Intermittent Peritoneal Dialysis Research Articles

Transperitoneal Calcium and Magnesium Transfer during an 8-Hour Dialysis

The authors studied transperitoneal calcium and magnesium transfer during an eight-hour dialysis in 13 CAPD patients with both 1.5% dextrose and 4.25% dextrose solutions with a Ca concentration of 1.75 mM/L and Mg 0.75 mM/L. The mean mass transfer of calcium was 0.733 mmol with 1.5% dextrose exchanges, and - 0.151 mmol with 4.25% dextrose solutions. The mean mass transfer of magnesium was negative with both 1.5% and 4.25% dextrose solutions. Mass transfer of both calcium and magnesium correlated inversely with the initial peritoneal fluid: blood osmotic gradient and positively with the initial peritoneal fluid/blood calcium or magnesium gradients. The ionic calcium gradient was dissipated rapidly because of the disappearance of pH gradient. Peritoneal fluid ionic calcium concentrations correlated positively with peritoneal fluid pH. It is suggested that calcium traverses the peritoneal membrane in the forms of ionic and chelated calcium. Transperitoneal transfer of calcium and magnesium during peritoneal dialysis has been the subject of a few studies (1–4), which were concerned with intermittent peritoneal dialysis (1,2) or with continuous peritoneal dialysis (CAPD) involving four 2-litre exchanges daily (3, 4). Because three exchanges per day is our usual practice (15) and because there is a paucity of data on calcium and magnesium transfer during an eight-hour peritoneal dialysis, we undertook to determine transperitoneal transfer of calcium and magnesium, and to examine in detail the various factors affecting these trans peritoneal fluxes.

Erythrocyte Sodium and Potassium in Patients on Peritoneal Dialysis

Intracellular sodium and potassium concentrations were determined on erythrocytes obtained, before and after treatment, from patients with end-stage renal disease undergoing 48-hour intermittent peritoneal dialysis. Erythrocyte sodium increased from 7.5 +/- 0.3 to 8.6 +/- 0.4 mmol/L cells with a mean of 1.1 +/- 0.1 mmol/L cells (P less than .001), but erythrocyte potassium and cellular water content were virtually unchanged. Plasma potassium decreased during dialysis from 4.2 +/- 0.2 to 3.3 +/- 0.1 mEq/L (P less than .001). The increase in red-cell sodium correlated with this decrease in plasma potassium (r = .51, P less than .01). In contrast, erythrocyte sodium and potassium in undialyzed control patients with chronic renal failure did not change over a similar period, and plasma potassium was unchanged (4.3 +/- 0.1 mEq/L before and 4.3 +/- 0.2 mEq/L after 48 hours). Incubation of postdialysis erythrocytes from the dialysis patients in their own plasma at varying potassium concentrations showed that the rise in cell sodium was blunted as the plasma potassium was increased from 3.2 +/- 0.1 to 4.5 +/- 0.2 mEq/L. These results suggest that unlike hemodialysis, which is not associated with short-term changes in red-cell electrolytes, intermittent peritoneal dialysis results in a reversible increase in erythrocyte sodium. This change appears to be causally related to the decrease in extracellular potassium concentration.

Diminished Blood Selenium Levels in Renal Failure Patients on Dialysis: Correlations with Nutritional Status

Selenium deficiency has been implicated as contributing to the development of cardiovascular disease, skeletal muscle myopathy, anemia, increased cancer risk, and deranged immune function. Since these problems may also be associated with renal failure, and the kidney plays an important role in selenium homeostasis, we measured selenium and compared it with nutritional status in 24 stable hemodialysis patients, 12 chronic intermittent peritoneal dialysis patients, and 29 healthy controls. Whole blood and plasma selenium was determined by a spectrofluorometric method. For whole blood the mean (±SD) selenium levels were 0.11±0.02 ug/ml in controls vs. 0.071±0.01 ug/ml in hemodialysis cases and 0.052±0.006 ug/ml in peritoneal dialysis (p<0.005). Significant decreases were seen also for plasma and red blood cell selenium in all groups respectively. Pre- and postdialysis plasma and whole blood selenium levels showed no significant changes in both dialysis groups. However, predialysis residual peritoneal fluid did contain selenium (0.029±0.005 ug/ml).Some evidence of protein-energy undernutrition was noted in both dialysis groups compared with controls. However, no significant differences in nutritional parameters were noted between hemodialysis and peritoneal dialysis patients. When all groups were combined, significant correlations were found between whole blood selenium and serum albumin (r=0.61; p<0.001), triceps skin fold in females (r=0.62; p<0.001), and midarm muscle circumference in males (r=0.71; p<0.001).We conclude that low blood selenium is present in renal failure patients undergoing hemodialysis. This abnormality is even greater in peritoneal dialysis cases. Although pre- and postdialysis selenium levels do not change appreciably, peritoneal fluid contained selenium and represents a source of loss. Poor protein-calorie nutritional status was also evident in both dialysis groups and probably contributed to this abnormality.

TREATMENT OF END-STAGE RENAL FAILURE DUE TO DIABETES IN THE UNITED KINGDOM, 1975-84

In 1975-84 762 new patients with end-stage renal failure (ESRF) due to diabetes mellitus were accepted onto renal replacement programmes in the United Kingdom. They formed 5·7% of the total intake of ESRF patients. This proportion rose from 1·4% in 1975 to 11·1% in 1984. 4·1% of the patients on renal replacement therapy at the end of 1984 were reported as having ESRF due to diabetic nephropathy. During 1983-84, 272 patients taken on were type I (76%) and 87 (24%) were type II diabetics. Continuous ambulatory peritoneal dialysis (CAPD) was most popular as both initial (51%, plus 24% on intermittent peritoneal dialysis in 1983-84) and long-term treatment (48% of 446 under treatment at Dec 31, 1984); 163 patients (36·5%) had successful allografts, and only 14% of patients were on haemodialysis. Actuarial survival was 49% at 3 years, irrespective of type of treatment; the death rate for type II diabetics approached the intake rate in 1983-84. There was considerable regional variation in the numbers of diabetics on treatment. Even though the proportion of diabetics entering British end-stage renal failure programmes is rising, many patients who may benefit from treatment are probably not receiving it.

Bicarbonate, L-Lactate and D-Lactate Balance in Intermittent Peritoneal Dialysis

Systemic acid-base values and bicarbonate and lactate balance were measured during dialysis in seven patients on chronic intermittent peritoneal dialysis (IPD). Dialysate contained 40 mM lactate, including 20 mM D-Iactate and 20 mM L-Iactate. Mean predialysis plasma bicarbonate concentration was 22 mM and rose to 25 mM after dialysis. The average net alkali gain during dialysis, calculated as lactate gain minus bicarbonate loss, was 80 mmoles/ treatment or 34 mmoles/day. There was considerable variability in alkali gain between patients and between treatments in the same patient. The major factors influencing alkali gain were peritoneal solute clearance and dialysate effluent volume, or ultrafiltration. Both in the balance study, and in a shorter study comparing the effects of consecutive 4.25% or 0.5 % glucose exchanges on net alkali gain, the authors demonstrated that increasing ultrafiltration reduced net alkali gain by about 26 mmoles/liter ultrafiltrate. D-Iactate appears to be quantitatively as important as Llactate in bicarbonate generation. Further longitudinal studies are required to define the relationship between net alkali gain, dietary hydrogen-ion generation and blood acid-base values.

Issues in Pediatric Dialysis

CHILDREN, in increasing numbers , require long-term dialysi s due to the lack of availability of suitable kidneys for tran splantation, the development of high titers of cytotoxic antibodies, the loss of a functioning allograft, and the need in infants for an increase in body size. The availability in the past decade of automatic cyclers and the development of continuous ambulatory peritoneal dialysis (CAPD) followed by continuous cyclic peritoneal dialysis (CCPD) have resulted in peritoneal dialysis being offered to a greater fraction of children with end-stage renal disease. Peritoneal dialysis, with rare exception, is the modality used for chronic dialysis in neonates . Even though most advances in pediatric dialysis during the past 5 years have occurred in the area of peritoneal dialysis, improvements in pediatric hemodialysis continue. Despite significant advances in dialytic care for children with end-stage renal disease , long-term data comparing various forms of dialysis from single centers are sparse. Considered in this report are data comparing CAPD with hemodialysis and intermittent peritoneal dialysis (IPD) with CAPD. A long-term experience with CAPD in neonates and single-center experience with continuous forms of peritoneal dialysis (CPD) also will be reviewed. Finally, the role of urea kinetic modeling in pediatric hemodialysis will be considered .

Stopping long-term dialysis. An empirical study of withdrawal of life-supporting treatment.

Dialysis was discontinued in 155 (9 percent) of 1766 patients being treated for end-stage renal disease, accounting for 22 percent of all deaths. Treatment was withdrawn more frequently in older than in younger non-diabetic patients, and more often in young diabetic patients than in young nondiabetic patients. Withdrawal was twice as common in nondiabetic patients with other degenerative disorders (P less than 0.005); in patients receiving intermittent peritoneal dialysis (P less than 0.025); and in patients living in nursing homes (P less than 0.025). Half the patients were competent when the decision to withdraw was made, and 39 percent of this group had no new preceding medical complications. Among incompetent patients, the physician initiated the decision for withdrawal in 73 percent, and the patient's family in 27 percent; all patients had recent medical complications. In the early 1970s the physician initiated the decision in 66 percent of all patients; in the early 1980s this figure had decreased to 30 percent (P less than 0.0005). We conclude that stopping treatment is a common mode of death in patients receiving long-term dialysis, particularly in those who are old and those who have complicating degenerative diseases. Because of the increasing age of patients on dialysis, withdrawal of treatment will probably become more common in the future.

Gentamicin removal during intermittent peritoneal dialysis.

Gentamicin removal during intermittent peritoneal dialysis was studied in 13 uremic patients. The peak serum level after 80 mg of gentamicin intravenous drip was 6.00 +/- 1.3 micrograms/ml with a serum half-life of 13.6 +/- 4.07 h. The gentamicin dialysate level did not correlate with the corresponding serum concentration. The peritoneal gentamicin clearance (10.0 +/- 3.65 ml/min) correlated with the rate of protein loss, but not with the peritoneal clearances of urea and creatinine. When 4% glucose dialysate was used, the clearance of the drug increased considerably along with the ultrafiltration rate. Adding gentamicin (5 micrograms/ml) to the dialysate resulted in a sustained serum drug level. The mechanism of gentamicin transport through the peritoneal membrane is discussed. The study demonstrated significant removal of gentamicin during intermittent peritoneal dialysis.

Serum free carnitine, carnitine esters and lipids in patients on peritoneal dialysis and hemodialysis.

Serum free and esterified carnitine levels as well as lipids were investigated in patients undergoing regular hemodialysis (HD) treatment before and during 12 weeks of treatment with L-carnitine (1 g i.v.) at the end of each HD. The results were compared with those obtained in patients on continuous ambulatory peritoneal dialysis (CAPD; n = 15) or intermittent peritoneal dialysis (IPD; n = 3) and healthy controls (CO; n = 20). In HD patients (n = 23) total carnitine (TC) was 49.9 +/- 3.9 (CO: 46.0 +/- 2.5; NS), free carnitine (FC) was 31.6 +/- 2.8 (CO: 37.4 +/- 1.3; p less than 0.05), short-chain acylcarnitine (SCC) was 17.0 +/- 1.8 (CO: 7.2 +/- 0.9; p less than 0.0001) and long-chain acylcarnitine (LCC) was 1.2 +/- 0.2 mumol/l (CO: 0.6 +/- 0.1; p less than 0.05). FC was in the normal range in CAPD (35.6 +/- 3.2) and IPD (44.5 +/- 8.0 mumol/l) patients, whereas SCC (30.1 +/- 3.5) and LCC (2.9 +/- 0.2) levels were maximal elevated in IPD patients (11.8 +/- 0.8 and 1.5 +/- 0.2 on CAPD). Therefore, TC was higher in IPD than in CAPD patients (77.5 +/- 5.0 vs. 49.0 +/- 3.5 mumol/l). 12 weeks after L-carnitine supplementation in HD patients, TC was 313.9 +/- 22.6, FC was 207.7 +/- 12.4, SCC was 99.6 +/- 12.1 and LCC was 7.1 +/- 0.6 mumol/l. TC and FC were significantly lower in females compared with males. Total cholesterol and ketone bodies were normal, HDL cholesterol was significantly decreased before and after L-carnitine supplementation.(ABSTRACT TRUNCATED AT 250 WORDS)

The Acute Intermittent Peritoneal Dialysis in Acute Renal Failure of Newborn and Young Infants

We studied the effects of the acute intermittent peritoneal dialysis in severe acute renal failure of 1 newborn infant and 2 young infants during 18 months period from February 1985 to April 1986. The predisposing illnesses were severe acute gastroenteritis with dehydration. Reye's syndrome, and bilateral nephrolithiasis with hyperuricemia. The concomittent illnesses were severe hypernatremia, hyponatremia, hyperkalemia, hypocalcemia, hypoglycemia, DIC(disseminated intravascular coagulopathy), paralytic ileus, metabolic acidosis and gastrointestinal bleeding. As a dialvsate, Imperinol , 1.5% was used in all cases. The cycles of dialysis were 8, 16, and 41 times in each cases. Observed complications during dialysis were leakage, and abdominal wall and scrotol swelling in 2 cases, hyperglycemia in 1 case, and peritonitis in 1 case. Acinetobacter calcoaceticus was cultured in peritoneal fluid of peritonitis. These complications were treated by stopping dialysis in leakage and abdiminal wall swelling, insulin therapy in hyperglycemia, and intraperitoneal and systemic antibiotics therapy in peritonitis. We experienced improvements of severe acute renal failure with variable concomittant illnesses by acute intermittent peritoneal dialysis despite of the treatable complications of dialysis in all cases.

Cellular response to peritonitis among peritoneal dialysis patients.

White blood cell counts and differential cell counts were performed on 249 peritoneal dialysis effluents from 48 patients using chronic peritoneal dialysis. The finding of more than 50% polymorphonuclear leukocytes in the dialysate was a more sensitive indicator of peritonitis than was an absolute cell count of 100 cells/microL. This finding was true for patients using intermittent peritoneal dialysis, continuous ambulatory peritoneal dialysis, and continuous cycling peritoneal dialysis.

Complete Dialysate Drainage: An Unnecessary Step in Intermittent Peritoneal Dialysis

Peritoneal dialysis was performed in 16 renal-failure patients to study the necessity of complete drainage during the outflow period. Comparison between complete drainage (CD) and the accelerated inflow and limited outflow (AILO) showed no difference of drainage volume despite the accelerated outflow during the AILO period. It is postulated that the higher level of dialysate in the fluid line during the AILO period resulted in a relative increase availability of the outflow through the catheter perforations. In the CD period the peritoneal clearances of urea, creatinine and inulin were lower because of inefficient transport of these solutes during the outflow phase. The authors concluded that complete drainage is not necessary in intermittent peritoneal dialysis. During intermittent peritoneal dialysis, dialysate drainage volume usually is a major concern among medical and nursing staffs. Particularly during the initial exchange, dialysate frequently is retained because of a pocket of fluid in an inaccessible area of the peritoneal cavity (1). Thus, in subsequent exchanges considerable effort is made to stimulate drainage so as to avoid further accumulation. This prolongs outflow time and takes up the time and attention of paramedical personnel. The present study was done to evaluate the necessity of complete dialysate drainage in term of mechanics and efficiency of dialysis.

Reduplicated Basal Lamina of Small Venules and Mesothelium of Human Parietal Peritoneum: Ultrastructural Changes of Reduplicated Peritoneal Basement Membrane

We examined under the electron microscope samples of parietal peritoneum obtained from nine nondiabetic chronic uremics -six of them on maintenance intermittent peritoneal dialysis, ranging in age from 52 to 82 years -mean 64.4 ± 8.1 years and of nine non-uremic, non-diabetic patients -mean age 40.7 ± 12.2 years. Postcapillary venules and small venules showed areas with several layers of reduplicated basal lamina. Some microvessels showed gaps in basallamina with and/or without focal reduplication. Reduplicated submesothelial basal lamina was found in only one patient. These changes were not observed in the nine non-uremic, non-diabetic controls. To the best of our knowledge, this is the first description in humans of such alterations in the aforementioned locations, which may well be secondary to aging and/or to the intense mesothelial renewal observed in I.P.D. patients. We need to determine the possible influence of these ultrastructural changes on transperitoneal transfer of water and solutes during peritoneal dialysis. The basal lamina of blood vessels may not be of uniform thickness. Human non-diabetic adults show significant increase in capillary basal lamina thickness as one moves from head to foot (1). Those regional variations may be related to differences in venous hydrostatic pressure effective on the capillary bed (1). This paper decribes the first observations of reduplicated basal lamina of microvessels in the parietal peritoneum and of that subjacent to mesothelial cells in elderly, non-diabetic uremic patients.

Abdominal Hernias in Chronic Peritoneal Dialysis Patients: A Review

Of 1365 patients on continuous ambulatory peritoneal dialysis (CAPD) identified by a literature review, 174 (12.7%) developed one or more abdominal hernias. Twenty-three per cent of these hernias were inguinal, 19.1% developed at the site of catheter insertion, 18.6% were umbilical, 8.3% were ventral, 9.8% were at other incisional sites, 7.4% were at other sites, and 13.7% were unclassified. Twenty-seven (13.2%) of the hernias were strangulated or incarcerated. The incidence of abdominal hernias in 827 CAPD patients was one per 104.2 cathetermonths, with a range among dialysis centers of one hernia per 47.4 to 779.0 catheter-months. Among 436 patients on intermittent peritoneal dialysis, 12 (2.8%) developed an abdominal hernia, four times less frequently than in CAPD patients (P &lt; 0.001).

Manual Intermittent Peritoneal Dialysis: A Successful Alternative to CAPD in Developing Countries

Manual Intermittent Peritoneal Dialysis: A Successful Alternative to CAPD in Developing Countries

Antibiotic treatment of infectious peritonitis in chronic peritoneal dialysis.

Antibiotic treatment of infectious peritonitis was evaluated in 97 primary episodes registered among 66 patients treated with chronic intermittent peritoneal dialysis over a 3-year period. 87% of the cases could be treated with antibiotics of low toxicity. The chance of continuing peritoneal dialysis after treatment of peritonitis was better among out-patients than among hospitalized patients. The overall continuance rate was 90%. Relapse of the primary infection occurred in 10% of the cases and was associated with a treatment duration shorter than 2 weeks. Superinfection occurred in 5% of the cases. In 15% the dialysis catheters had to be replaced, due primarily to problems of dialysis technique. Death during active peritonitis occurred in 4% of the cases and was associated with severe underlying diseases or complications, such as intestinal perforation and intraperitoneal abscess formation. Side effects attributable to antibiotic treatment occurred in 13% of the cases, the most common side effect being self-limiting diarrhoea.

Successful Use of Continuous Ambulatory Peritoneal Dialysis in Refractory Heart Failure

Four patients with end-stage heart failure, massive ascites refractory to medical interventions and a variable degree of renal failure were treated successfuly with CAPD for eight to 24 months. The New York Heart Association functional class improved in all four. In two patients, who presented initially with signs and symptoms mainly of right-sided heart failure, ejection fraction improved. Each day dialysis achieved a significant degree of ultrafiltration and a negative sodium balance. We propose that CAPD is an alternative therapeutic modality in patients with severe heart failure refractory to the conventional medical treatment. The advent of potent diuretics and preload and afterload reducing agents has had a major impact in the treatment of refractory congestive heart failure. Recently, captopril, an angiotensinconverting enzyme inhibitor, has been used with major benefit in some patients (I). However, some patients still do not respond to these treatments and their management presents a major therapeutic challenge. Furthermore, overzealous therapy with diuretics may lead to intravascular volume depletion resulting in hypotension, azotemia and electrolyte disturbances which further complicate their management. In the past, intermittent peritoneal dialysis (IPD) or hemodialysis (HD) has been used to remove fluid from patients with intractable edema due to heart failure (2 7). But the benefit is only transient and fluid accumulates again, requiring repeated sessions of acute dialysis. However, hypotension is a frequent complication during either form of acute dialysis especially in hemodynamically unstable patients due to rapid removal of large amounts of fluid from intravascular space. Continuous ambulatory peritoneal dialysis (CAPD), whose main characteristic is the slow continuous removal of sodium and water, offers obvious advantages in patients with intractable heart failure. This paper describes our experience of four patients with intractable heart failure who have been treated with CAPD for eight to 24 months.

Academic-industrial clinical pharmacology: a working model.

The Journal of Clinical PharmacologyVolume 25, Issue 1 p. 4-7 Free Access Academic-Industrial Clinical Pharmacology: A Working Model Roger K. Ferguson MD, Corresponding Author Roger K. Ferguson MD Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, and Merck Sharp & Dohme Research Laboratories, West Point, PA.Division of Clinical Pharmacology (M-502), Thomas Jefferson University, Philadelphia, PA 19107.Search for more papers by this authorPeter H. Vlasses PharmD, Peter H. Vlasses PharmD Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, and Merck Sharp & Dohme Research Laboratories, West Point, PA.Search for more papers by this authorWilliam B. Abrams MD, William B. Abrams MD Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, and Merck Sharp & Dohme Research Laboratories, West Point, PA.Search for more papers by this author Roger K. Ferguson MD, Corresponding Author Roger K. Ferguson MD Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, and Merck Sharp & Dohme Research Laboratories, West Point, PA.Division of Clinical Pharmacology (M-502), Thomas Jefferson University, Philadelphia, PA 19107.Search for more papers by this authorPeter H. Vlasses PharmD, Peter H. Vlasses PharmD Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, and Merck Sharp & Dohme Research Laboratories, West Point, PA.Search for more papers by this authorWilliam B. Abrams MD, William B. Abrams MD Department of Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, and Merck Sharp & Dohme Research Laboratories, West Point, PA.Search for more papers by this author First published: January‐February 1985 https://doi.org/10.1002/j.1552-4604.1985.tb02795.xCitations: 3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Atkinson AJ, Becker RE, Galletti PM, et al: University and pharmaceutical industry cooperation: The need to plan for the future. Clin Pharmacol Ther 1984; 35: 431– 437. 2 Ferguson RK, Vlasses PH, Koplin JK, et al: Relationships among timolol doses, plasma concentrations and beta-adrenoceptor blocking activity. Br J Clin Pharmacol 1982; 14: 719– 725. 3 Mojaverian P, Fedder IL, Vlasses PH, et al: Cimetidine does not alter morphine disposition in man. Br J Clin Pharmacol 1982; 14: 809– 813. 4 Swanson BN, Boppana VK, Vlasses PH, et al: Dimethyl sulfoxide inhibits bioactivation of sulindac. J Lab Clin Med 1983; 102: 95– 101. 5 Vlasses PH, Rocci ML Jr, Porrini K, et al: Immediate-release and sustained-release procainamide. Ann Intern Med 1983; 98: 613– 614. 6 Boppana VK, Swanson BN: Determination of norfloxacin, a new nalidixic acid analog, in human serum and urine by high performance liquid chromatography. Antimicrob Agents Chemother 1982; 21: 808– 810. 7 Swanson BN, Boppana VK: Measurement of sulindac and its metabolite in human plasma and urine by high performance liquid chromatography. J Chromatogr Bio Applic 1981; 225: 123– 130. 8 Ferguson RK, Vlasses PH, Irvin JD, et al: Effects of enalapril, a new converting enzyme inhibitor, in hypertension. Clin Pharmacol Ther 1982; 32: 48– 53. 9 Vlasses PH, Rotmensch HH, Swanson BN, et al: Low-dose captopril: Its use in patients unresponsive to diuretics. Arch Intern Med 1982; 142: 1098– 1101. 10 Rotmensch HH, Belhassen B, Swanson BN, et al: Serum amiodarone concentrations: Relationships with antiarrhythmic efficacy and toxicity. Ann Intern Med (in press). 11 Vlasses PH, D'Silva H, Rocci ML Jr, et al: Disposition of intravenous and intraperitoneal cefoxitin during chronic intermittent peritoneal dialysis. Am J Kidney Dis 1983; 3: 67– 70. 12 Mojaverian P, Swanson BN, Dudash ML, et al: Influence of cimetidine on the pharmacokinetics of morphine in rats. Res Comm Substance Abuse 1982; 3: 1– 10. 13 Swanson BN, Mojaverian P, Boppana VK, et al: Effect of dimethyl sulfoxide on sulindac disposition in rats. Drug Metab Dispos 1981; 9: 499– 502. 14 Cummings DM, Larijani GE, Conner DP, et al: The binding of dexamethasone in normal and uremic serum (abstract). Drug Intell Clin Pharm 1984; 18, 500. 15 Ferguson RK, Vlasses PH: Clinical pharmacology for fourth-year medical students. J Clin Pharmacol 1984; 24: 271– 272. Citing Literature Volume25, Issue1January‐February 1985Pages 4-7 ReferencesRelatedInformation

Cefuroxime pharmacokinetics in continuous and intermittent peritoneal dialysis.

Pharmacokinetics of cefuroxime was studied in patients on continuous ambulatory or intermittent peritoneal dialysis. A single intravenous bolus (15 mg/kg) of cefuroxime provided a mean serum concentration of 86 mg/litre 5 min, 40 mg/litre 1 h, 163 mg/litre 24 h after the injection. The peritoneal clearance of cefuroxime varied widely among different individuals, ranging from 1.45 to 6.17 ml/min with a mean of 3.59 ml/min during 4-hour exchanges, and from 0,52 to 11.3 ml/min during 2-hour exchanges. A single injection (15 mg/kg) of the antibiotic could not provide satisfactory antibiotic concentrations in peritoneal effluent during peritoneal lavage. When cefuroxime had been added to peritoneal dialysis solution before the solution was instilled into the peritoneal cavity, a significant decrease in cefuroxime concentration occurred in the peritoneal effluent even after a short equilibration time. Furthermore, cefuroxime concentrations measured in residual dialysis solutions in the plastic bags ranged from 44.3 to 1,351% of the concentration of cefuroxime calculated from the added doses, indicating that despite great care, mixing of the antibiotic with dialysis solutions in plastic bags was far from uniform.

Anterior Abdominal Wall Leakage in CAPD Patients; Management by Intermittent Peritoneal Dialysis

Anterior Abdominal Wall Leakage in CAPD Patients; Management by Intermittent Peritoneal Dialysis