Search PubMed⌕ Search

Biomedical subjects

R Selgas

Publications and source records attributed to R Selgas.

At least 73 records · Page 4Linked to original sources
PubMed1996

Circulating burst-forming unit-erythroid (BFU-E) colonies as an early marker to measure the recombinant human erythropoietin response in peritoneal dialysis patients.

To evaluate circulating burst-forming unit-erythroid (BFU-E) cells after erythropoietin (EPO) treatment, 7 female continuous ambulatory peritoneal dialysis patients were studied [baseline hemoglobin (HB): 7-10.5 g/dL)]. EPO (4000 U subcutaneously) was administered twice weekly for two months. The control group consisted of 7 healthy women with similar demographic characteristics. Mononuclear cells (MC) (5 x 10(5)) were added to 1 mL of culture medium, supplemented with 30% fetal bovine serum, 2 U/mL of EPO, 1% bovine serum albumin, and 0.3% agar. To enumerate colonies derived from each circulating BFU-E, plates were examined by inverse light microscopy, identifying BFU-E as large aggregates with more than 100 hemoglobinized cells (HC). A remarkable individual response was observed, with Hb values ranging 8.4-13.6 g/dL at week 4 and 8.8-16.5 g/dL at week 8. Baseline levels of BFU-E in patients ranged 0-100/5 x 10(5) MC (0-358 mL of whole blood), and in controls they ranged 6-24/5 x 10(5) MC (29.6-101.3/mL) (NS). Hemoglobin levels after four and eight weeks of EPO showed a significant relationship with circulating BFU-E at baseline (r = -0.873, r = -0.928, respectively). The increment in Hb after eight weeks showed a significant relationship with baseline BFU-E (r = 0.812). Hemoglobin levels at the fourth to eighth week, and the increment in Hb after eight weeks, showed a significant, direct relationship with the increments in circulating BFU-E registered after one to two weeks of treatment. We conclude that, after the first week of EPO treatment, its effect on hemoglobin may be predieted by the increment in circulating BFU-E. Thus; a new tool to measure the earliest EPO effects has become available.

Adult↗
PubMed1996

Serum insulin and insulin-like growth factor binding protein-1 levels in adult patients undergoing peritoneal dialysis.

It is known that serum insulin-like growth factor binding protein-1 (IGFBP-1) concentrations are inversely related to insulin levels both in healthy and diabetic subjects. The aim of the present study was to assess serum IGFBP-1 levels in a group of patients undergoing peritoneal dialysis (PD) and to evaluate their relationship with serum insulin concentrations. Thirty-five patients [19 males, 16 females; age (mean +/- SEM) 53.2 +/- 2.5 years; range 18-78; duration of continuous ambulatory peritoneal dialysis 33.1 +/- 6.0 months; Kt/V 2.00 +/- 0.05; normalized protein catabolic rate 1.00 +/- 0.05 g/kg/day] were studied. Nine patients were diabetics. In all patients, baseline IGFBP-1, insulin, and growth hormone (GH) levels were determined. Fasting IGFBP-1 levels were elevated in 19 (54%) patients and were normal in 16 patients. In all patients, high levels of serum insulin levels (> 25 microU/mL) were observed. Baseline IGFBP-1 levels were only slightly higher in diabetic patients (53.7 +/- 14.6 vs 40.5 +/- 8.2 micrograms/L,NS), however, serum levels of GH were similar in both groups (3.0 +/- 1.8 vs 2.9 +/- 0.5 microgram/L, NS). There was no correlation between fasting insulin and IGFBP-1 levels both in the whole group (r = 0.2; NS) and the diabetic (r = 0.2; NS) and nondiabetic (r = 0.3; NS) subgroups, despite high fasting insulin levels. We could only find a significant positive correlation between fasting glucose and IGFBP-1 levels in the diabetic group (r = 0.7, p < 0.05). Our data suggest that adult patients undergoing PD show hyperinsulinemia associated with normal or high serum IGFBP-1 levels. This suggests that insulin does not affect IGFBP-1 production in this group of patients. It could be explained, at least in part, by the insulin resistance present in uremia.

Adolescent↗
PubMed1995

Effect of oral calcidiol treatment on its serum levels and peritoneal losses.

OBJECTIVES: To evaluate calcidiol serum levels in a group of continuous ambulatory peritoneal dialysis (CAPD) patients and the effect of oral calcidiol treatment on serum levels and peritoneal losses. STUDY DESIGN: Twenty patients (13 female, 7 male) were studied for 12-60 months. Their ages ranged 22-72 years (mean 46 +/- 15). Serum calcidiol, total protein and urea were determined at baseline and after the administration per os of 0.133 mcg/day of calcidiol for 10 days. At the same time, calcidiol and total protein were measured in peritoneal effluent at baseline and at 5, 10, and 40 days after starting this treatment. RESULTS: A significant and direct correlation between the calcidiol dialysis/plasma ratio and the peritoneal protein losses was found, both before and 40 days after calcidiol administration when calcidiol serum levels were the lowest. As calcidiol serum levels rose to the normal range in the course of the study, peritoneal losses of this metabolite increased slightly and correlated with calcidiol serum levels and urea mass transfer coefficient (MTC); the significant correlation between calcidiol serum levels and peritoneal protein losses disappeared. CONCLUSIONS: When serum calcidiol levels are low, calcidiol peritoneal losses in patients on CAPD correlate with protein peritoneal losses. However, when serum calcidiol levels rise, the calcidiol peritoneal losses correlate with calcidiol serum levels and urea MTC, and not with protein peritoneal losses.

Administration, Oral↗
PubMed1995

Pituitary dysfunctions in uremic patients undergoing peritoneal dialysis: a cross sectional descriptive study.

Several hormonal alterations have been described in patients with chronic renal failure. However, there are few epidemiological studies on uremia-associated endocrine derangements, in particular in patients undergoing peritoneal dialysis (PD). A cross-sectional descriptive study was performed to assess the prevalence of hormonal dysfunctions affecting pituitary secretions in the whole population of patients in the PD unit of our hospital. The total population included 69 patients, 66 on continuous ambulatory PD and 3 on continuous cycling PD. There were 31 men and 38 women, the mean age was 55 years (range 23-82 years), and the mean duration of PD was 32 months (range 1-161 months). There were 27 (39.1%) patients with diabetes mellitus (7 type I and 20 type II). Clinical records were reviewed for hormonal alterations affecting the pituitary and its target glands. The whole population had available data on the pituitary-thyroid axis. The following diagnoses and prevalences were found: hypothyrotropic hypothyroidism 4 (5.8%), subclinical hypothyroidism 4 (5.8%), primary hypothyroidism 8 (11.6%), and low T3 syndrome 11 (15.9%). The remaining pituitary hormones were available in 20 patients. Hyperprolactinemia was found in 7 (35%) patients and abnormally increased growth hormone levels in 6 (30%). Gonadotropin levels were normal for the age of the women and showed a tendency to be increased in most of the men. Corticotropin levels were normal in all patients with available data. There was no relationship between the high prevalence of diabetes mellitus in our population and the remaining hormonal derangements found. These results suggest that there is a non-negligible prevalence of pituitary abnormalities in uremic patients undergoing PD.

Adrenocorticotropic Hormone↗
PubMed1995

Mitral annular calcification in CAPD patients with a low degree of hyperparathyroidism. An analysis of other possible risk factors.

Chronic renal failure has been suggested as a risk factor for mitral annular calcification (MAC), a degenerative process of the mitral annulus. The objective of the present study was to define MAC risk factors at the start of dialysis and 'de-novo' appearance after medium- or long-term CAPD, in a non-selected population (135 patients) with a low degree of secondary hyperparathyroidism. Echocardiographic studies were performed at the beginning of CAPD and every 1-1.5 years thereafter. Diagnosis of MAC was established by M mode and 2-D study. Seventeen of 135 patients studied at the start of dialysis showed MAC. Patients who showed MAC were older and presented a higher mean systolic blood pressure. The other anthropometric/demographic parameters did not show statistically significant differences. MAC thickness: mean 6.21 +/- 3.65 mm (range 3-17.2 mm). The posterior annulus was universally affected and in four patients the anterior annulus was involved. Seventeen of 76 patients included in the follow-up study developed MAC. No significant differences for demography, except age, with MAC patients being older, were found. Mean time on CAPD until de-novo MAC diagnosis was 49.7 +/- 26.9 months. MAC thickness: mean 4.97 +/- 1.6 mm (range 3-8.42 mm). The posterior annulus was affected in all patients except for one and in four patients the anterior annulus was involved. The most remarkable echocardiographic feature is the almost constant association of MAC with left atrial dilatation (LAD). The last one does not seem a consequence of mitral insufficiency, or systolic dysfunction. Left ventricular hypertrophy was universally found, with no different intensities for patients with or without MAC. In conclusion, a high incidence of mitral annular calcification has been found in CAPD patients. Our data do not confirm the role of classical invoked risk factors. Blood CaP product under 75, a moderate to mild degree of hyperparathyroidism and/or hypertension with left ventricular hypertrophy do not seem to be isolated risk factors during the CAPD period. Length of time on CAPD, for unknown reasons, seems to favour the appearance of MAC. At starting dialysis, high systolic blood pressure and left ventricular hypertrophy seem to be related to MAC. Diabetes appears to represent an additional risk factor. Further research on mitral annular calcification pathogenesis and its consequences is urgently required.

Calcinosis↗
PubMed1994

Functional longevity of the human peritoneum: how long is continuous peritoneal dialysis possible? Results of a prospective medium long-term study.

Long-term peritoneal dialysis requires the maintenance of the transport function of the peritoneal membrane, and appropriate studies of possible changes are necessary. The quantification of peritoneal mass transfer coefficients (MTCs) has been judged to be the ideal method for the evaluation of peritoneal diffusion. The aim of the present study was to show the results of the prospective evaluations in long-term continuous ambulatory peritoneal dialysis patients. We have studied the clinical incidents and peritoneal function of 56 patients who started continuous ambulatory peritoneal dialysis between 1980 and 1988, and have completed at least 3 years of follow-up. Ultrafiltration capacity was calculated with a standardized formula. All patients were studied for peritoneal diffusion of urea and creatinine at least once a year. The evaluation consisted of a kinetic study done by means of a peritoneal equilibration curve for urea and creatinine, applying a bicompartmental mathematical model to calculate the MTCs. The sequential mean values for urea-MTC did not show significant changes over the observation period (20.7 +/- 5.9 mL/min for the first year v 19.8 +/- 6 mL/min for the fifth year). Creatinine-MTC values showed a significant increase over this period in the paired data analysis. The decrease of the urea-MTC to creatinine-MTC ratio may be an early and appropriate index for measuring these changes when the individual values are in the normal range. On the other hand, peritoneal ultrafiltration capacity significantly decreased over this period (1,800 +/- 530 mL/d v 1,400 +/- 600 mL/d, P < 0.01). The high rate of accumulated days of peritoneal inflammation was related to these significant changes, and thus may be proposed to be a good prognostic index of long-term peritoneal survival. These long-term functional changes might be related to the effect of injuries on the preservation of the normal peritoneal structure. We conclude that after 5 to 11 years, the human peritoneum shows functional stability (diffusion and water transport) in patients with low rates of peritoneal inflammation. With a few exceptions, represented by patients with a high rate of peritoneal inflammation, long-term peritoneal dialysis accomplished its newly entrusted task.

Adolescent↗
PubMed1994

Influence of erythropoietin on paradoxical responses of growth hormone to thyrotropin-releasing hormone in uremic patients.

Several alterations in growth hormone (GH) secretion have been reported in patients with chronic renal failure. The aim of the present report has been to assess the effect of acutely administered recombinant human erythropoietin (rHuEPO) infusion on GH responses to thyrotropin-releasing hormone (TRH) in uremic patients. Twelve male patients (mean age 46.2 years, range 24 to 69) were studied. Seven of them were on continuous ambulatory peritoneal dialysis (CAPD), two on chronic hemodialysis (HD) and two in pre-dialysis (PreD). None had been treated before with rHuEPO. Each patient was tested with TRH (400 micrograms i.v. in bolus), and with TRH plus rHuEPO (40 U/kg in constant infusion for 30 min) on different days. TRH administration provoked a paradoxical response of GH (peak > 5 micrograms/liter) in nine (5 CAPD, 2 HD, 2 PreD) out of 12 patients. In this group of patients with anomalous GH responses, rHuEPO infusion produced an abolishment of the paradoxical responses (GH peak < 5 micrograms/liter) in eight patients and a marked decrease in a further one. On the contrary, in patients with no paradoxical GH response, stimulation with TRH plus rHuEPO did not induce any change in GH release compared with that observed after TRH alone. rHuEPO had no effect on TRH-induced thyrotropin release. These results suggest that the paradoxical GH response to TRH in patients with chronic renal failure is blocked by rHuEPO administration. This rHuEPO action might be mediated by an increased release of somatostatin or an inhibited GH-releasing hormone secretion.

Adult↗
PubMed1994

Clinical significance of exit-site infections due to Xanthomonas in CAPD patients: a comparison with Pseudomonas infection.

We have assessed the clinical significance of exit-site infections secondary to Xanthomonas maltophilia in continuous ambulatory peritoneal dialysis (CAPD) patients, and compared them with episodes due to Pseudomonas. The study was a retrospective survey of all episodes of Xanthomonas and Pseudomonas-related exit-site infections (ESI) in all patients treated in our unit between 1984 and 1992. Thirteen episodes of Xanthomonas-related ESI were observed in eight patients and 17 episodes of Pseudomonas-related ESI were seen in 15 patients. Xanthomonas-related ESI was frequently associated with other microorganisms, while Pseudomonas-related ESI was not (66% versus 5%, P < 0.02). Only one episode of Xanthomonas-related ESI resulted in peritonitis and subsequent catheter removal, after 15 months of resistant colonization. Another case was considered to be chronic and indolent, as the Xanthomonas-related ESI continued after 23 months of local treatment. The other 11 episodes were resolved either without treatment or with an antibiotic cream after 7-120 days. However, all but two episodes of Pseudomonas-related ESI required intravenous antibiotics (usually ceftazidime); seven patients developed peritonitis, and 11 required surgical catheter manipulation (five external cuff extrusion, and six catheter removal) (1/13 Xanthomonas-related versus 11/17 Pseudomonas-related ESI, P < 0.03). Most Xanthomonas-related ESI do not lead to peritonitis, and constitute a mild condition, easily treatable without parenteral antibiotics or catheter replacement. The appearance of other associated organisms and the favourable evolution with local treatment suggest a saprophytic behaviour for Xanthomonas in our CAPD patients. On the contrary, Pseudomonas-related ESI is usually severe, requires parenteral antibiotics, frequently leads to peritonitis, and requires catheter replacement.

Adult↗
PubMed1994

Cell populations present in the nocturnal peritoneal effluent of patients on continuous ambulatory peritoneal dialysis and their relationship with peritoneal function and incidence of peritonitis.

OBJECTIVE: To study the relationship between peritoneal effluent cells and infection rate and to relate this population with functional characteristics. DESIGN: Prospective, longitudinal, and comparative study. SETTING: Outpatient continuous ambulatory peritoneal dialysis (CAPD) unit of a university medical center. PARTICIPANTS: Seventy-one uninfected patients, treated for 0-156 months on CAPD, in stable condition were studied (33 female, 38 male). INTERVENTIONS: Nocturnal peritoneal effluent (NPE) was drained with EDTA (2.5 mmol/L) at 37 degrees C and centrifuged at 2500 rpm for 9 minutes. MEASUREMENTS: Accumulated peritoneal inflammation days/year and ultrafiltration/diffusion (mass transfer coefficients (MTCs) for small molecules) capacities were recorded. Cellular count (cells/night) was performed using a Neubauer chamber. Macrophage function was assessed by cytochemical (lysosomal enzyme content: ANAE, beta-glucuronidase, acid phosphatase) and immunohistochemical procedures (expression of membrane antigens, CD4, 11b, 11c, 14, 16, 25, 35, and 71). RESULTS: The macrophage is the most frequently appearing cell in the NPE. Cell count decreases over time on CAPD (from 20 x 10(6) to 5 x 10(6) after the first year). Intrapatient variability was low, but interpatient differences were marked. Mesothelial cell count remained stable over time (0.25-0.5 x 10(6)). Four of our patients showed a "transforming" change in these cells. Previous incidence of peritonitis and values of functional measurements did not correlate with cell count or expressions of macrophage function (lysosome enzyme content and percentage of cells expressing different membrane antigens). CONCLUSION: There is difficulty interpreting the results on peritoneal effluent cells and their relationship with the incidence of peritonitis and functional characteristics of the peritoneum. No definite conclusions can be drawn other than the great interpatient and intrapatient variability. The presence of abnormal peritoneal cells with undetermined origin and function suggests the need for periodic studies of peritoneal effluent cells on long-term CAPD patients.

Cell Count↗
PubMed1994

Moncrief's technique for peritoneal catheter placement: experience of a CAPD unit.

A decrease in the peritonitis rate and the incidence of catheter exit-site/tunnel (E/T) infection are the most important factors affecting the permanent peritoneal catheter in continuous ambulatory peritoneal dialysis (CAPD) patients. Moncrief et al. have introduced a novel methodology (two phases) for peritoneal catheter placement (7.8). The most relevant characteristic is that the external portion remains buried on the subcutaneous tissue (sterile environment) during the healing process. After four to six weeks, the catheter is brought out through a small incision (0.5 cm) distal 2 cm from the subcutaneous cuff, and peritoneal dialysis may be initiated. The data available, presented by Moncrief et al., show a lower incidence of peritonitis rate and E/T infection with this implantation technique, when compared with a classic technique. The aim of this study is to learn if the placement of a peritoneal catheter with Moncrief's methodology decreases the incidence of complications related to peritoneal catheters. We treated 29 patients (group C) with the conventional procedure and 25 patients (group M) with the Moncrief technique. Follow-up was similar for both groups (C = 12.2 +/- 7.9 months vs M = 11.1 +/- 6.1 months, NS). The time buried was 3.23 +/- 0.9 weeks (2-5). Eleven patients completed four weeks with the catheter buried subcutaneously (group M-4). The incidence of E/T infection was similar for groups C and M, and lower in group M-4 (p < 0.05). The number of catheters free of infection was less in group C (31%) than in group M (46%) and M-4 (67%) (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1994

Growth hormone and cortisol secretion before and after erythropoietin therapy in CAPD patients.

Correction of anemia with recombinant human erythropoietin (rHuEPO) in patients with end-stage renal disease (ESRD) has been associated with improvement of several endocrine abnormalities. However, long-term effects of this therapy on pituitary secretion in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is not known. The aim of the present work was to assess the growth hormone (GH) and cortisol responses to insulin-induced hypoglycemia before and after the correction of anemia with rHuEPO therapy in CAPD patients. Five well-nourished and clinically stable patients were studied before and after 12-24 weeks of rHuEPO treatment. Seven normal volunteers were studied as controls. Insulin-induced hypoglycemia tests were performed prior to starting rHuEPO therapy and again after partial correction of anemia. Blood samples for GH, cortisol, and glucose were collected between -30 and 120 min after insulin (0.1 U/kg bw) administration. GH responses to hypoglycemic stress were characterized by marked differences in single patients when compared with the control group. However, the GH peak and the area under the secretory curves (AUC) of GH responses in CAPD patients (10.6 +/- 4.8 micrograms/L and 15.4 +/- 6.1 micrograms h/L, respectively) did not differ from those obtained in control subjects (14.3 +/- 4.1 micrograms/L and 19.4 +/- 3.5 micrograms h/L, respectively). The study, after correction of anemia, showed an evident decrease of GH values at each time point on the response curve in 4 patients, and no modification in 1 patient. Mean values of GH peak and AUC were 8.8 +/- 2.8 micrograms/L and 9.6 +/- 2.3 micrograms h/L.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

CAPD for treatment of ESRD patients with ascites secondary to liver cirrhosis.

The treatment of cirrhotic patients with ascites and end-stage renal disease (ESRD) is complex. Continuous ambulatory peritoneal dialysis (CAPD), as a continuous therapy, represents an alternative to hemodialysis-associated hemodynamic intolerance. We report our experience with 5 cirrhotic patients with ascites who were treated by CAPD. Three had been transferred from hemodialysis (HD) for intolerance. The hemodynamic tolerance was excellent in all patients, and solute and water peritoneal transport were increased over the normal range in all cases. Morbidity was principally related to liver disease. Peritoneal protein losses, initially high, decreased over time. Serum albumin was within the low normal range. The incidence of peritonitis was higher than usual in these patients; episodes caused by gram-negative bacteria, streptococci and listeria, were predominant. The cause of death was not CAPD-related. In our experience, CAPD should be the treatment of choice for cirrhotic patients with ascites who require dialysis.

Adult↗
PubMed1993

Presence of different mitogenic activities in the nocturnal peritoneal effluent of patients treated with CAPD.

Peritoneal cells in continuous ambulatory peritoneal dialysis (CAPD) patients are continually being regenerated. We previously reported that nocturnal peritoneal effluent is mitogenic on human and mouse fibroblasts in culture, especially when a comitogen is present. The nature, origin, and role of this mitogenic activity remain undetermined. The data resulting from the addition of different comitogen to dialysate suggest that the peritoneal effluent contains different growth factors with molecular weight greater than 10,000 dalton. Also, the presence of a growth inhibitor is plausible. In conclusion, different growth-promoting and inhibiting activities are present in the peritoneal effluent, suggesting a complex cellular relationship as a result of peritoneal dialysis with unknown consequences.

Animals↗
PubMed1993

Influence of recombinant human erythropoietin treatment on cortisol responses to insulin-induced hypoglycemia in CAPD patients.

The effect of chronic treatment with recombinant human erythropoietin (rHuEPO) on pituitary-adrenal axis responses to stress in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is not known. The purpose of this study was to assess the influence of rHuEPO treatment on corticotropin (ACTH) levels and cortisol responses to insulin-induced hypoglycemia in CAPD patients. Nine clinically stable and well-nourished patients (age 19-59 years) treated with subcutaneous rHuEPO, 34-208 U/kg BW/week, during 6-25 months were studied. Nine patients matched for age, sex, and duration of CAPD and not previously treated with rHuEPO were studied as the control group. Crystalline insulin (0.1 U/kg BW) was injected IV to the fasting subjects. Blood samples were collected before and 15, 30, 60, 90, and 120 minutes after insulin administration. In all blood samples serum cortisol and glucose concentrations were assessed. There were no statistically significant differences between both groups in hematocrit values and blood hemoglobin concentrations. Insulin administration induced a decrease in glucose levels that reached a nadir at 30 minutes in both groups (1.8 +/- 0.1 mmol/L in the rHuEPO group vs 2.1 +/- 0.2 mmol/L in the control group). After hypoglycemic stimuli cortisol levels clearly rose in rHuEPO-treated patients reaching a peak of 720 +/- 71 nmol/L at 60 minutes. However, in the control group the cortisol peak, which was not different from that observed in the rHuEPO group (676 +/- 44 nmol/L), occurred at 90 minutes. The areas under the secretory curve of cortisol did not differ between groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenocorticotropic Hormone↗
PubMed1993

Peritoneal resting is beneficial in peritoneal hyperpermeability and ultrafiltration failure.

Ultrafiltration failure (UFF) is one of the most frequent causes of continuous ambulatory peritoneal dialysis (CAPD) dropout and is a common consequence of peritoneal hyperpermeability secondary to inappropriate regeneration of mesothelial cells. In this paper we present the results of 25 peritoneal resting periods of 4 weeks in 16 patients who showed UFF. The mean duration of CAPD was 44 +/- 22 months. All patients had been free of peritonitis for at least 3 months when included in the peritoneal resting trial. UFF was always defined as a long-lasting decrease of UF capacity such that dry weight could no longer be achieved by CAPD. The former incidence of peritonitis was 3.9 +/- 2.3 episodes. Results compared to the preresting data: urea MTC (mass transfer coefficient) decreased from 24.9 +/- 6.8 to 21.0 +/- 6.1 (p < 0.05), creatinine MTC from 16.5 +/- 6.0 to 13.8 +/- 4.0 (p < 0.05), and UF increased from 493.8 +/- 278.0 to 881.3 +/- 388.1 (p < 0.001). The response in terms of UF in patients with low permeability ultrafiltration (creat MTC less than 13) was heterogeneous and lower than in patients with criteria of hyperpermeability (greater than 13): 720 +/- 396 to 1150 +/- 533 (NS) versus 491 +/- 310 to 808 +/- 205, respectively. Simultaneously, creatinine MTC did not change in the former group (10.2), while hyperpermeability patients showed a remarkable decrease (19 +/- 5 to 15 +/- 2, p < 0.05). In conclusion, peritoneal resting is a useful tool in the management of ultrafiltration failure in CAPD patients, primarily in those with peritoneal hyperpermeability.

Adult↗
PubMed1993

An analysis of adequacy of dialysis in a selected population on CAPD for over 3 years: the influence of urea and creatinine kinetics.

Adequacy of dialysis is addressed to minimize the negative consequences of underdialysis. The results of the NCSD demonstrated that urea kinetic modelling (UKM) is a useful tool in the measurement of adequacy of dialysis: Kt/V values of 1 are considered adequate to prevent complications when daily protein intake is appropriate. For CAPD no similar prospective studies exist, and consequently there is no information comparable to that for haemodialysis. Preliminary data have communicated controversial results about the usefulness of UKM for CAPD prescription. On the other hand creatinine kinetics has been proposed as an alternative to UKM to define adequacy of dialysis on CAPD. However, these results should be considered preliminary because of the small size of the series and the short observation period. The objective of this paper is to study the role of these two kinetic models in defining adequacy of dialysis in a long-term, selected CAPD population. We have studied 56 patients treated for at least 3 years on CAPD (3-11 years; mean observation period 5 years; 3996 patient-months). Urea kinetic model (UKM) (urea weekly (W) Kt/V and NPCR) and creatinine kinetics (Efficacy number (EN) and K) were determined annually. According to the present data we can conclude that Kt/V is an appropriate tool for defining adequacy in patients on CAPD. Values of weekly Kt/V greater than 1.7-1.8, with NPCR more than 1 g/kg/day, assure an adequate clinical outcome. Conversely, values on the Kt/V scale less than 1.7 entail a greater rate of complications. Our data also confirm that maintaining a serum albumin > 536-551 mumol/l (3.7-3.8 g/dl) is related to lower morbidity and mortality, and should be a major objective for CAPD patients. Consequently a relationship between dose of dialysis in terms of urea mass balance and protein nutrition can be established. After 5 years on CAPD, when all residual renal function is generally lost, Kt/V values in excess of 1.9 are difficult to achieve. Based on currently available information, we do agree with the interest of performing a prospective study on adequacy of dialysis based on the urea kinetic model in CAPD, which definitely defines its role. On the other hand, creatinine kinetics did not show sufficient discriminative capacity in terms of adequacy of dialysis. EN and Kt of creatinine values in the lower range (4.5-6 and less than 45-50 1/week respectively) were not necessarily associated with a poorer clinical outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗