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K D Nolph

Publications and source records attributed to K D Nolph.

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

Clinical implications of membrane transport characteristics on the adequacy of fluid and solute removal.

It is important to identify the peritoneal transport characteristics of each patient and to guide the peritoneal therapy accordingly. High transporters on CAPD are prone to protein malnutrition because of increased protein losses and suppression of appetite with excessive carbohydrate loading from the peritoneal cavity. Anephric high transporters often do better on short-cycle therapies. Anephric low transporters of large size cannot readily meet clearance targets on standard peritoneal dialysis prescriptions. In patients with low rates of peritonitis, changes in peritoneal dialysis prescriptions are more commonly dictated by changes in residual renal function rather than changes in peritoneal transport.

Biological Transport↗
PubMed1994

Computer interaction: catheters.

A computer interaction session conducted during the 14th Annual Peritoneal Dialysis Conference in Orlando, Florida, on January 24, 1994, revealed the preferences and practices of 650-690 respondents voting on questions related to peritoneal catheters. Compared to the surveys conducted in 1987 and 1989, the most striking change was an increase in the use of catheters with the bent intramural segment, particularly the Swan neck catheter, and an increase in the use of catheters with the coiled intraperitoneal segment. The Tenckhoff catheter continued to be the most popular, although its use was decreasing. The remaining catheters were used in small numbers. The vast majority of nephrologists remain convinced of the superiority of double cuff catheters over single cuff ones, and the use of the former continued to exceed 70%. Essentially no change occurred in the method of catheter placement; surgical dissection (72.7%) remained the most popular implantation method. Surgeons were primarily responsible for catheter implantations (87.4% of votes). The use of prophylactic antibiotics prior to catheter implantation seems to be increasing. The majority of respondents did not consider a Staphylococcus aureus nasal carrier status as important in the development of catheter-related infections, as indicated by the small number of centers where routine culture of nares was performed. The majority of institutions delayed ambulatory peritoneal dialysis after catheter implantation, but ambulatory peritoneal dialysis was started in some centers (5.7% of votes) in the immediate postimplantation period.

Attitude of Health Personnel↗
PubMed1994

Computer interaction: demographics, adequacy, and nutrition.

Over 700 people attending the Opening Session of the Fourteenth Annual Peritoneal Dialysis Conference participated in the computer interaction exercise as keyboard responders. Responders were 50.5% nurses and 40.4% physicians. Of these, 70.4% were from North America and 19.6% were from Europe. Only 9.5% had been involved in chronic peritoneal dialysis for less than one year. Over half (56%) worked in programs with more than 30 chronic peritoneal dialysis patients. Their own personal choice of dialysis therapy was a form of chronic peritoneal dialysis in 82%. Serum albumin concentration was indicated as the main monitor of nutritional status by 79.1%. Dietary protein intake ranging from 1-1.2 was considered the preferred goal by 84.4% of responders, even though the majority of chronic peritoneal dialysis patients probably do not achieve dietary protein intake in this range. A minimum weekly KT/V urea of 1.7 was chosen as a minimum target by 53.4%. An increase in exchange volume was the most frequently chosen approach to the large, anuric, low-peritoneal transporter. Numerous other questions dealing with adequacy and nutrition were posed to the audience, and the findings are summarized herein.

Attitude of Health Personnel↗
PubMed1994

Reproducibility of peritoneal equilibration test (PET) in rats.

The aim of the study was to investigate the reproducibility of the peritoneal equilibration test (PET) for evaluating changes in peritoneal function in a rat model of peritoneal dialysis. A PET with 4.25% Dianeal was performed twice within 48 hours under similar conditions after a catheter insertion (n = 10). No significant differences were found between the D/P ratios of PET 1 and PET 2 for urea nitrogen, creatinine, total protein, and D/D0 ratio for glucose. The results for PET 1 and PET 2 showed highly significant correlations. This study indicates, when carried out under similar conditions, that the PET is a highly reproducible test and can be used to evaluate the function of the peritoneum during peritoneal dialysis in rats.

Animals↗
PubMed1994

Absorption of iron from the peritoneal cavity of rats.

The purpose of this study was to determine absorption rate and toxicity of intraperitoneal iron in rats. Twelve (12) male S-D rats were divided into two groups. Group 1 was given 1.5% Dianeal containing 4 mg/L of iron as ferric chloride and group 2 was given standard 1.5% Dianeal. Preblood samples were obtained at the start of the experiment, and 25 mL of the designated dialysis solution was injected into the peritoneal cavity. Six hours after injecting the solution, the dialysate was drained and post-blood samples were obtained. A specimen for histological examination was taken from each rat at the end of the experiment. The iron concentrations of preserum, postserum, dialysis solution with and without added iron, and drained dialysate, were determined. No remarkable changes of serum iron concentration were observed with the six-hour cycle time. Sixty percent of the injected iron was absorbed. No acute toxicity to the peritoneum was observed.

Absorption↗
PubMed1993

Familial unilateral renal agenesis and focal and segmental glomerulosclerosis.

Renal dysplasia and agenesis may be a familial disorder. We report the familial occurrence of unilateral renal agenesis and proteinuria that, at least in one case, was related to focal glomerulosclerosis. Whether these abnormalities are related to an intrinsic abnormality in the remaining kidney, hyperfiltration injury, systemic hypertension, or some other poorly defined factor is unclear at present. However, this report, along with previous case reports of familial renal agenesis, suggests that ultrasonographic screening of first-degree relatives of patients with renal agenesis is appropriate. Whether treatments such as dietary protein restriction, use of angiotensin-converting enzyme inhibitors, or other therapeutic interventions will have a beneficial effect in asymptomatic individuals with unilateral renal agenesis remains to be determined.

Adult↗
PubMed1993

Lipid-lowering effects of lovastatin in CAPD patients.

Increased incidence of cardiovascular morbidity and mortality has been observed in continuous ambulatory peritoneal dialysis (CAPD) patients. Hyperlipemia is an important etiologic factor in the pathogenesis of coronary artery disease. Lovastatin has been shown to effectively lower both the serum total cholesterol and triglyceride levels, the most common abnormalities in these patients. In a retrospective study we assessed the lipid-lowering effects of lovastatin (20 mg/day) in 8 CAPD patients whose serum cholesterol and/or triglycerides remained greater than 240 mg/dL, despite a low cholesterol diet. At 6 months of lovastatin therapy, moderate reductions in total cholesterol and triglyceride levels were observed in 2 patients. Although 20 mg/day of lovastatin were well tolerated, the treatment was not universally effective in lowering the serum cholesterol and triglyceride levels.

Aged↗
PubMed1993

Age and indices of adequacy and nutrition in CAPD patients.

We have examined the correlations of age with 95 demographic, clinical, and laboratory parameters in a continuous ambulatory peritoneal dialysis (CAPD) population. Significant inverse correlations were found with lean body mass, dialysate creatinine concentration, serum creatinine concentration, and dialysate creatinine nitrogen output in grams per week; all these findings are compatible with the well-known decrease in muscle mass with aging. Urea nitrogen output in dialysate and urine predicts Kjeldahl nitrogen output in urine and dialysate applying the Randerson equation similarly in older and younger CAPD patients. The relationship of normalized net protein catabolic rate to weekly urea clearance normalized to total body water is similar for older and younger CAPD patients. Older and younger patients have similar values for serum albumin concentration. In conclusion, the findings suggest that comparable weekly creatinine clearances should yield much lower serum creatinine concentrations in older patients. Poor protein intakes in the elderly should not be attributed to age if weekly urea clearances are low. Increases in protein intake in response to increases in urea clearances are similar in older and younger CAPD patients.

Adult↗
PubMed1993

Cross sectional assessment of weekly urea and creatinine clearances and indices of nutrition in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: To perform a cross sectional analysis in 71 patients on continuous ambulatory peritoneal dialysis (CAPD) to identify significant correlations of weekly small solute clearances and indices of nutritional status with each other and with patient demographics and other commonly monitored clinical and laboratory parameters. DESIGN: This was a retrospective, cross sectional analysis in 71 patients on CAPD from less than 1 to 105 patient-months (average, 20 months). SETTING: An outpatient CAPD program. PATIENTS: All patients on CAPD in our program at the time of the study willing to undergo the clearance and nutritional status measurements. INTERVENTIONS: No interventions other than the monitoring of their status. MAIN OUTCOME MEASURES: Weekly small solute clearances, dietary protein intake, serum albumin, lean body mass, net protein catabolic rate, and urinary and dialysate nitrogen. RESULTS: Weekly Kt/V urea (weekly urea clearance normalized to total body water) of at least 1.7 and weekly total creatinine clearances (liter/week/1.7 m2) of at least 50 are associated with net protein catabolic rates (PCR) greater than 0.9 g/kg of normalized body weight in average CAPD patients. Kt/V urea and net PCR correlate significantly with serum albumin. High transporters identified by the peritoneal equilibration test have greater albumin losses and lower serum albumin concentrations. Estimates of lean body mass correlate significantly with serum albumin and net PCR; lean body mass correlates significantly and inversely with age. CONCLUSIONS: Greater small solute clearances are associated with better nutritional status.

Adult↗
PubMed1993

Swan neck presternal peritoneal dialysis catheter.

We hypothesized that a swan neck catheter for peritoneal dialysis with the exit in the presternal area will be less likely to develop an exit-site infection than currently used peritoneal dialysis catheters with the exit located on the abdomen. The chest is a sturdy structure with minimal wall motions; the catheter exit located on the chest wall is subjected to minimal movements decreasing the chances for trauma and contamination. Also, in patients with abdominal ostomies and in children with diapers, a chest exit location will decrease chances of contamination. The presternal peritoneal dialysis catheter is composed of two flexible (silicone rubber) tubes joined through a titanium connector at the time of implantation. Four such catheters were implanted in four patients: two in extremely obese patients, one in a patient with a suprapubic catheter, and one in a patient with a chronic exit infection with a previous catheter. Tensile strength tests showed that the two parts of the catheter practically cannot separate spontaneously in the tunnel. Flow rates were adequate in the supine and sitting positions. All catheters functioned and healed well, and the exits have not become infected during the whole observation period up to 11 months. These preliminary experiences support the rationale of catheter design.

Catheterization↗
PubMed1993

Access problems plague both peritoneal dialysis and hemodialysis.

Both chronic peritoneal dialysis and center hemodialysis require a transcutaneous access. Costs of maintaining access to the bloodstream and the costs of maintaining access to the peritoneal cavity are substantial for both therapies. Complication rates for blood access clotting and exit site infection may be similar. Exit site infections can often be treated on an outpatient basis. Clotted blood access devices frequently need surgical revision. Peritonitis can in some instances be related to access (excluding internal sources for peritonitis), but with newer devices these rates can be as low as 0.5 episodes per patient year or lower. Thus, the sum of exit site infection rates and peritonitis rates may give totals approaching one episode per patient year. If clotted access incident rates are near half of this, as the recently quoted study suggests, then overall access complications may be more common in peritoneal dialysis. However, the outpatient treatment of most episodes of peritonitis and the outpatient treatment of many if not most episodes of exit site infection implies a lower level of severity than a clotted access device requiring hospitalization and surgical revision. Also of note, bacteremia is a rare complication of exit site infection and peritonitis. In contract, bacteremia and sepsis occur in a high percentage of patients with an infected blood access. Thus, both chronic peritoneal dialysis and chronic hemodialysis continue to be plagued by access problems. Efforts to decrease these problems if successful can result in increased acceptability and safety of both therapies.

Anti-Bacterial Agents↗
PubMed1993

Peritoneal dialysis catheter exit-site care: results of an international survey.

A survey was developed to determine the prevalence of specific components of postoperative and chronic peritoneal catheter exit-site care procedures. Surveys were mailed to approximately 1800 participants of the 1991 Peritoneal Dialysis Conference; 585 surveys (80.6% from the United States and 96% from adult units) were analyzed. The most frequent components of postoperative exit-site care were the use of prophylactic antibiotics, daily dressing changes, procedures limited to specially trained staff, use of sterile technique, povidone iodine and hydrogen peroxide as cleansing agents, and gauze dressings. The most frequent components of chronic exit-site care procedures were daily care done with shower or bathing, antibacterial or pure soap for cleansing, hydrogen peroxide only as needed, catheter stabilization, dressings optional, and gauze dressings when used. Twice daily exit care, change in cleansing agent, and topical antibiotics were recommended for inflamed or infected exit sites. There were significant differences between the United States and other locations, particularly in the type of cleansing agent, use of hydrogen peroxide, and use of dressings for chronic care. Pediatric programs (all located in the United States or Canada) differed somewhat from adult programs in North America. Pediatric patients and their families were significantly more likely to be trained to do postoperative dressing changes and significantly less likely to perform exit-site care at the time of showering or bathing.

Adult↗
PubMed1992

Risk of peritonitis and technique failure by CAPD connection technique: a national study.

Peritonitis has been a leading complication of long-term therapy with continuous ambulatory peritoneal dialysis (CAPD). This study was designed to evaluate the risk of peritonitis and technique failure according to the initial CAPD connection technique. Patients from all U.S. facilities starting CAPD therapy at home between January 1 and June 30, 1989 were followed for up to 21 months on the initial CAPD connection technique to change in technique or dialytic modality, to transplantation, death or loss to follow-up. Patients were grouped into standard connection techniques (SCT) (N = 1,133), Y-set (N = 1,067), standard UV set (N = 916) and O-set (N = 167). The time to first peritonitis episode was analyzed actuarially and by using the Cox proportional hazards model which adjusted for age, sex, race, cause of ESRD, CAPD program size and ESRD therapy prior to CAPD. Peritonitis occurred on average at 9.0 month intervals with SCT, 15.0 months with Y-set, 13.4 with standard UV and 9.4 with O-set. The relative risk (RR by Cox analysis) of first peritonitis compared to SCT was 0.60 (40% lower) for the Y-set (P less than 0.01), 0.75 for standard UV (P less than 0.01), and similar to SCT (RR = 0.96) for the O-set (NS), all else being equal. Analysis time to second (N = 1,271) peritonitis episode gave similar results as did analysis of time to CAPD technique failure. Significantly higher RR of peritonitis and technique failure was observed for younger and black patients. These findings suggest the utilization of connection techniques with superior results.

Adult↗
PubMed1992

Peritoneal clearances of carbon dioxide in the rat.

In our previous rat studies (Kidney Int. 1991; 39: 608-617) we evaluated peritoneal clearances (Cp) representing near exclusively diffusive CO2 transfer: for isosmotic (0.37% dextrose) and hyperosmotic (15% dextrose) solutions with pH 7.2-7.3, CpCO2 were 1.20 +/- 0.08 and 1.84 +/- 0.04 ml/min, respectively. In the present studies we have compared Cp of CO2 gas and HCO3- in anesthetized rats (n = 22) using solutions with dextrose contents as mentioned above but with pH 6.5 or 7.6; we have also evaluated how much Cp CO2 measurements obtained with solutions at these pH values differ from Cp shown earlier with the solutions of pH 7.2-7.3. Cp of CO2 gas and HCO3- were significantly higher under hyperosmotic than isosmotic conditions. The use of solutions of pH different from 7.2-7.3 resulted in higher Cp of CO2 gas: with isosmotic solutions of pH 6.5 and 7.6 mean increases were 25 and 75%, respectively; with hyperosmotic solutions respective increases were 45 and 134%. We conclude that dialysis solution osmolality and pH significantly change Cp of CO2 gas and HCO3- in the rat. For evaluation of peritoneal blood flow from diffusive transfer parameters of CO2 gas, smaller overestimation can be expected when dialysis solution pH is slightly under-than overadjusted compared to blood pH.

Animals↗