Continuous Ambulatory Peritoneal Dialysis Group Research Articles

Pharmacokinetics of recombinant human erythropoietin in children with chronic renal failure.

Basal erythropoietin (Epo) levels and single dose-pharmacokinetics of recombinant human erythropoietin (rhuEpo) were investigated in 8 predialysis (PD) patients (mean age 11.6 +/- 1.4 years) and in 8 patients on continuous ambulatory peritoneal dialysis (CAPD) (mean age 12.7 +/- 0.6 years). Basal Epo levels were found to be 1.0 +/- 0.0 mu/ml in PD group, 1.6 +/- 0.7 mu/ml in CAPD group and 8.5 +/- 1.8 mu/ml in control group. Following administration of 50 mu/kg rhuEpo (s.c.) serum Epo concentration (Cmax) was 23.2 +/- 2.5 mu/ml in 18.5 +/- 2.6 hours (tmax) in PD patients and 9.9 +/- 0.8 mu/ml in 26.8 +/- 7.7 hours in CAPD patients. Mean elimination half-lives (t1/2) were 13.3 +/- 1.9 hours and 13.5 +/- 3.0 hours in PD patients and CAPD patients, respectively. The volume of distribution (Vd) was 840.0 +/- 100.0 ml/kg; the clearance (Epo Cl) was 37.0 +/- 5.5 ml/kg/hour in PD patients. These values were significantly lower in PD patients than in CAPD patients (p < 0.05) (Vd; 1500 +/- 240.0 ml/kg; Epo Cl 110 +/- 30.0 ml/kg/hour). During the course of CAPD, more efficient clearance of uraemic toxins that inhibit erythropoiesis and more rapid extraction of erythropoietin by erythroid precursors may cause higher Vd in CAPD patients than in PD patients.

Magnesium fractions in serum of healthy individuals and capd patients, measured by an ion-selective electrode and ultrafiltration

Objectives: Validation and comparison of a magnesium ionselective electrode (ISE) with a cation-exchange resin technique, followed by determination of all magnesium fractions in serum of healthy volunteers and continuous ambulatory peritoneal dialysis (CAPD) patients. Design and Methods: The analytical aspect has been studied by measuring the influence of complexing agents on the fraction ionized magnesium (friMg 2+). A theoretical approximation of friMg 2+, based on mass equilibria and complexation constants, was calculated and compared with the measurements. Results: ISE measurements showed good agreement with theory. Reference values of the ionized, protein-bound, and complexed magnesium fractions were (mean ± SD) 0.65 ± 0.04, 0.27 ± 0.04, and 0.08 ± 0.03, respectively. Fractions obtained in the CAPD group were 0.62 ± 0.04, 0.22 ± 0.05, and 0.16 ± 0.05, respectively, and differed significantly from the values of the reference population. Conclusions: All known serum magnesium parameters can be established by a combination of ultrafiltration, atomic absorption spectrometry, and ISE measurements. Unknown complexing compounds most probably account for the increased fraction of complexed magnesium in the serum of CAPD patients.

Eicosanoid Precursors: Potential Factors for Atherogenesis in Diabetic Capd Patients?

Prostaglandins, thromboxanes, and other eicosanoids represent a widespread lipid-mediator system for intercellular signalling, and, hence, have multiple cellular actions. Thus it is not surprising that numerous events in the pathogenesis of atherosclerosis are associated with an altered formation of eicosanoids. To reconsider the availability of eiconsanoid precursors as one possible cause of atherogenesis, the dietary intake and the serum concentrations of arachidonic acid (AA) and eicosapentaenoic acid (EPA) were determined in patients with high risk for atherosclerosis on continuous ambulatory peritoneal dialysis (CAPD) with and without diabetes in comparison to healthy controls and diabetic patients without late complications. The factor AA/EPA in serum was created as a marker for the atherosclerosis risk. The setting was in a CAPD unit in one city hospital. There were 26 CAPD patients [9 with insulin-dependent diabetes mellitus (IDDM), 9 with noninsulin-dependent diabetes mellitus (NIDDM), and 8 without diabetes], 27 IDDM without late complications, and 41 healthy control persons. The AA levels in serum were significantly higher in all of the CAPD groups. In contrast, the EPA concentrations in serum were significantly lower in the CAPD groups, with the lowest EPA levels found in the CAPD-IDDM group. Therefore, the factors AA/EPA in serum were significantly higher in all of the CAPD groups, and again significantly higher in the CAPD-IDDM group than in the other CAPD groups. No differences in the amount of dietary intake of AA existed between the groups. The daily intake of EPA was significantly highest in the control group. Higher concentrations of AA and a lack of n-3 fatty acids lead in the presence of a reduced prostaglandin I2 biosynthesis, to a higher formation rate of potentially proatherogenic metabolites such as thromboxane A2, a vasoconstricting and platelet aggregating agent. Thus, the quotient AA/EPA could possibly be used as a marker of atherogenicity in the future.

Effect of immunosuppressive drug regime on cardiovascular risk profile following kidney transplantation

We have previously studied cardiovascular risk markers apolipoprotein (a) (apo(a)) and plasma fibrinogen in 146 control, 60 haemodialysis (HD), 53 continuous ambulatory peritoneal dialysis (CAPD) and 66 renal transplant subjects. Fibrinogen concentration was higher in all 3 renal replacement groups compared to controls. Apo(a) was higher in the CAPD group only. We have now restudied those dialysis patients (24 HD, 16 CAPD) who have since undergone transplantation. Fibrinogen concentration remained elevated in CAPD patients (mean (SE) 3.9 (0.17) vs. 3.77 (0.20) grams/l) and increased in HD patients (2.88 (0.16) vs. 3.72 (0.13) grams/l, P < 0.0001). Apo(a) fell in both groups (CAPD, geometric mean 287 vs. 151 U/l, P = 0.008; HD, 230 vs. 179 U/l, P = 0.013). Fibrinogen concentration was higher in the recent group compared to the original group (3.74 (0.11) vs. 3.19 (0.12) grams/l, P = 0.001). None of the 66 original patients received cyclosporin (cyA) compared to 35 of the 40 in the present study. In this recent group, patients maintained on prednisolone and azathioprine alone had significantly lower fibrinogen levels than those receiving cyA. Furthermore, the fall in apo(a) was smaller (31% vs. 74%) and the increase in apolipoprotein B (apo B) greater (0.55 (0.15) vs. 0.18 (0.05) grams/l, P = 0.014) in cyA-treated patients. CyA may have an adverse effect on cardiovascular risk profile in renal transplant recipients.

Serum Advanced Glycosylation End-Products in Patients on Hemodialysis and CAPD

Part I: To evaluate the long-term effects of daily glucose absorption from the peritoneal dialysis fluid on the formation of low-molecular-weight advanced glycosylation end-products (AGE-peptides) in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Part II: To determine the acute effect of CAPD on serum AGE-peptide concentrations. Part I: Noninterventional, parallel, cross-sectional clinical trial. Part II: Crossover clinical trial. A university-based hospital, and clinics. Part I: Sixty nondiabetic subjects recruited into three age-matched (+/- 5 years) groups, as follows: 20 healthy volunteers (controls); 20 hemodialysis patients; and 20 CAPD patients. Part II: Eight patients with diabetes mellitus (type I or II) and chronic renal failure who were about to undergo CAPD. Part I: None. Part II: Uninterrupted CAPD, as medically required. Part I: To determine serum AGE-peptide concentrations blood samples were obtained randomly from controls and CAPD patients, and predialysis from hemodialysis patients. Hemoglobin A1c was also measured in all subjects. Part II: To determine serum AGE-peptide concentrations, blood samples were collected within one month prior to initiation of CAPD (predialysis) and, again, one week after initiation of uninterrupted CAPD (postdialysis). Hemoglobin A1c was measured predialysis. Part I: Mean hemoglobin A1c values for all groups were within the normal range; however, the mean value for CAPD patients was significantly higher than for both hemodialysis patients and healthy controls (controls, 5.21% +/- 0.6%; hemodialysis, 5.12% +/- 0.5%; CAPD, 5.78% +/- 0.6%; p < 0.01). The dialysis patients had a significantly higher mean serum AGE-peptide concentration than the control subjects (controls, 7.02 +/- 3.4 units/mL; hemodialysis, 11.9 +/- 3.6 units/mL; CAPD, 11.1 +/- 4.5 units/mL; p < 0.01). There was no difference in the mean serum AGE-peptide concentration of patients in the hemodialysis and CAPD groups. Part II: The mean hemoglobin A1c value in the diabetic predialysis patients was 9.2% +/- 1.9%. There was no difference between the predialysis and postdialysis serum AGE-peptide concentrations (predialysis, 16.9 +/- 9.6 units/mL; postdialysis, 16.0 +/- 2.9 units/mL; p = 0.78). Despite the increased glucose load and the higher hemoglobin A1c values, indicating poor glycemic control, nondiabetic CAPD patients did not have higher serum AGE-peptide concentrations than the nondiabetic hemodialysis patients. In diabetic patients, CAPD did not further increase the serum concentrations of AGE-peptides.

Triglyceride-rich lipoprotein abnormalities in CAPD-treated patients.

In the present study intermediate-density lipoproteins (IDL) and very-low-density lipoproteins (VLDL) composition, structure, and mass were analysed in fasting uraemic patients on continuous ambulatory peritoneal dialysis (CAPD) (n = 12) and on haemodialysis (HD) (n = 15), and in 15 healthy volunteers. All the groups were matched for sex, age, and time on dialysis. Both groups of patients had elevated very-low-density lipoprotein levels, CAPD patients four and HD group three times that of control. We found a fourfold and a twofold increase in the concentration of IDL cholesterol in the CAPD and HD group respectively when they were compared with the control group. Both groups of patients present an increased VLDL mass. The CAPD group showed a four-fold increase in IDL mass compared with the control group, which indicated a preponderance of large size and suggested that defective IDL clearance was involved. The IDL composition of the CAPD patients was significantly different from that of the HD patients: a twofold increase in IDL mass was observed in the CAPD patients if compared with HD patients. We report new data concerning the metabolism of triglyceride-rich lipoproteins in CAPD treated patients, which confirm the adverse effect of CAPD on serum lipids.

Decreased Uroporphyrinogen Decarboxylase Activity in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Raised plasma uroporphyrin levels were found in all the 14 patients with end-stage renal disease studied, 7 of whom were on continuous ambulatory peritoneal dialysis (CAPD) and 7 on hemodialysis (HD). The elevation observed in the HD group was higher than that noted in the CAPD group; 18-fold in the former and 13-fold in the latter. The difference in uroporphyrin plasma levels between the two dialysis populations might be explained, at least partially, by the reduced activity of uroporphyrinogen decarboxylase (UROD), the enzyme which converts uroporphyrinogen to coproporphyrinogen. A decrease of 48% was noted in the HD group, whereas no change was observed in the CAPD group. A significant negative correlation (r = -0.37, p < 0.01) was found between the concentration of uroporphyrin in plasma and the activity of UROD. In view of the data shown, it is suggested that erythrocyte UROD activity should be interpreted with caution in HD patients suspected of having porphyria cutanea tarda.

Increased renal allograft thrombosis in CAPD patients

In a retrospective analysis of 202 renal transplant procedures in the years 1989-1992 we identified an excess of grafts lost from primary renovascular thrombosis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) compared to haemodialysis (HD) patients (9 CAPD versus 0 HD, Chi-squared = 9.63; P < 0.01). All graft losses from thrombosis occurred within 16 days of surgery. Possible predisposing causes were identified in three patients. Donor age was greater in CAPD patients losing their kidneys from thrombosis compared to the overall CAPD group [mean (SD) years, 43.0(12.9) versus 29.1(15.8); P = 0.01] whereas no significant difference in haematocrit, platelet count, antibody status, cyclosporin use, peroperative hypotension, primary diagnosis, smoking, or diabetes mellitus was found. Data from the EDTA registry for 1990-91 show that graft loss from primary renovascular thrombosis in UK-treated patients was reported in 7.1% of CAPD recipients compared with 1.8% in haemodialysis. We suggest that CAPD patients are at greater risk of graft loss from renovascular thrombosis than HD patients and may require more intensive fluid and anticoagulant treatment in the perioperative period.

Reduced erythrocyte defense mechanisms against free radical toxicity in patients with chronic renal failure.

In this study, activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) and catalase (CAT) enzymes were determined in the erythrocytes from patients with chronic renal failure (CRF) and from healthy subjects. In the conservative drug management group and intermittent ambulatory peritoneal dialysis group, CAT activity was lower than in the control group. However, SOD and GSH-Px activities of these groups were not statistically different from the control values. In the continuous ambulatory peritoneal dialysis group and the hemodialysis group, SOD, GSH-Px and CAT activities were lower than control values. In the patient groups, correlation coefficients between the enzyme activities were also found to be different from the control values. Results suggested that enzymatic antioxidant defense mechanisms were suppressed in the erythrocytes from the patients with CRF, in particular in the erythrocytes from those who were under hemodialysis and continuous ambulatory peritoneal dialysis management. It is proposed that reduced antioxidant defense mechanisms in the erythrocytes is one of the important factors leading to peroxidation in the membrane lipid structure of the erythrocytes and thereby to hemolysis and anemia in the patients with CRF.

Pharmacokinetics and ex vivo susceptibility of cefpodoxime proxetil in patients receiving continuous ambulatory peritoneal dialysis

Pharmacokinetics of cefpodoxime, an extended-spectrum cephalosporin, were determined for eight noninfected patients on continuous ambulatory peritoneal dialysis (CAPD) and eight healthy volunteers. Subjects were matched for sex, age (+/- 6 years), and body weight (+/- 10 kg, except for one pair) and received a single 200-mg (cefpodoxime equivalents) oral dose of the prodrug cefpodoxime proxetil in an open-label, paired-design fashion. Dialysate (CAPD group only), plasma, and urine samples were collected and assayed for cefpodoxime by a microbiologic method. In addition, mean bactericidal titers of the effluent dialysate against selected bacterial strains often associated with CAPD-related peritonitis were determined at 6 and 24 h after the dose. There was a significant difference (P < 0.05) in all pharmacokinetic parameters between healthy and CAPD subjects, except for lag time to absorption. The mean peak plasma cefpodoxime concentration of 1.88 +/- 0.6 micrograms/ml occurred at 2.44 +/- 0.5 h for healthy volunteers, while the peak concentration of 3.25 +/- 1.4 micrograms/ml occurred at 12.0 +/- 4.2 h for patients on CAPD. The average elimination half-life in CAPD patients was approximately 12 times greater than that seen in healthy volunteers. Peritoneal dialysis had a minimal effect on cefpodoxime clearance. In healthy volunteers, 24.2% +/- 13% of the dose was recovered from the urine, in contrast to only 5.59% +/- 6.9% for CAPD patients. The mean bactericidal titers for all CAPD patients, at 6 and 24 h, were mostly less than 1:2 and did not exceed 1:4 for any of the isolates. Because of the decreased renal clearance and negligible dialysate clearance of cefpodoxime, and delayed drug absorption, the dosage interval for cefpodoxime proxetil may need to be extended in CAPD patients.

Food preferences and food habits of patients with chronic renal failure undergoing dialysis

Objective To examine and compare the food preferences of patients undergoing maintenance hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) with those of age- and sex-matched controls. Design We administered two questionnaires, one assessing preferences for 88 food items (according to a nine-point hedonic scale) and the other assessing factors influencing dietary habits. Subjects Thirty-three patients on HD, 17 patients on CAPD, and 30 control subjects with normal renal function. Main outcome measures The 88 foods were grouped into 14 classes to compare preferences. Taste aversions, food preparation details, and psychological and social determinants of food intake were also compared. Statistical analysis The preference ratings of the HD, CAPD, and control groups were compared using analysis of variance. The dietary habits results were examined using a X 2 analysis. Results Sweet foods ( P = .002, vegetables ( P = .003), red meats ( P = 0.10), and fish and poultry ( P = .015) were less pleasant for patients on HD than for control subjects. Red meats ( P = .019), and fish and poultry ( P = .032), and eggs ( P = .005) were less pleasant for patients on HD than for patients on CAPD. Red meat was the most unpopular food group for all dialysis patients. The most common factor affecting dietary intake was a loss of interest in food and/or cooking. Conclusion We conclude that chronic renal failure influences patients' food preferences and food habits. Knowledge of these preferences will help dietitians plan more adequate and enjoyable diets for such patients.

The Serum Complement System in Children on Continuous Ambulatory Peritoneal Dialysis

During continuous ambulatory peritoneal dialysis (CAPD), the loss of complement factors via the dialysate may cause complement deficiencies. This hypothesis was tested in a group of children treated with CAPD. Classical (CH50) and alternative (AP50) complement activity and serum levels of factors C1q, C3, C4, C3d, B, D, and P in CAPD patients were compared to normal controls and to children with preterminal renal failure. Patients were seen in a university hospital; normal controls were seen in an outpatient clinic of a general hospital. A group of 22 children on CAPD was compared to a normal control group of 44 children and to a group of 12 children with preterminal renal failure with a creatinine clearance below 25 mL/min/1.73 m2. CH50, AP50, C3, and B were not significantly different from the control group in both the CAPD and preterminal groups. Factors C1q (p = 0.01) and C4, C3d, D, and P (p < 0.001) were higher in the CAPD group in comparison to the normal control group. The factors D (p < 0.001) and P (p = 0.02) were also elevated in the preterminal group. For the measured factors there was no significant difference between the CAPD group and the preterminal group. There is no deficiency of complement in children treated with CAPD. High levels of C3d and D can be explained by the reduction of their elimination by the kidney. The increased levels of the other factors are presumably due to increased synthesis in renal failure. This does not seem to be caused by CAPD.

Low platelet glutathione peroxidase activity and serum selenium concentration in patients with chronic renal failure: relations to dialysis treatments, diet and cardiovascular complications.

1. Selenium status was investigated in patients with chronic renal failure, with special regard to its relations to the dialysis treatments, dietary habits and clinical signs of atherosclerosis. 2. Serum selenium concentration and platelet glutathione peroxidase activity were measured in 45 patients with chronic renal failure subdivided into three groups according to the type of treatment: 15 non-dialysed, 15 on haemodialysis, 15 on continuous ambulatory peritoneal dialysis. A 7-day diet history was carried out in all patients. Seventeen of the patients with chronic renal failure had clinically overt cardiovascular disease. Forty-five age-matched healthy subjects were considered as controls. 3. Both serum selenium concentration and platelet glutathione peroxidase were significantly reduced in all patients with chronic renal failure compared with control subjects; a direct and significant correlation was found between the two parameters. No differences in selenium status were observed among the non-dialysed, haemodialysis and continuous ambulatory peritoneal dialysis groups. No correlation between total calorie or protein intakes and selenium indices were observed. The chronic renal failure patients with cardiovascular complications showed a further significant reduction in both serum selenium concentration and platelet glutathione peroxidase activity as compared with the patients without cardiovascular complications; these two groups were similar with respect to the other well-known cardiovascular risk factors (age, smoking, plasma lipids, hypertension, body mass index). 4. It is concluded that a low selenium concentration is present in chronic renal failure, which is independent of dialysis and is accompanied by biological repercussion in terms of reduced platelet glutathione peroxidase activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical Nephrology and Dialysis in the 1990s

End-stage renal disease (ESRD) afflicts more than 200,000 patients in the United States today, and they undergo chronic dialysis or transplantation in order to sustain life. The primary causes of treated ESRD today are diabetes mellitus, hypertension, and glomerulonephritis. Hemodialysis remains the mainstay of therapy for patients, primarily due to the chronic shortage of organs available for transplantation. Technological advances have led to numerous improvements in hemodialysis therapy during the last 30 years. Dialysis is now provided in a variety of settings, including hospitals, outpatient dialysis units, and the home. Despite these advances, morbidity and mortality remain high for patients with ESRD. Patients with diabetes have the highest mortality rates primarily due to cardiac and infectious complications. Patients undergoing continuous ambulatory peritoneal dialysis (CAPD) are generally younger and healthier than their hemodialysis counterparts. Mortality is lower in the CAPD group for younger patients, whereas mortality is lower among older hemodialysis patients. Various methods have been described to assess adequacy of dialysis in order to develop the optimal dialysis prescription. Although these may ultimately prove beneficial, recent observations indicate an increased mortality in American hemodialysis patients compared with their European counterparts. These differences may be due in part to variances in reimbursement rates for dialysis therapy, and a reduction in dialysis time among U.S. centers. In light of the increasing number of patients and the complexity of their therapy, multiple opportunities exist for pharmacists to become actively involved in the comprehensive care of the ESRD patient.

Endothelin-1In Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients: A Preliminary Study

To determine the effects of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) on endothelin-1 (ET-1) levels in patients with end-stage renal disease (ESRD) and to assess the relationship between plasma ET-1 levels and selected patient parameters. Prospective, nonrandomized comparison study. Outpatient CAPD and HD units of a university medical center. Twelve ESRD patients (6 on CAPD and 6 on HD) and 5 healthy normotensive subjects. CAPD patients had blood and peritoneal dialysate samples collected and measurements made following an overnight exchange. HD patients had blood collected and measurements made at 0 hours (basal) and again at 3 hours during a midweek HD session. Blood samples were also collected from normal subjects and served as ET-1 controls. ET-1 and patient parameters (creatinine, peritoneal dialysate volume, blood pressure, body weight, age, and treatment duration) were determined. Data are reported as the mean +/- one standard deviation. Plasma and dialysate ET-1 levels in the CAPD group were 19.5 +/- 4.2 pg/mL and 9.2 +/- 4.2 pg/mL, respectively. The control group plasma and unused dialysate contained no detectable ET-1 (< 3.0 pg/mL, the limit of detection). The peritoneal clearance of ET-1 was less than that of creatinine (2.29 +/- 0.69 mL/minute vs 4.22 +/- 0.66 mL/minute, p = 0.005). The basal (0 hour) plasma ET-1 level in the HD group (16.5 +/- 7.8 pg/mL) did not differ from that of the CAPD group, p = 0.423. Furthermore, no differences in patient parameters were detected between the CAPD and basal HD groups. Although the mean arterial pressure (MAP) decreased during HD, the plasma ET-1 level at 3 hours (13.5 +/- 5.4 pg/mL) remained unchanged from the basal level, p = 0.307. An analysis of pooled data from the CAPD and HD groups revealed no significant correlation between plasma ET-1 and MAP, body weight, creatinine, or treatment duration. There was, however, a positive correlation between plasma ET-1 and age (r = 0.643, p = 0.024).

Atrial Natriuretic Factor in Patients on Continuous Ambulatory Peritoneal Dialysis

The aim of this study was to compare the levels of the atrial natriuretic factor (ANF) and the renin system in patients on continuous ambulatory peritoneal dialysis (CAPD) with patients on chronic hemodialysis (HD). We studied three groups. The CAPD group comprised 10 patients (25-66 years); the HD group: 10 patients (35-69 years), before (pre-HD) and after (post-HD) a HD session. The control group comprised 10 subjects with normal renal function (29-65 years), matched for age, height, weight, and diastolic pressure with the CAPD group. Blood pressure (BP) and blood samples for plasma renin activity (PRA), plasma aldosterone (PA), and ANF were taken. The BP and levels of ANF, PRA and PA were: in the control group, 121 +/- 15/75 +/- 4 mmHg, 7.3 +/- 5.6 pmol/L, 1.1 +/- 0.8 ng/mL/hour, 0.4 +/- 0.3 nmol/L. In the CAPD group, 132 +/- 26/76 +/- 12 mmHg (NS), 8.3 +/- 3.5 pmol/L (NS), 5.6 +/- 4.4 ng/mL/hour (p < 0.001), 4.9 +/- 4.0 nmol/L (p < 0.001). In the pre-HD, 159 +/- 25/95 +/- 12 mmHg (p < 0.001), 16.0 +/- 8.5 pmol/L (p < 0.005), 11.99 +/- 9.0 ng/mL/hour (p < 0.001), 2.6 +/- 2.3 nmol/L (p < 0.001). In the post-HD, 145 +/- 29/84 +/- 15 mmHg (p < 0.05 vs CG), 13.4 +/- 6.9 pmol/L (p < 0.05 vs control), 14.9 +/- 10.3 ng/mL/hour (p < 0.001 vs control), 3.8 +/- 2.9 nmol/L (p < 0.001 vs control).(ABSTRACT TRUNCATED AT 250 WORDS)

Psychiatric and Psychosocial Status of Elderly Patients Undergoing Dialysis

We investigated the psychiatric and psychosocial status of 31 elderly (age > 65 years) end-stage renal disease patients undergoing hemodialysis (HD) (17 patients) and continuous ambulatory peritoneal dialysis (CAPD) (14 patients). There was no difference between the two groups in terms of age (67.3 +/- 2.3 and 68.5 +/- 4.3 in HD and CAPD groups, respectively), duration of dialysis treatment, and biochemical profile. The psychiatric and psychosocial status of the patients was assessed using the standardized psychiatric interview (SPI), Hamilton's depression scale (HRS-D), and a questionnaire for the evaluation of the psychosocial impact of the method of treatment. Sixteen of 31 patients presented with psychiatric morbidity (9 mild, 5 moderate, 2 severe). However, there was no significant relationship between psychiatric morbidity and method of dialysis (HD or CAPD). The mean values of SPI (21.47 +/- 16.38 and 17.14 +/- 13) and HRS-D (20.91 +/- 17.33 and 15.41 +/- 13.13) scores for the HD and CAPD groups, respectively, did not differ significantly. The analysis of the results of the questionnaire regarding the impact of the method of treatment on psychosocial status indicated that the HD patients felt that their lives were more dependent on factors that they could not influence (i.e., the dialysis equipment, etc.). Our findings suggest that the psychiatric status of elderly patients undergoing chronic dialysis treatment is not affected by the method of treatment, a factor that should be taken into consideration when deciding the proper dialysis treatment for these patients.

Does Continuous Ambulatory Peritoneal Dialysis Induce Hypercholesterolemia?

Hypercholesterolemia has been recognized as a significant risk factor for atherosclerosis and coronary artery disease. The aim of this study was to evaluate the prevalence of hypercholesterolemia and the role, if any, of type of dialysis. In 19 hemodialysis (HD) and 20 continuous ambulatory peritoneal dialysis (CAPD) subjects, body weight, body mass index (BMI), arm muscle area (AMA), total cholesterol (C), HDL and LDL fractions, triglycerides, C/HDL ratio, glycosylated hemoglobin, and apolipoproteins AI, AII, B, CII, CIII, and E were evaluated. Hypercholesterolemia was defined as cholesterol greater than 220 mg/dL and LDL greater than 150 mg/dL. Body weight, body mass index, and arm muscle area were higher (p < 0.05) in CAPD as compared with HD; so were total cholesterol, LDL, C/HDL ratio, and glycosylated hemoglobin (Hbalc). Hypercholesterolemia prevalence was 3/19 in HD and 11/20 in CAPD (p < 0.05). A relationship between Hbalc and C/HDL ratio was found in the CAPD group (r = 0.48; p < 0.05). We are greatly concerned about these metabolic effects of CAPD; therefore, we should carefully select patients to be treated by CAPD. Aggressive nutritional and pharmacological treatment for glucose intolerance and hypercholesterolemia in CAPD patients must be performed in order to reduce the incidence of coronary artery disease (CAD).

Immune status of children on continuous ambulatory peritoneal dialysis.

Immunological parameters including serum IgG, IgA and IgM, lymphocyte phenotypes (CD3, CD4, CD8, HLA-DR+CD3-), natural killer cell activity and lymphocyte proliferation with phytohaemagglutinin were assessed in 10 children on continuous ambulatory peritoneal dialysis (CAPD) and 10 control subjects. Live vaccines were injected into 6 of the 10 children on CAPD (4 had a combined measles-mumps-rubella vaccine and the other 2 mumps vaccine). Serum antibody titres to these viruses were measured before and after vaccination. The serum IgG level was statistically lower in the CAPD group than in the control group (P less than 0.01), but there was no difference in the percentage of HLA-DR+CD3- cells and in the ratio of CD4 to CD8 between the two groups. There were no differences in the other parameters between the two groups. All of the 6 vaccinated children seroconverted, and serious side effects were not noted. Our results suggest that children on CAPD have no significant immune impairment.

The Effect of Recombinant Erythropoietin on the Early Hematocrit Rise after Capd Initiation

To determine if the simultaneous initiation of continuous ambulatory peritoneal dialysis (CAPD) and Erythropoietin therapy masks the hematocrit (Hct) rise that frequently follows the initiation of CAPD alone. Single-center retrospective analysis. University multidisciplinary dialysis program. All adult CAPD patients with a Hct less than or equal to 28% whose nephrologist felt they would benefit from Erythropoietin therapy and who did not have technical reasons for exclusion (N = 25). Eight patients began CAPD and Erythropoietin alfa subcutaneously, at a dose of 128 +/- 9 (X +/- SEM) units/kg/week at the same time. Seventeen patients already on CAPD for 8.7 +/- 1.5 months received Erythropoietin alfa subcutaneously at a dose of 124 +/- 7 units/kg/week. Pre-epoetin Hct's were similar. Hematocrit changes, status of iron stores, incidence of peritonitis, and dosage of Erythropoietin. In 1 month, the group initiating both therapies simultaneously demonstrated a mean Hct rise of 7.6 +/- 0.5% while established CAPD patients receiving Erythropoietin increased their Hct by only 4.7 +/- 1.0% (p less than .03). Iron status could not explain this difference. Peritonitis did not appear to dampen the Hct rise following Erythropoietin in either CAPD group. By 2 months after Erythropoietin, the differences were less apparent. The early rapid increase in Hct is probably the combined effect of CAPD and Erythropoietin and should not be attributed to Erythropoietin alone. When comparing responses to Erythropoietin from patients on different therapies, the timing of dialysis initiation and Erythropoietin initiation must be considered.