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Biomedical subjects

K D Nolph

Publications and source records attributed to K D Nolph.

At least 109 records · Page 6Linked to original sources
PubMed1990

Comparison of patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis: a multicenter study.

Patient and technique survival were compared in adult patients new to continuous ambulatory peritoneal dialysis (CAPD) or (primarily) center hemodialysis (HD) in the time period 1981 to 1983, and followed-up in March 1985. Risk factors were identified at entrance into the study, and results were analyzed using Cox's proportional hazards model. For nondiabetic patients, the difference in survival which favored CAPD (relative risk = 0.62) was not significant at the 5% level (p = 0.08). Age was a significant risk factor in both groups. The average number of hospital visits was the same; however, CAPD showed a small but significant increase in average annual hospital days per year (10.14 vs. 9.18). For diabetic patients, there was no significant difference in survival between CAPD and HD. The CAPD group showed a significant increase in hospital visits (relative risk 1.81 vs. 1.40) and average hospital days per year (19.43 vs. 13.41). Both CAPD groups showed significantly higher treatment changeover rates.

Adult↗
PubMed1990

Tidal peritoneal dialysis with racemic or L-lactate solutions.

UNLABELLED: To see if rapid lactate absorption on tidal peritoneal dialysis (TPD) would overwhelm D-lactate metabolism using racemic lactate and/or L-lactate metabolism using all L-lactate, five patients underwent 8-h TPD treatments with racemic lactate solution one day and with L-lactate another. Lactate concentrations (total) were 40 mmole/L, flow rates 27.3 L/8 h, tidal and reservoir volumes each 1.5L, tidal cycles 24-26 min, and net ultrafiltration per tidal cycle 70 to 99 mL. RESULTS: Mean absorptions of D and L-lactate were 24.2 and 25.1%, respectively, compared to glucose at 14.6%. Urea clearances averaged 21.4 mL/min. Mean blood D-lactates at baseline were 0.6 +/- 0.5 SD mmole/L and after 8 h of TPD were 0.6 +/- 0.4 and 0.7 +/- 0.3 using L-lactate and racemic solutions, respectively; similar values for L-lactate were 1.2 +/- 0.3 at baseline and 1.2 +/- 0.3 and 1.2 +/- 0.5 after 8 h with L-lactate and racemic solutions. delta blood pH values were + 0.02 +/- 0.01 and + 0.04 +/- 0.03, while delta bicarbonate values were + 1.7 +/- 0.9 and + 0.7 +/- 1.0 for the all L and racemic studies, respectively. The total mmoles of L-lactate absorbed per 8 h of TPD with all L solution (greater than 300 mmoles) are greater than ever reported for peritoneal dialysis, but did not increase blood lactate levels. It would seem that either type of solution is suitable for TPD. Absorptions and metabolic rates are similar for L-Lactate and D-Lactate.

Adult↗
PubMed1990

Hematocrit values in the CAPD/CCPD population: a report of the National CAPD Registry.

A survey of the National CAPD Registry population was conducted to assess the distribution of hematocrit levels in a large group of peritoneal dialysis patients, to characterize the anemia of the population, and identify factors which relate to variation in hematocrit levels. A random sample of 812 patients was selected from the Registry population. Information was provided on 608 patients. Characteristics of sampled patients were similar to the Registry population as a whole. The mean hematocrit level in this cohort was 29.4% and the median was 29% Recent peritonitis, time on CAPD, folate therapy, androgen therapy, and iron therapy had no obvious influence on hematocrit distributions. Significantly higher hematocrits were seen in males, whites, and patients with polycystic kidney disease. Significantly lower hematocrits were seen in surgically anephric patients and in patients who had received transfusions 60 days before the survey. Eighty-nine percent of patients had not received a transfusion 60 days prior to the survey. Some patients, especially those with hematocrits below the median, might benefit from recombinant erythropoietin therapy.

Anemia↗
PubMed1990

Hematocrit and residual renal creatinine clearance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).

In a recent report, the relationship between renal creatinine clearance and hematocrit in patients with renal creatinine clearances, ranging from 55 to 8 mL per min. per 1.73 square meters of body surface area, was analyzed. The authors of this study have performed a cross-sectional analysis of the relationship of hematocrit to residual renal creatinine clearance in patients on continuous ambulatory peritoneal dialysis (CAPD). The authors of this study wanted to examine whether or not these hematocrits fall within extrapolations of the published 95% confidence limits for males and females with renal failure prior to end-stage renal disease and dialytic intervention. Authors also compared regression intercepts at residual creatinine clearances of 0. Most of the CAPD patients had hematocrits within the upper half or above the extrapolated 95% confidence limits for the predialysis population. Within the CAPD population, there were no significant correlations of hematocrit with residual creatinine clearance at these lower ranges. The degree of scatter in the CAPD population for hematocrit values was similar to that in the predialysis population. Residual creatinine clearance appears to be a crude index of the increasing severity of multiple factors that may contribute to the anemia. CAPD appears to maintain or improve hematocrit as renal mass and function decline.

Anemia↗
PubMed1989

Lymphatic absorption during peritoneal dialysis.

These studies suggest that lymphatic absorption reduces net ultrafiltration by significant amounts and plays a major role in the overall ultrafiltration kinetics. Intraperitoneal drugs which decrease lymphatic absorption may increase net ultrafiltration, drainage volume, and solute clearances. Decreases in net ultrafiltration with drugs that decrease lymphatic absorption may provide an alternative means to increase net ultrafiltration with less use of hypertonic dextrose exchanges.

Absorption↗
PubMed1989

Timing and characteristics of multiple peritonitis episodes: a report of the National CAPD Registry.

Patterns of recurrent peritonitis episodes were examined in 6,335 new continuous ambulatory peritoneal dialysis (CAPD) patients entered into the National CAPD Registry. Forty-six percent of all peritonitis episodes were initial occurrences, with 8% of the patients reporting four or more episodes. The proportion of gram-positive and gram-negative infections was constant across episodes. In patients with multiple infections, negative organisms were found to have increased risk of recurring as gram-negative infection. A similar observation was made for fungal infections. Of patients with multiple peritonitis episodes, more than 40% of those who transferred to other maintenance renal replacement therapy identified peritonitis as the reason for transfer. A discrete time logistic model was used to estimate peritonitis risk in 4-month follow-up periods. Patients like those on the registry are estimated to have a 22% risk of developing peritonitis during any 4-month period. This risk was increased 4% for patients aged less than 21 years, 7% for nonwhite patients, and 19% in the period following a peritoneal infection.

Adult↗
PubMed1989

Pentoxifylline does not influence maximum ultrafiltration rates and peritoneal transport in rats.

Previous publications have suggested that peritoneal capillary blood flow and filtration pressure equilibrium may limit ultrafiltration rates with very hypertonic exchanges. Rats were treated with pentoxifylline, which decreases blood viscosity by increasing red blood cell deformability. Decreases in blood viscosity should reduce microcirculatory resistance and increase effective capillary flow. Transport studies were performed after 2, 4, and 8 weeks of therapy with peritoneal dialysis solutions containing 15 grams % dextrose and using 30-min cycles. Even though rats ingested near the maximum recommended dose of pentoxifylline (20 mg/kg) significant changes in blood viscosity and shear stress were not detected compared to controls. Also, there were no significant differences in clearances of urea and phosphorus, glucose absorption, protein losses, and net ultrafiltration compared to controls.

Animals↗
PubMed1989

The peak concentration hypothesis: a urea kinetic approach to comparing the adequacy of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis.

The KT/V urea index (K, clearance; T, treatment time; V, volume of urea distribution) has become an established index of hemodialysis (HD) adequacy, values of KT/V less than 0.8 being associated with overt uremic toxicity. For the typical continuous ambulatory peritoneal dialysis (CAPD) regimen of 4 X 2 L exchanges/day, the equivalent KT/V approximately 0.6. Paradoxically, overt uremic toxicity is not commonly observed in CAPD patients with this typical therapy prescription. Application of the urea kinetic model demonstrates that HD and CAPD have the same time-averaged urea concentration at the same KT/V. However, as HD is an intermittent therapy, the urea concentration in HD exceeds the time-averaged concentration for about half the hours in the week. If uremic toxicity is related to the peak rather than the time-averaged urea concentration, a higher KT/V would be required in HD to achieve a peak concentration at or below the steady-state CAPD concentration. This peak concentration hypothesis predicts, based on the results of the National Cooperative Dialysis Study, that underdialysis with CAPD would occur at KT/V less than 0.4 for a protein intake of 1.1 gm/kg/day.

Blood Urea Nitrogen↗
PubMed1989

Calcium carbonate as a phosphate binder: is there a need to adjust peritoneal dialysate calcium concentrations for patients using CaCO3?

The widespread use of calcium carbonate as a phosphate binder is limited by its tendency to develop hypercalcemia in some patients using effective dosages needed to control hyperphosphatemia. Most common continuous ambulatory peritoneal dialysis (CAPD) regimens using dialysis solutions containing 3.5 mEq/L of calcium result in net absorption of calcium from the dialysis solution and, hence limit the amount of oral calcium that can be administered. Peritoneal dialysis solutions with reduced calcium levels are needed for effective use of CaCO3 to control hyperphosphatemia in some dialysis patients.

Calcium↗
PubMed1989

Long-term increase in peritoneal membrane transport rates following incidental intraperitoneal sodium hypochlorite infusion.

A patient on continuous ambulatory peritoneal dialysis using an "O" set connection system with sodium hypochlorite as a disinfectant incidentally infused the disinfectant intraperitoneally on two occasions. The product of peritoneal membrane permeability and peritoneal membrane surface area increased after both infusions as judged by peritoneal equilibration test results and/or serum chemistries. Elevated peritoneal solute transport rates and reduced ultrafiltration gradually subsided but did not return to preinfusion values. This observation suggests that intraperitoneal sodium hypochlorite infusion may cause significant long-term alteration in peritoneal membrane transport characteristics.

Dialysis Solutions↗
PubMed1988

Current concepts. Continuous ambulatory peritoneal dialysis.

As a long-term dialysis therapy, CAPD has attractive features for use in children (in whom access to the circulation and immobility are often problems), adults in whom blood access is difficult, patients with diabetes, patients prone to hypotension, and patients seeking independence from a machine or medical facility. CAPD and related procedures are still evolving and improving. Efforts to reduce the rates of peritonitis are ongoing and should decrease the rates of treatment dropout and increase the use of this alternative method of dialysis. Continued research toward improvements in catheter configuration and connection devices and the tailoring of technique to meet the particular needs of patients have made peritoneal dialysis an acceptable replacement therapy in patients with end-stage renal disease. Neither peritoneal dialysis nor hemodialysis is the superior long-term dialysis therapy for all patients; the choice depends on numerous medical, social, geographic, and life-style considerations.

Child↗
PubMed1988

Effect of increasing intraabdominal pressure and volume on left ventricular function in continuous ambulatory peritoneal dialysis (CAPD).

To determine the effect of increasing intraabdominal pressure on left ventricular (LV) systolic function in patients undergoing continuous ambulatory peritoneal dialysis (CAPD), we studied 15 patients who had been on CAPD for at least 2 months. The study protocol included measurement of echocardiographic LV internal dimensions in diastole and systole, LV wall thickness and mass, LV ejection time, the mean velocity of circumferential fiber shortening (mean Vcf), heart rate, BP, and intraabdominal pressure. Measurements were obtained at baseline (OL) and following intraperitoneal infusion of 1-L increments of dialysate solution (up to 4 L) in both the recumbent and standing positions. Significant differences in LV systolic function resulting from intraperitoneal infusion of dialysate were confined to the subgroup with increased LV wall thickness (n = 8). In this subgroup, mean Vcf decreased progressively from 0.99 +/- 0.18 circumferences/second at baseline to 0.88 +/- 0.16 circumferences/second at 1 L (P = NS), to 0.86 +/- 0.16 circumferences/second at 2 L (P = NS), to 0.66 +/- 0.18 circumferences/second at 3 L (P less than 0.005), and to 0.60 +/- 0.14 circumferences/second at 4 L (P less than 0.005) in recumbent position. Measurements obtained in the standing position paralleled those observed during recumbency. These changes were accompanied by a significant decrease in the mean LV internal dimension in diastole and a significant increase in intraabdominal pressure, but no significant change in the mean LV internal dimensions in systole, mean heart rate, or mean systolic or diastolic BP.(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1988

Kinetics of peritoneal dialysis in children: role of lymphatics.

Intraperitoneal fluid is absorbed continuously by convective flow into the peritoneal cavity lymphatics. We evaluated the role of lymphatic absorption in the kinetics of peritoneal dialysis during standardized four hour exchanges in six children using 40 ml/kg of 2.5% dextrose dialysis solution. Cumulative lymphatic absorption averaged 10.4 +/- 1.6 ml/kg and reduced the total net transcapillary ultrafiltration during the dwell time by 73 +/- 10%. Due to the considerable lymphatic absorption rate, maximum intraperitoneal volume was observed before osmolar equilibrium. Extrapolated to four study exchanges per day, lymphatic absorption decreased the potential daily drain volumes in the children by 27 +/- 5% and daily peritoneal urea and creatinine clearances by 24 +/- 4% and 22 +/- 5%, respectively. Compared with four hour exchanges using two liters of 2.5% dextrose dialysis solution in 10 adult CAPD patients with average peritoneal transport, the children had more rapid equilibration of urea, greater absorption of dialysate glucose, higher lymphatic absorption and lower net ultrafiltration (P less than 0.01 to P less than 0.05). Lymphatic absorption therefore causes a relatively greater reduction in net ultrafiltration and solute clearances in children than in adults.

Adolescent↗