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J A Diaz-Buxo

Publications and source records attributed to J A Diaz-Buxo.

At least 19 recordsLinked to original sources
PubMed2006

Complications of peritoneal dialysis catheters: early and late.

The complications of peritoneal dialysis catheters are often due to errors made during the initial catheter insertion procedure. Other complications relate to the improper selection of the catheter type or size. Thus, many complications are preventable. This review summarizes the complications resulting from the insertion or presence of a PD catheter and classifies them as either early or late events. A short comment on early diagnosis and appropriate management is also provided.

Catheterization↗
PubMed2006

Peritoneal dialysis solutions--at a crossroad.

After many decades of evolution and with many choices available for the formulation of peritoneal dialysis fluids (PDF), we find ourselves at a crossroads. A review of related developments, laboratory trials and clinical evaluations is offered to stimulate future research in this area. The information presented here raises more questions than it provides answers, but opens the door to innumerable possibilities for improvement. The search for a biocompatible osmotic agent designed to replace those currently used has been frustrating and is far from being considered a success. Research on cytokines and other mediators of inflammation produced a huge amount of interesting scientific knowledge that may help our understanding. However, it is unlikely that it will identify a specifically targeted anticytokine, or combination of them, designed to neutralize and/or reverse inflammatory changes resulting from the use of poorly biocompatible PDF. The development of low glucose degradation product (GDP) solutions by means of multi-chambered bags appear to be a step in the right direction and perhaps is the most significant improvement in this field in many decades. GDPs are important, but not the only offenders or the exclusive source of oxidative stress. Thus, the addition of antioxidants to PDF formulations, in our opinion, deserves further consideration. Additionally, repopulation of the mesothelial monolayer by means of periodic autotransplantation of mesothelial cells may well become a useful tool to prevent and/or correct membrane failure. We are fortunate to have choices at this crossroad, which we must evaluate rigorously.

Glucans↗
PubMed2001

Daily and nocturnal hemodialysis: how do they stack up?

A growing number of articles in the literature describe experiences using more frequent hemodialysis (HD), either short daily or long nocturnal. Most of these publications highlight successes obtained by these programs with a fragmented look at specific areas and outcomes. This review of published results from the use of these therapies shows that universal improvement is noted in dialysis adequacy, nutrition, quality of life, blood pressure control, fluid and electrolyte balance, and hospitalizations when these parameters are mentioned. However, data reporting is often incomplete. Most studies do not have adequate control groups, patient populations are often different from the standard HD population, and many have small numbers that preclude statistical significance. Nonuniformity of patient selection and study design prevents accurate comparison and pooling of patient data. In some cases, the same patients' data for the same periods of observation are reported in several studies. Despite data that can be characterized as preliminary and anecdotal, the results reported in this review show remarkable patient improvement worthy of serious consideration by the renal community. To reach a level of evidence that will be widely acceptable, the renal community needs to partner with such government institutions as the National Institutes of Health and the Health Care Financing Administration to study systematically the outcomes and costs associated with using more frequent HD. In the process, important ramifications of such a cooperative study, including potential changes in policy, need to be considered.

Acidosis↗
PubMed2001

Daily hemodialysis: a dialysis provider perspective.

Regardless of size, ownership or corporate structure, the goal of the dialysis provider is to deliver the best renal substitution therapy in the safest and most convenient manner, at a cost commensurate with reimbursement. This paper reviews the available data on daily hemodialysis, focusing on its ability to satisfy this goal. In addition, it examines the potential influence of frequency, time, and dose of dialysis on clinical outcomes of various series over the last 3 decades. The available data strongly suggest the clinical benefits of daily hemodialysis, but are not sufficient to show statistically better outcomes. Under the present reimbursement system, daily hemodialysis is not economically feasible in the United States. Prospective clinical trials designed to prove the benefits of these therapies and justify their reimbursement are needed.

Appointments and Schedules↗
PubMed2001

The treatment of anemia in peritoneal dialysis patients.

The management of anemia in patients with end-stage renal disease (ESRD) treated with peritoneal dialysis (PD) has gained increasing attention over the past decade, similar to patients on hemodialysis (HD). However, there are many differences between the 2 renal replacement therapies that pose unique challenges and solutions for monitoring, diagnosis and treatment of anemia in PD patients. These differences are not always evident and may be the result of different patient selection, physical, emotional and motivational factors, specific requirements of the modality or an indeterminate blend of infinite gradations of all these factors. This review will highlight current issues in anemia management in PD patients.

Anemia↗
PubMed2000

Quality-of-life evaluation using Short Form 36: comparison in hemodialysis and peritoneal dialysis patients.

Short Form 36 (SF-36) is a well-documented health-related quality-of-life (HRQOL) instrument consisting of 36 questions compressed into eight scales and two primary dimensions: the physical and mental component scores. This tool was used to evaluate QOL among peritoneal dialysis (PD) and hemodialysis (HD) patients. The results of 16,755 HD and 1,260 PD patients (728 continuous ambulatory PD [CAPD] and 532 continuous cycling PD [CCPD]) completing an SF-36 during 1996 were analyzed. Three analyses of variance were performed, consisting of (1) no adjustment, (2) case mix (age, sex, race, and diabetes), and (3) case mix plus laboratory parameters. PD patients were younger (P < 0.001), a larger fraction were white (P < 0.001), fewer had diabetes (P < 0.001), and had lower serum albumin concentrations (P < 0.001) and higher creatinine, hemoglobin, and white blood cell count values (P < 0.001) than HD patients. Diabetes was present in a larger fraction of CCPD than CAPD patients (P < 0.001). HD and PD patients scored similarly for scales reflecting physical processes. PD patients scored higher for mental processes, but only after statistical adjustment for the laboratory measures. Scores on scales reflecting physical processes were worse, and those reflecting mental processes were better among CCPD than CAPD patients. HD and CAPD scores were similar. CCPD patients perceived themselves as more physically impaired but better adjusted than HD or CAPD patients. These descriptive data show that perception of QOL among PD and HD patients is similar before adjustment, but PD patients score higher for mental processes with adjustment. CCPD patients score worse for physical function and better for mental function than either CAPD or HD patients. We cannot, however, exclude the influence of therapy selection.

Female↗
PubMed2000

Peritonitis and antibiotic therapy in patients on cycler peritoneal dialysis--an update.

The increased use of automated peritoneal dialysis (APD) and the inherent differences between continuous ambulatory peritoneal dialysis (CAPD) and APD have generated interest in the treatment of peritonitis in cycler patients. This review considers variations in the incidence of peritonitis and in its microbiological spectrum among CAPD and APD patients, and discusses the potential causes for these variations, with emphasis on recent literature. Flow-pattern variances between CAPD and APD demand special considerations in the diagnosis of peritonitis. Multiple alternatives for the management of peritonitis in APD are discussed in light of recent clinical experiences and pharmacokinetic considerations.

Anti-Bacterial Agents↗
PubMed1999

Associates of mortality among peritoneal dialysis patients with special reference to peritoneal transport rates and solute clearance.

The current report describes the distributions of selected demographic and biochemical parameters, clearance, and other transport values among patients undergoing peritoneal dialysis (PD) and evaluates the associates of mortality using those values, with and without clearance and peritoneal equilibration test (PET) data. All patients receiving PD on January 1, 1994 were selected (n = 2,686). Patients who switched to another form of dialysis during the study period were removed from the study at the time of therapy change. Working files were constructed from the clinical database to include demographic, laboratory, and outcome data. Laboratory data were available in only 1,603 patients and were used to evaluate the biochemical associates of mortality after merging the biochemical, demographic, and outcome data. Patients with clearance data or PET studies underwent a second analysis to assess the effects of peritoneal and renal clearance on survival. The analysis of demographic and laboratory data confirmed the importance of age and serum albumin concentration as predictors of death. Residual renal function (RRF) was strongly correlated with survival, but peritoneal clearance was not. Several possible explanations for the lack of correlation between peritoneal clearance and survival are discussed. The data suggest that RRF and peritoneal clearance may be separate and not equivalent quantities. Substantial work is required to confirm or refute these findings, because the information is essential to establish the adequate dose of PD in patients with various degrees of RRF.

Adult↗
PubMed1999

Peritoneal dialysis adequacy: a model to assess feasibility with various modalities.

BACKGROUND: The current standard of adequacy for peritoneal dialysis (PD) is to provide a weekly normalized urea clearance (Kt/V) of 2.0 or more and a creatinine clearance (CCr) of 60 liter/1.73 m2 or more. As native renal function is lost, it is important to determine the effectiveness of the available therapeutic modalities in achieving these goals. METHODS: A model to assess our ability to provide a weekly Kt/Vurea of 2.0 or more and a CCr of 60 liter/1.73 m2 or more to anuric patients undergoing continuous ambulatory PD (CAPD) and automated PD (PD Plus) was developed. The body surface area (BSA) distribution was obtained from 38,768 patients undergoing dialysis during January 1997. The distribution of peritoneal transport rates (PTRs) was obtained from 2531 peritoneal equilibration tests performed during 1996. The weekly Kpt/Vurea was calculated for the various PTR groups and the range of BSA with four PD prescriptions: CAPD 8 liters, CAPD 10 liters, PD Plus 12 liters, and PD Plus 15 liters, using a previously validated kinetic program (PackPD). RESULTS: The predicted percentage of patients capable of achieving the adequacy goals for Kt/V and CCr, respectively, were 24.8 and 11. 2 for CAPD 8 liters, 54.2 and 33.0 for CAPD 10 liters, 77.8 and 54.9 for PD Plus 12 liters, and 93.2 and 72.9 for PD Plus 15 liters. CONCLUSIONS: Most patients can attain the current adequacy standards of therapy with automated PD, but few (less than 25%) can do so with standard CAPD in the absence of residual renal function.

Anuria↗
PubMed1999

Memory card: A tool to assess patient compliance with peritoneal dialysis.

Lack of compliance with prescribed peritoneal dialysis (PD) therapy is a common cause of inadequate dialysis and poor outcomes. Because measurements of delivered doses are performed infrequently, the values obtained may not reflect actual delivered therapy. To evaluate compliance with therapy and to record accurate and complete treatment history for each patient undergoing automated PD, a memory card with the capability to track and store 2 months of treatment data was developed and incorporated into a commercial PD cycler. The memory card is brought to the clinic during the monthly visit. The data is downloaded into a personal computer (PC) with specific software. The following parameters can be retrieved and displayed as a graph or chart: the time of the exchange, length of the exchange, solution transit time, drain time, automated exchanges and last fill, inflow and drain volume, net ultrafiltration, and times of drain alarms. The data can be displayed as daily therapy, mean of therapy values, or total therapy. With the information available, the renal team can incorporate changes into the prescription and provide feedback to the patient based on his/her compliance record. The data can be transferred to a central data pool via modem. This data collection system can also be used for quality improvement, to model delivered therapy, and to compare compliance scores among centers and by cohorts of patients according to demographic or comorbid conditions.

Data Display↗
PubMed1999

Peritoneal dialysis prescriptions for diabetic patients.

Peritoneal dialysis offers several advantages for the treatment of diabetic patients with renal failure. The diabetic patients is often affected by comorbid conditions that influence the dialytic prescription and the clinical outcome. This article reviews the pertinent pathophysiology present in the diabetic patient with advanced renal insufficiency in an attempt to make specific recommendations for the initiation of peritoneal dialysis and the formulation of an adequate prescription.

Diabetes Mellitus↗