.73 m2, respectively. Median follow-up times among patients were 16.5 and 19.5 months pre- and postanuria, respectively. Patients with pKt/V > or = 1.85 experienced a strong decrease in patient mortality (RR = 0.54, p= 0.10); the effect was less pronounced for pCCr > or = 50 L/1.73 m2 (RR = 0.63, p = 0.25). No relationship was observed between pKt/V or pCCr and TF. CONCLUSION: Mortality was noticeably less frequent among patients with a pKt/V > or = 1.85 compared with those with a Kt/W < 1.85 (p = 0.10). Given the magnitude of the association, the failure to observe statistical significance relates to the size of the patient cohort. Our results imply that it is, in fact, possible to achieve DOQI targets among anuric patients on peritoneal dialysis.
Anuria↗
Decrease in Staphylococcus aureus exit-site infections and peritonitis in CAPD patients by local application of mupirocin ointment at the catheter exit site.
OBJECTIVE: To evaluate the potential effectiveness of the application of mupirocin ointment at the catheter exit site in preventing exit-site infection and peritonitis caused by Staphylococcus aureus (SA). DESIGN: This prospective, historically controlled study was done on 181 peritoneal dialysis patients treated between 1 November 1996 and 1 November 1997. They were instructed to apply mupirocin at the catheter exit site daily or three times per week at the conclusion of their exit-site care (Study 1). The patients were not screened to determine whether they were SA carriers. The group's historical control was the infection data from the previous year among these patients. A second group of 70 patients, who started using mupirocin within a month after catheter implantation (1996-1997), was compared with a historical group of 118 patients (controls) who were on continuous ambulatory peritoneal dialysis (CAPD) for 1 year after in-patient implantation without mupirocin, (1990-1995) (Study 2). RESULTS: In the group of 181 patients (Study 1), application of mupirocin at the exit site led to a significant reduction in SA exit-site infections--21 versus 3 episodes (0.11 vs 0.01 episodes/patient/year)--and a significant reduction of SA peritonitis--35 episodes in the year preceding mupirocin versus 11 episodes during the year of mupirocin treatment (0.19 vs 0.06 ep/pt/yr). The same results were observed in Study 2: the incidence of SA exit-site infection was significantly lower in the mupirocin-treated group--17 episodes among the 118 nontreated patients versus 4 episodes among 70 patients using mupirocin (0.14 ep/pt/yr vs 0.06 ep/pt/yr, respectively). Similarly there were 20 episodes of SA peritonitis among 118 patients during their first year of CAPD versus 4 episodes in 70 mupirocin-treated patients (0.16 ep/pt/yr vs 0.06 ep/pt/yr, respectively). No adverse effects were observed among the patients treated with mupirocin. Overall peritonitis rates decreased from 0.87 to 0.48 ep/pt/yr (p < 0.01) in Study 1 and from 0.56 to 0.41 ep/pt/yr (p = NS) in Study 2. We observed no differences in the incidence of exit-site infection and peritonitis rates among patients applying mupirocin ointment at the exit site daily, compared to three times per week. CONCLUSIONS: Mupirocin application at the exit site significantly lowers the incidence of SA exit-site infections and peritonitis due to SA infections. Since SA infections are accompanied by significant morbidity and occasional mortality, this treatment may improve long-term survival of patients on CAPD.
Administration, Topical↗
Nystatin prophylaxis: its inability to prevent fungal peritonitis in patients on continuous ambulatory peritoneal dialysis.
OBJECTIVE: To evaluate the potential effectiveness of nystatin as prophylaxis for fungal peritonitis (FP) in patients on continuous ambulatory peritoneal dialysis (CAPD). DESIGN: This historically controlled study was designed to investigate the effectiveness of nystatin in the prevention of FP. For this purpose we compared the incidence of FP among 240 (new and prevalent) CAPD patients between January 1996 and November 1996 (period A) with its incidence in 240 new and prevalent CAPD patients in our program between January 1997 and November 1997 (period B) when nystatin prophylaxis was used. There were 2400 patient-months in each period. Nystatin (500,000 IU four times per day), was given orally at the beginning of other antibiotic therapy (usually for peritonitis) and continued for 5 days after the end of the antibiotic therapy. RESULTS: During period A, 133 peritonitis episodes were recorded, and during period B, 99 episodes were recorded. Six episodes of FP were identified in over 2400 patient-months of period A, and 12 in over 2400 patient-months of period B. This difference was not statistically significant. Three episodes of antibiotic-related FP were seen in period A, and four in period B. The remaining episodes arose de novo, that is, unrelated to the use of antibiotics. We observed no side effects for nystatin. CONCLUSION: In CAPD patients the use of nystatin, a nonabsorbable antifungal agent, as prophylaxis in every instance of peritonitis or other indications for antibiotics, did not lower the incidence of fungal peritonitis.
Aged↗