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K D Nolph

Publications and source records attributed to K D Nolph.

At least 253 records · Page 14Linked to original sources
PubMed1969

Altered permeability of the peritoneal membrane after using hypertonic peritoneal dialysis fluid.

Previous work has shown that use of hypertonic peritoneal dialysis fluid (7% glucose) results in ultrafiltration and enhanced urea transfer across the peritoneal membrane. Simultaneous creatinine studies showed a similar enhancement with hypertonic fluid which persisted in lesser degree during subsequent isotonic exchanges. The mechanism of solvent drag has been shown to contribute significantly to the increased urea removal with ultrafiltration. In the present study, the role of altered diffusive permeability of the peritoneal membrane as suggested by the creatinine data was evaluated as a possible additional mechanism. Hypertonic exchanges were bracketed by isotonic (1.5% glucose) exchanges during 11 studies in four patients. During six other studies in four patients, isotonic exchanges only were performed. A mathematical model for peritoneal solute transport by diffusion was developed and a method to distinguish alterations in peritoneal membrane permeability from changes in membrane area proposed. The method incorporates the determination and comparison of transport characteristics for two test solutes of widely different molecular weights. Alterations in inulin and urea transperitoneal transport characteristics in the above studies indicate a significant increase in membrane permeability after exposure to hypertonic solutions that persists during subsequent isotonic exchanges. Varying patterns of membrane area and permeability changes occurred during repeated exposure to only isotonic exchanges. The findings are discussed in regard to recent concepts of passive transcapillary transport.

Biological Transport↗
PubMedDate not supplied

A survey of the NIH CAPD Registry population with end-stage renal disease attributed to diabetic nephropathy.

A survey of CAPD/CCPD patients with end-stage renal disease attributed to diabetes mellitus done by the USA NIH CAPD Registry obtained information from 499 patients. These data suggest that in diabetics with renal insufficiency, the time interval from age at diagnosis of diabetes to initiation of dialysis decreases as the age of diagnosis increases. Mean interval from the time of diabetes diagnosis to CAPD or CCPD initiation was 25 years for patients less than 20 years of age at diagnosis and 17 years for patients greater than or equal to 30 years of age. This trend is independent of the type of diabetes management and appeared to be independent of the type of diabetes. Patients were categorized on the basis of pre- and post-CAPD management of hyperglycemia. There were several associations noted between type of diabetes therapy and clinical findings: A higher proportion of legally blind patients had used insulin only (33%) compared with patients never using insulin (10%) and 78% of patients using insulin only were white compared with 49% among the never on insulin group. This latter result indicates that race influences the type of diabetes and/or progression of diabetes to renal insufficiency. Patients on insulin only reported parents and/or siblings with diabetes less often than did patients using insulin and oral agents, some insulin, or never any insulin to manage their diabetes. The authors also noted that peritonitis rates were not increased in those patients who added insulin to dialysis solutions.

Adult↗
PubMedDate not supplied

Past, present, and future of quantified peritoneal dialysis.

The role of peritoneal dialysis (PD) as a modality in renal replacement therapy has been well established. In this article we review various aspects in the evolution of PD, with special emphasis on adequacy. Until the late 1950s PD was still considered as a last resort in the treatment of terminal uremia. The introduction of a chronic indwelling catheter made chronic PD possible. The concept of continuous ambulatory peritoneal dialysis (CAPD), proposed in 1975, had a major impact on the way PD was performed later. The value of determining the adequacy, using urea clearance normalized to total body water (Kt/V) or creatinine clearance normalized to body surface area, was clearly highlighted by the Canada-USA (CANUSA) study. Introduction of standardized peritoneal equilibration tests has been very helpful in enhancing the efficiency of PD. In 1995 the National Kidney Foundation-Dialysis Outcomes Quality Initiatives (NKF-DOQI) established guidelines to improve patient survival and outcome on dialysis. These guidelines established minimum criteria for PD adequacy. Compliance and malnutrition remain important factors determining the efficacy of PD. The "healthy start" concept emphasizes an early start of dialysis in patients with end-stage renal disease (ESRD). The quest for an ideal PD modality has recently led to renewed interest in the idea of continuous flow peritoneal dialysis (CFPD). PD continues to grow and at the same time faces many challenges. Its role as a renal replacement therapy is likely to evolve further in the years to come.

Humans↗
PubMedDate not supplied

Factors associated with morbidity and mortality among patients on CAPD.

Since 1981, the National CAPD Registry, sponsored by the National Institute of Arthritis, Diabetes, Digestive, and Kidney Diseases of the National Institutes of Health, has been systematically collecting demographic and follow-up data on patients receiving continuous ambulatory peritoneal dialysis (CAPD) as maintenance therapy for end-stage renal disease. Using life-table methods, this study has identified the association of diabetic glomerulosclerosis with age over 60 or under 20 years as factors jointly relevant in predicting peritonitis, hospitalization, or death. In addition, these outcomes were more likely to occur if patients were black and had been exposed to other dialytic therapy earlier on. The latter two were the only factors jointly predictive of transfer from CAPD onto hemodialysis. Careful monitoring of patients with the above mentioned characteristics may reduce complications, and lead to greater success with this increasingly popular dialysis modality.

Adult↗
PubMedDate not supplied

The 1987 USA National CAPD Registry report.

The National CAPD Registry has noted encouraging trends in CAPD therapy in the U.S. Recently, trained patients have reported lower peritonitis rates, fewer days hospitalized for dialysis-related events, and lower probability of developing a first episode of a complication. If accumulating experience, better patient selection, and new technologic developments further these trends, then the relatively high transfer rates should begin to decrease since many transfers are related to peritonitis and other complications. The Registry's observations suggest that CAPD is an evolving therapy and that as complication rates and transfer rates decrease, CAPD may play an even greater role in the treatment of patients with end-stage renal disease.

Female↗