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PubMed2001

Involvement of Cdc25A phosphatase in Hep3B hepatoma cell growth inhibition induced by novel K vitamin analogs.

We previously found that K vitamin analogues caused cell growth inhibition in Hep3B hepatoma cells in vitro, which was associated with their inhibitory effects on protein tyrosine-phosphatases. In this study, we show that Cdc25A, a protein phosphatase, was inactivated by novel arylating K vitamin analogues. The inactivation of Cdc25A correlated with their effects on cell growth inhibition. Cyclin-dependent kinase (Cdk) 4, an important regulator for G(1) progression, was found to be tyrosine-phosphorylated by the arylating analogues, and this phosphorylation was correlated with the inhibitory effects of the analogues on Cdc25A activity. Furthermore, Cdk4 dephosphorylation experiments showed that Compound (Cpd) 5, a prototype arylating analogue, inhibited Cdc25A-mediated Cdk4 dephosphorylation, whereas Cpd 26, a nonarylating vitamin K analogue, had no effect on this event. We also examined Cdk4 kinase activity using retinoblastoma protein as a substrate and found that Cpd 5 inhibited retinoblastoma protein phosphorylation in a concentration-dependent manner, indicating that Cdk4 activity was inhibited by Cpd 5 treatment. Moreover, the thiol-antioxidants glutathione and N-acetyl-L-cysteine antagonized the Cpd 5-induced Cdk4 tyrosine phosphorylation, whereas the nonthiol-antioxidants catalase and superoxide dismutase did not. These results suggest that Hep3B cell growth inhibition by these K vitamin analogues may be related in part to inactivation of Cdc25A activity and support the hypothesis that Cdc25A is an attractive target for drugs designed to inhibit cancer cell growth.

Acetylcysteine↗
PubMedDate not supplied

Erectile dysfunction in chronic peritoneal dialysis patients: incidence and treatment with sildenafil.

OBJECTIVES: Sexual and erectile dysfunction (ED) have been reported to occur frequently in male patients with end-stage renal disease maintained on dialysis. Numerous etiologies for this ED have been suggested. Although a variety of therapies for the ED of the dialysis patient have been suggested, most clinicians indicate that patients report a poor response to therapy. Recently, sildenafil has been reported to be beneficial in treating patients with ED of both organic and psychogenic causes. The present study was designed to document the incidence of ED in male patients maintained on chronic peritoneal dialysis (CPD) and to determine the efficacy of prescribing sildenafil therapy to treat their ED. METHODS: All male patients in our CPD unit were notified by letter of the availability of sildenafil as a treatment modality for ED. A sexuality/erectile dysfunction assessment was conducted in all male patients by their primary nephrologist. Patients who reported ED and who had no medical contraindication to sildenafil were offered this therapy. Those patients who were interested in this treatment were interviewed by a social worker, and patients were asked to complete the International Index of Erectile Function questionnaire. Sildenafil was prescribed at a starting dose of 25 mg and increased to a maximum of 100 mg during a 12-week study trial. Patients were re-evaluated 6 and 12 weeks after the start of therapy. RESULTS: There were 68 male patients maintained on CPD at the time of the study. Mean age of all patients was 60.8 +/- 15.3 years and mean duration on PD was 32.6 +/- 25.6 months. Thirty-three patients had diabetes, 66 hypertension, 35 peripheral vascular disease, and 32 coronary artery disease. Thirty-two of 68 male patients in the CPD unit were assessed to have ED. Only 17 of the 32 patients expressed interest in pursuing sildenafil therapy. Two of these patients were excluded because they were receiving nitrate therapy. Of the 15 patients who agreed to take sildenafil, only 6 completed the 12-week study. Two of these patients responded to sildenafil. CONCLUSION: Erectile dysfunction is common in male patients maintained on CPD. Only about half of patients with ED in the present study were willing to consider sildenafil therapy to treat the ED and, of those who agreed to treatment, only a minority completed the 12-week trial; 2 of these 6 patients reported a satisfactory response.

Erectile Dysfunction↗
PubMed2001

Normal statural growth in 2 infants on chronic peritoneal dialysis: anecdotal or whole management-related.

AIMS: Growth retardation is usual in children on chronic peritoneal dialysis (CPD). Despite attention to many contributing factors (nutrition, dialysis dose, hemoglobin level, adynamic bone disease, hyperparathyroidism or rickets, growth hormone resistance, etc.), normal growth is rarely obtained in infants on CPD. MATERIALS AND METHODS: We had the chance to observe normal growth over a 1 year period in 2 consecutively treated infants on CPD. Louise (renal hypodysplasia) required CPD at the age of 1 month: creatinine 430 micromol/l; oliguric, creatinine clearance lower than 5 ml/min/1.73 m2. Nutrition was achieved orally with human milk during the first 6 months of life. Tidal peritoneal dialysis allowed a high dialysis dose Kt/V urea 3.8/week and Kcreatinine 105 l/week/1.73 m2. Hemoglobin was maintained over 13 g/dl and low levels of vitamin D analogue were prescribed to avoid adynamic bone disease. At the age of 1 year her height was 75 cm. i.e. in the normal range for age. Madeline (renal hypodysplasia) commenced on CPD at the age of 6 weeks and managed similarly. Her height at 1 year of age was 74 cm. RESULTS: In our 20 years of experience with children on dialysis, these 2 cases of normal statural growth for age at 1 year warrant discussion. As well as nutritional support, the new and recent therapeutic options in our team were: firstly, to avoid high doses of activated vitamin D to control PTH, as high doses are able to induce both a risk of adynamic bone disease and a direct bone cartilage toxicity: secondly, to maintain normal hemoglobin level; and thirdly, to deliver a high dialysis dose (urea, creatinine clearance) based on an individually adapted prescription. CONCLUSION: We feel this management approach is necessary to achieve optimal statural growth in children on chronic peritoneal dialysis. But this management concept only based on clinical anecdotal observations needs further evaluation before its use in clinical guidelines.

Body Height↗
PubMed2002

Small solute clearances and nutrition indices in obese patients on continuous peritoneal dialysis.

To investigate the relationship between obesity, small-solute clearances, and nutrition in continuous peritoneal dialysis (CPD), we compared clearances and nutrition indices between 270 obese and 502 normal-weight CPD patients. Degree of obesity was classified by the ratio of body weight (W) to desired weight (DW) at the first clearance study. The DWs were obtained from the tables of the Metropolitan Life Insurance Company, assuming a medium skeletal frame. The obese patients (group I) had W/DW > 1.2 (1.38 +/- 0.17), and the normal-weight patients (group II) had 0.9 < or = W/DW < or = 1.2 (1.05 +/- 0.08). Nutrition indices derived from urea nitrogen and creatinine excretion were normalized by both W and DW. The following variables differed between group I (first value) and group II: sex (women: 48.2% vs. 33.9%), W (87.6 +/- 14.4 kg vs. 68.2 +/- 8.7 kg), body surface area (1.95 +/- 0.22 m2 vs. 1.77 +/- 0.16 m2), body water by method of Watson (41.2 +/- 7.7 L vs. 36.3 +/- 5.5 L), body mass index (31.8 +/- 3.9 vs 24.3 +/- 2.0), protein nitrogen appearance (PNA: 62.9 +/- 17.6 kg in 24 h vs. 57.7 +/- 15.7 kg in 24 h), PNA normalized to DW (1.08 +/- 0.29 g/kg in 24 h vs. 0.96 +/- 0.26 g/kg in 24 h), creatinine excretion (CrEx: 1111 +/- 396 mg in 24 h vs. 991 +/- 348 mg in 24 h), CrEx/W (12.6 +/- 3.7 g/kg in 24 h vs. 15.4 +/- 4.5 g/kg in 24 h), CrEx/DW (17.3 +/- 5.3 g/kg in 24 h vs. 15.1 +/- 4.8 g/kg in 24 h), lean body mass (LBM: 49.3 +/- 13.8 kg vs. 43.6 +/- 11.9 kg), LBM/W (0.56 +/- 0.12 vs. 0.64 +/- 0.15), and LBM/DW (0.77 +/- 0.18 vs 0.67 +/- 0.16), all at p < or = 0.034. Marginal differences (0.10 > p > 0.05) were found in the diabetes prevalence (53.0% vs. 40.8%), height (165.9 +/- 11.7 cm vs. 167.4 +/- 9.8 cm), and serum albumin (3.64 +/- 0.55 g/dL vs. 3.53 +/- 0.62 g/dL). No differences were found in age, duration of CPD until the first clearance study, percent of subjects with anuria, Kt/V urea, creatinine clearance, blood urea nitrogen, serum creatinine, and PNA normalized to W. Obese CPD patients tend to have better nutrition indices than do normal-weight CPD patients with similar small-solute clearances. In obese subjects, normalization by W creates inappropriately low values for nutrition indices derived from urea nitrogen and creatinine excretion. Normalization of those indices by DW appears preferable.

Anthropometry↗
PubMed2003

[Study of corrected visual performance and vision quality].

OBJECTIVE: The present study was designed to examine the visual acuity (VA) and contrast sensitivity function (CSF) under three refractive correction methods, the visual performance and vision quality under different correction methods were compared and analyzed. METHODS: Twenty three college students with myopia (41 eyes, myopia range: -1.25 D approximately 9.25 D; astigmatism < 0.50 D) were enrolled and fully corrected by three different methods: 1) spectacles with resin lens material (SP); 2) soft contact lens (SCL); 3) rigid gas-permeable lens (RGP). The distant and near LogMar VA and CSF were examined. To avoid the subjective bias, the correction procedure was randomly selected and the VA chart and CSF chart used had the same pattern but different letters' organization or directions. RESULTS: The best corrected distant VA was significantly higher in RGP wearing eyes than those in the Soft-CL and SP wearing eyes (P < 0.01 and P < 0.05, respectively). No statistically significant difference was detected between the SP and SCL wearing eyes. There was no significant difference in the near VA among these three conditions, although the near VA in RGP group was slightly better than that in the SCL condition. There was no significant difference in CSF value at low spatial frequencies (1.5 cpd and 3 cpd) among these three conditions. However, at middle and high spatial frequencies (6 cpd, 12 cpd and 18 cpd), the RGP curve was the highest and followed by the SCL and SP curves. CONCLUSION: RGP correction offers the best visual acuity quality for myopia subjects. The CSF assessment can be used as an indirect method to evaluate the quality of corrected retinal image.

Adult↗
PubMed2003

Contrast sensitivity after +Gz acceleration.

BACKGROUND: This study was designed to determine the extent and duration of contrast sensitivity (CS) loss after high sustained +Gz acceleration in a centrifuge. METHODS: The subjects were 12 healthy male flight surgeons between 20 and 22 (mean = 21.1) yr of age. The human centrifuge at the Aviation Physiology Research Laboratory in Tainan, Taiwan, was used to expose the subjects to an acceleration profile. Each subject experienced three centrifuge runs made up of one gradual onset and two rapid onset profiles. Contrast sensitivity (CS) was measured before, and at 5 min, 10 min, and 20 min for the right eye; and 7 min, 12 min, and 22 min for the left eye after the acceleration. Both eyes were measured with the right eye being tested first. RESULTS: There was a generalized depression of CS at 5-12 min for both eyes. The depression was more severe at low and medium frequencies (1.5, 3.0, 6.0 cycles per degree, cpd) than at a high spatial frequency (18.0 cpd). There was a significant decrease in CS of the right eye at 1.5 cpd (p < 0.05 between control and 5 min), and on the left eye at 3.0 cpd (p < 0.05 between control and 7 min, p < 0.05 between control and 12 min) and 6.0 cpd (p < 0.05 between control and 12 min). The CS loss was more obvious at 5-12 min for both eyes, and there was only partial recovery at 22 min after the acceleration. CONCLUSIONS: These results demonstrated that +Gz acceleration is associated with CS loss. The recovery time was greater than expected. Factors other than ocular blood flow may be involved in the prolonged CS loss.

Adult↗
PubMed1991

[Right ventricular function evaluated by thermodilution method in patients with chronic pulmonary diseases].

The right ventricular ejection fraction (RVEF) is an objective evaluation of the right ventricular systolic function. Recently a rapid-response thermister pulmonary artery catheter which measures RVEF and stroke volume (SV) was introduced. With this new method, RVEF and the right ventricular volumes (RVV) were measured in patients with chronic pulmonary diseases (CPD) and normal subjects. In addition, to evaluate the validity of this method, the data was compared with Kr81m perfusion method. The RVEF and the RVV of CPD patients were also compared with pulmonary hemodynamic data. There was a good correlation between the RVEFs obtained by the Kr81m perfusion method and the TD method. (r = 0.71, p less than 0.001). There was a tendency towards a low RVEF in patient with CPD with pulmonary hypertension (PAm greater than 20 mmHg) or high pulmonary vascular resistance (PAR greater than 160 dyne/sec/cm-5) and the RVV increased in the same group. These results suggested that the right ventricle was unable to respond to the increase of afterload in the CPD group and the evaluation of RVEF and RVV in patients with CPD using the new TD method was valuable for assessing the right ventricular function.

Adult↗
PubMed1988

Bladder cancer in relation to cigarette smoking.

The importance of smoking-related variables in the development of bladder cancer was examined in data from a hospital-based case-control study of 1316 male and 505 female cases, and 3940 male and 1504 female age-matched controls interviewed in 20 hospitals from 9 United States cities between 1969 and 1984. For male current smokers, odds ratios for number of cigarettes smoked per day (cpd) increased to approximately 2.5 for smokers of more than 20 cpd, after adjustment for duration and nonsmoking-related covariates. Above 20 cpd, no further increase in odds ratio was observed. In females, the adjusted odds ratios showed no significant effect of increasing cpd level. In males, the odds ratios for duration increased from 1.18 (0.52-2.72) in those who smoke for less than 20 years to 2.31 (1.65-3.24) in those who smoked for greater than 40 years. In females, the corresponding odds ratios were 0.97 (0.27-3.44) and 1.62 (1.00-2.62). The results did not suggest an increased risk with early age at start of smoking in either sex. Ex-cigarette smokers, as a whole, had reduced odds ratios for bladder cancer, but the extent of the reduction was similar in short-term and longer-term quitters. The findings of this investigations support an association between smoking and bladder cancer. The pattern of risk associated with cpd and duration among current smokers and the early decline in risk associated with quitting are discussed in relation to possible mechanisms of bladder carcinogenesis.

Adult↗
PubMed1986

Ionized calcium in plasma during cardiopulmonary bypass.

The composition of the priming fluid in the heart-lung machine is of importance for the homeostasis of the patient during and after cardiopulmonary bypass. We have studied the effect of 5 different priming solutions on the degree of ionization of calcium. The primingsolutions all contained 1700 ml of a basic solution and 800 ml of one of the following solutions: CPD-plasma CPD-plasma added heparine and CaCl2 heparinized plasma 5% albumin in saline 6% dextran 70 in saline. With CPD-plasma in the priming solution, the concentration of ionized calcium dropped to very low values, followed by a normalization during the next 30 minutes, as the citrate disappeared. The addition of CaCl2 to CPD-plasma prevented the abrupt initial drop, but resulted later on in values above the normal range. Heparinized plasma, albumin, and dextran in the priming solution lead to small changes only. Bolus injections of CaCl2 during weaning from bypass resulted in substantial increases in ionized calcium, while the use of CPD-blood products lead to decreases. Citrate has great affinity to calcium ions, making strong complexes. When significant amounts of citrate are used, the level of ionized calcium cannot be predicted, but has to be measured directly. These measurements must be performed frequently.

Adult↗
PubMed1978

Prevention of oxalate urolithiasis by some compounds.

Male Wistar rats were fed a basal diet, Purina Laboratory Chow, and an oxalate calculi-producing diet (CPD). The CPD was the basal diet containing 3 per cent glycolic acid. Sodium pyruvate, DL-alanine, alpha-keto glutaric acid, thiamine pyrophosphate, and L-glutamic acid were added to the CPD to determine their effectiveness in preventing calculi formation. The effectiveness of methyl glyoxal was determined by adding it to the drinking water. Rats fed CPD for 4 weeks developed calculi in the ureters, bladder, renal tubules, and/or renal pelvis and papilla. Rats in groups fed alanine and/or pyruvate had no calculi in their renal tubules or ureters; additionally, these rats had a significant reduction in incidence and amount of deposits in the renal pelvis and bladder. Rats in groups fed alpha-keto glutaric acid, thiamine pyrophosphate, L-glutamic acid, and methyl glyoxal developed equally or more severe oxalate urolithiasis than those on CPD alone. Results of this study show that either pyruvate or alanine at appropriate levels may be beneficial in preventing oxalate urolith formation.

Alanine↗
PubMed1994

Continuous peritoneal dialysis in children with acute renal failure.

Continuous peritoneal dialysis (CPD) was performed in 13 children with acute renal failure (ARF) in our intensive care units (ICU). The median age was 6 months (range 3 days to 77 months). Sixty-nine percent of the patients (9/13) were below the age of 12 months. CPD was performed for a median duration of 5 days (range 1-35 days). In 62% of the patients (8/13), the cause of ARF was acute tubular necrosis (ATN) due to cardiac surgery. The outcome of CPD regarding total survival was 54% (7/13). A high mortality was registered (83% of the deaths [5/6]) within the first year of life, which suggests a worse prognosis if ARF occurs at this age. Half of the total deaths (3/6) were among the cardiac surgery patients. Peritoneal equilibration tests (PET) were performed utilizing measurement of urea and glucose transport through the peritoneal membrane at short intervals during a period of 45-60 min from the start of treatment. Short dwell times of 5-20 min were found to be sufficient for adequate uremic control until a satisfactory daily urine production was noted. CPD is a useful and simple treatment modality for ARF in critically ill ICU children. Equilibration tests are useful and should be considered for optimization of CPD treatment in critically ill children with ARF in order to achieve the goal of controlling uremia and fluid overload, and giving nutritional support.

Acute Kidney Injury↗
PubMed1993

Serum and urinary cefpodoxime levels and time killing curves performed in the urine of children presenting urinary tract infections.

Since resistance to several oral antimicrobials useful for the treatment of pediatric urinary tract infections (UTI) is overwhelming in Argentina, an in vitro investigation was performed testing 400 isolates obtained from urines of children suffering UTI's, 200 collected in 1990 and 200 in 1991. Their susceptibility against oral antimicrobials marketed in Argentina and appropriate for the treatment of UTI was determined by the agar dilution methods. An increase of the resistance to aminopenicillin combined with beta-lactamase inhibitors and to fluoroquinolones was observed comparing the two periods. Cefpodoxime (CPD), cefixime and fluoroquinolones except norfloxacin were the sole oral antimicrobials showing in vitro activity at the 90 per cent level. Unfortunately fluoroquinolones are not yet approved for pediatric use. Consequently we realized an in vitro and in vivo pharmacokinetic study in order to determine CPD activity against E. coli isolated in UTI cases. Five children (6-10 y) showing E. coli UTI infections received 10 mg/kg/d CPD in a single oral daily dose and were treated up to 10 days, 3 had lower UTI and 2 upper UTI. All patients were clinical and bacteriologically cured. Cultures obtained up to 4 weeks after treatment were negative. CPD serum levels at 2 hours after the first dose of treatment showed a median of 2.7 mg/l (2.3-3.4 range). Bactericidal serum titers at the same time against the patients own strain and an E. coli TEM-1 hyperproducer strain (MIC 4,096 mg/l for ampicillin and 0.5 mg/l for CPD) showed a median value of 1/8 against patients strains and 1/2 against the THP strain.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1994

Continuous peritoneal dialysis in newborns.

OBJECTIVES: To report the complications and outcome of 10 newborns affected by acute renal failure (ARF), treated by continuous peritoneal dialysis (CPD). DESIGN: All newborns admitted for tertiary treatment to the Neonatal Intensive Care Unit of the University of Padova, who underwent CPD between February 1986 and December 1990, were analyzed retrospectively. PATIENTS: Ten newborns (mean weight 2077 g, range 540-4930 g) received CPD, 6 of whom were preterm. All the survivors completed the study. INTERVENTIONS: A number 9, 5 French Tenckhoff catheter was used, and a closed circuit was created by means of a modified continuous ambulatory peritoneal dialysis (CAPD) technique. The mean duration of dialytic therapy was 7 days. RESULTS: At the end of the dialytic period, 7 of the 10 patients had normal serum potassium and sodium values. CPD produced two different types of complications: leakage of the dialytic fluid in very low weight newborns and one episode of peritonitis during a chronic dialysis treatment. Six died of severe respiratory failure (in no case, however, was this attributable to ARF or CPD procedure). All but one of the survivors regained normal renal function. The only exception necessitated a kidney transplant. CONCLUSION: We believe that this technique, although invasive, improves the outcome of both preterm and low birth weight newborns affected by ARF.

Acute Kidney Injury↗
PubMed1995

The minimal dose of dialysis required for a target KT/V in continuous peritoneal dialysis.

This study attempted to define the minimal dose of dialysis needed to produce a target KT/V in continuous peritoneal dialysis (CPD). In a training set of 143 clearance studies performed in 92 CPD patients, logistic regression identified low urine volume (UV) and low dialysate drain volume normalized by body water (DV/V) as predictors of weekly KT/V urea < or = 1.70. Solution of the regression equation with UV fixed at 0.00 1/24 h and at different probabilities of low KT/V provided a series of minimal DV/V values consistent with weekly KT/V > or = 1.70 in anuria. The accuracy of the logistic regression model and of the DV/V cut-offs was tested in a validation set (VS) of 189 urea kinetic studies performed in another 102 CPD patients. In the VS, the area under the Receiver Operating Characteristic curve generated by the regression model was 0.832 (95% Confidence Interval: 0.798-0.866). The DV/V cut-off value of 0.301 per 24 h, calculated by solving the regression model at p = 0.442 and with UV = 0, identified studies with weekly KT/V < 1.70 with a sensitivity of 89.3% and a specificity of 78.1% in anuric VS subjects (n = 60). Use of only the first urea kinetic study from each patient did not modify the predictors of KT/V or the cut-off values derived from solution of the regression model. The DV/V cut-off of 0.324 per 24 h, derived from the logistic regression model predicting KT/V < or = 1.90, identified KT/V < 1.90 in VS anuric subjects with a sensitivity of 94.3% and a specificity of 81.0%. Low UV and DV/V predict low KT/V urea in CPD. Prescribed 24 h exchange volume in anuric CPD subjects should be calculated to produce DV/V values exceeding 0.301 1/24 h per 1 body water for a KT/V of 1.70 and 0.324 1/24 h per 1 body water for a target weekly KT/V of 1.90.

Creatinine↗
PubMedDate not supplied

Creatinine clearance in continuous peritoneal dialysis: dialysis dose required for a minimal acceptable level.

OBJECTIVES: To identify the most advantageous formula for estimating creatinine clearance (CCr) and to establish a dose of dialysis that will ensure minimal acceptable levels of creatinine clearance in patients on continuous peritoneal dialysis (CPD). DESIGN: Analysis of all CCr studies performed in CPD patients over 40 months. SETTING: All four dialysis units following CPD patients in one city. One dialysis unit is government-owned, one is university-affiliated, and two are community based. PARTICIPANTS: One hundred and ninety-four patients representing almost the entire CPD population in Albuquerque. INTERVENTIONS: Creatinine and urea clearance studies were performed in 24-hour urine and drained dialysate samples. Creatinine clearance (peritoneal plus urinary) was normalized to either 1.73 m2 body surface area (CCr) or body water estimated by the Watson formulas (KT/VCr). CCr and KT/VCr were either corrected by averaging urinary creatinine and urea clearances or were not corrected. Two dialysis units were designated as the training set (92 patients, 143 clearance studies) and the other two units as the validation set (102 patients, 181 clearance studies). MAIN OUTCOME MEASURES: Minimal acceptable creatinine clearance levels were determined in the training set by computing the creatinine clearance value corresponding to 1.70 weekly KT/V urea by linear regression. Logistic regression models predicting low creatinine clearance were developed in the training set and were tested in the validation set. RESULTS: The following weekly creatinine clearance values corresponded to 1.70 KT/V urea: corrected CCr 52.0 L/1.73 m2, uncorrected CCr 54.4 L/1.73 m2, corrected KT/VCr 1.46, uncorrected KT/VCr 1.53. Logistic regression identified as predictors of low creatinine clearance low daily urine volume (UV) and low daily dialysate drain volume/body water (DV/V) for all four creatinine clearance formulas, plus low/low-average peritoneal solute transport (only for uncorrected CCr) and serum creatinine (for both KT/VCr formulas). In the validation set, the predictive models produced an area under the receiver operating characteristic (ROC) curve between 0.835 and 0.919 indicating very good predictive accuracy. For corrected CCr and anuria, the regression model produced a minimal normalized drain volume (DV/V) value consistent with minimal acceptable CCr equal to 0.305 L/L per 24 hours. This DV/V cutoff detected low corrected CCR in validation set anuric subjects (n = 55) with a sensitivity of 85% and a specificity of 71%. For uncorrected CCR and anuria, DV/V cutoffs were 0.273 L/L per 24 hours (high/high-average peritoneal solute transport) and 0.420 L/L per 24 hours (low/low-average transport). Sensitivity and specificity of these cutoffs in validation set anuric subjects were 87% and 85%, plus 86% and 33%, respectively. CONCLUSIONS: The uncorrected CCr appears to be the most advantageous creatinine clearance formula in CPD, because it allows the use of peritoneal solute transport type in the calculation of the minimal required normalized drain volume. The minimal acceptable uncorrected CCr is 54.4 L/1.73 m2 weekly. To achieve this uncorrected CCr in anuria, the required minimal normalized drain volume is 0.273 L per liter of body water daily if peritoneal solute transport is high or high-average and around 0.420 L per liter of body water daily if peritoneal solute transport is low or low-average. The required total daily drain volume is computed by multiplying the required normalized drain volume by body water.

Biological Transport↗
PubMed1996

Estimated versus predicted creatinine generation as an indicator of compliance with the prescribed dose of continuous peritoneal dialysis.

The expression (Estimated-Predicted)/Predicted creatinine generation ¿(E-P)/P¿ has been proposed as an index of compliance in continuous peritoneal dialysis (CPD). We attempted to define an (E-P)/P value that can be used as a cut-off for non-compliance and to characterize the relation of (E-P)/P to serum albumin. In 324 clearance studies, (E-P)/P had a normal distribution with a mean of +0.094 and an SD of 0.357. In these studies, there was a weak correlation between (E-P)/P and serum albumin (r = 0.12, P < 0.05), but (E-P)/P was not a predictor of serum albumin by logistic regression. In 34 CPD patients, who had an increase in the dose of CPD resulting in an increase in measured creatinine clearance from 43.8 +/- 14.0 to 66.1 +/- 17.6 L/1.73 m2 weekly (P < 0.001), (E-P)/P increased correspondingly from +0.018 +/- 0.284 to +0.153 +/- 0.369 (P = 0.018), although all subjects should be in a steady state of creatinine excretion in the second study. The rise in (E-P)/P was statistically significant in the subgroup of 17 subjects who had a decrease in serum albumin, but not in the subgroup of 14 subjects who had an increase in serum albumin from the first to the second clearance study. The (E-P)/P cut-off for a definitive diagnosis of CPD non-compliance may be around +0.400 or +0.500. The findings of this study suggest that non-compliance, as indicated by (E-P)/P, has an adverse effect on serum albumin and that non-compliance increases after a prescribed increase in the dose of CPD.

Creatinine↗
PubMed1996

Patient stratification by cardiopulmonary status in the diagnosis of pulmonary embolism.

UNLABELLED: The purpose of this investigation is to provide further evidence in support of the interpretation of ventilation/perfusion (V/Q) lung scans on the basis of criteria dependent on whether or not the patient has prior cardiopulmonary disease (CPD). METHODS: Data are from the collaborative PIOPED study. We evaluated the original PIOPED database to obtain the consensus probability estimates of pulmonary embolism (PE) among patients stratified according to the presence or absence of prior CPD. RESULTS: Among patients with no prior CPD, nuclear physicians consistently underestimated the probability of PE (odds ratio 1.62, 95% confidence interval 1.10-2.38, p = .014). CONCLUSION: Past experience guided nuclear physicians into correctly estimating the probability of acute PE on V/Q scans of patients with prior CPD. The criteria they subjectively used was inadequate for estimating the probability of acute PE in patients with no prior CPD. Different criteria, therefore, apply to the interpretation of V/Q scans in these two groups.

Heart Diseases↗
PubMedDate not supplied

Continuous peritoneal dialysis in heavyweight individuals: urea and creatinine clearances.

OBJECTIVE: To study whether or not continuous peritoneal dialysis (CPD) can provide acceptable levels of normalized urea and creatinine clearance in heavyweight individuals. DESIGN: Retrospective analysis of urea and creatinine clearance studies. SETTING: CPD patients followed in four dialysis units in Albuquerque, two dialysis units in Thessaloniki, and two dialysis units in Athens. PARTICIPANTS: One hundred and ninety-nine patients on CPD with 266 clearance determinations between 1991 and 1995. INTERVENTIONS: The heavyweight group consisted of 22 patients (24 clearance studies) weighing 100 kg or more (109 +/- 8.7 kg) at the time of the clearance study. All subjects were obese. The reference group consisted of 177 CPD subjects (242 clearance studies) of normal weight (68.7 +/- 12.2 kg). Urea fractional clearance (KT/V) and normalized creatinine clearance (Ccr) were compared between the heavyweight and the reference groups. MAIN OUTCOME MEASURES: The lowest acceptable weekly levels were set at 1.70 for KT/V and 54.4 L/1.73 m2 for Ccr. RESULTS: Weekly KT/V was 1.75 +/- 0.41 in the heavyweight group and 1.94 +/- 0.52 in the reference group (p = 0.047). Corresponding weekly Ccr levels were 64.0 +/- 24.3 and 77.6 +/- 40.3 L/1.73 m2, respectively (p = 0.021). In the heavyweight group, 13 studies (54.2%) had acceptable KT/V values compared to 160 studies (66.1%) in the reference group (NS). Corresponding values for acceptable Ccr were 17 (70.8%) and 165 (68.2%), respectively (NS). Drain volume was 12.96 +/- 4.40 L/24 hours in the heavyweight group and 9.63 +/- 2.58 L/24 hours in the reference group (p = 0.001). High daily exchange volume was delivered by a combination of daily continuous ambulatory peritoneal dialysis (CAPD) and nocturnal automated peritoneal dialysis (APD) in 13/16 heavyweight studies. This combination was tolerated better than any other method of delivering a large daily exchange volume. CONCLUSION: Although normalized urea and creatinine clearances are lower in obese, heavyweight individuals than in lean CPD subjects with lower weight, approximately equal percentages of these two groups achieve acceptable clearance levels. However, heavyweight individuals require larger-than-usual daily exchange volumes. The preferred way to deliver these large dialysate volumes is a combination of daily CAPD and nocturnal APD.

Body Weight↗