Long-term Continuous Ambulatory Peritoneal Dialysis Research Articles

Varicella-zoster virus immune status in CAPD and chronic hemodialysis patients.

Patients on chronic dialysis who are supposed to disclose an impairment of the immune potential, seldom show clinical viral illnesses. Since severe varicella-zoster virus (VZV) infection develops in immunocompromised patients, we have examined the proliferative activity to VZV in the blood lymphocytes of 16 patients on continuous ambulatory peritoneal dialysis (CAPD) and compared it to healthy matched controls. The cellular in vitro response of these patients to specific VZV antigens was essentially normal. The mean stimulation index for CAPD patients was 7.06, and for matched controls 3.68 (p greater than 0.05). The mean percentage of lymphocytes in CAPD patients as determined by CD3 monoclonal antibodies was 57%, the CD4 helper and CD8 suppressor cells were 41 and 21%, respectively. When those 16 CAPD patients were followed up for the presence of anti-VZV IgA, IgM and IgG immunofluorescent antibody to membrane antigen antibodies during a period of 6 months, the recrudescence of VZV was documented by the appearance of IgA and IgM antibodies and/or fourfold increase in IgG titer in some patients, but no clinical illness was observed. The frequent reactivation of the virus without clinical symptoms in patients undergoing long-term intermittent chronic hemodialysis (HD) or CAPD was strengthened by the presence of increased anti-VZV geometric mean titers (52.68 and 53.00, respectively) in these patients as compared to control subjects (11.75).

Long-Term Continuous Ambulatory Peritoneal Dialysis

Long-term mass transfer and nutritional and metabolic stability of end-stage renal disease patients maintained on continuous ambulatory peritoneal dialysis (CAPD) continue to be of concern. This study longitudinally monitored 43 Japanese CAPD patients (29 males, 14 females) from three centres within the Tokyo Metropolitan Area for an average period of 15 +/- (SD) 8 months. The mean time for patients on CAPD at study initiation was 18 +/- 15 months. Monitored parameters included urea and creatinine mass transfer coefficients, clearances and blood levels, ultrafiltration, lipid levels, dietary protein intake, and weight. Lipid data were also gathered retrospectively from patient records from the time of CAPD initiation. The results were analyzed using regression growth curve analysis and analysis of variance. Statistically significant linear rises with time were apparent only for the creatinine mass transfer coefficients, although this was not considered clinically significant in terms of changes either in peritoneal creatinine clearances or ultrafiltration. Serum cholesterol levels were found to rise significantly above pre-dialysis levels 11 months after CAPD onset, thereafter returning to levels not significantly above baseline levels. In summary, CAPD provided stable, acceptable treatment over the study period.

Peritoneal Functional Parameters after Five Years on Continuous Ambulatory Peritoneal Dialysis (CAPD): The Effect of Late Peritonitis

Functional stability of the peritoneum is essential for patients on long-term continuous ambulatory peritoneal dialysis (CAPD) treatment. Sixteen patients on CAPD treatment for at least 4 years were studied. Their mean age was 47 +/- 15 years, 5 were males, and none were diabetic. Residual creatinine clearance at the beginning was 2.1 +/- 2.6 mL/min. Once yearly since starting CAPD, we have evaluated their peritoneal ultrafiltration (UF) and diffusion capacities by calculating the peritoneal mass transfer coefficient (MTC, mL/min) for urea and creatinine. Patients were categorized so that we could distinguish the effect of peritonitis, betablockers, and hypertension. For all patients the average initial and final MTCs and UF values were not different. Early episodes of peritonitis (those occurring less than 36 months after starting CAPD) did not influence long-term function. However, late peritonitis (occurring greater than 36 months since initiation) induced a decrease in urea-MTC (22.3 +/- 6 to 15.8 +/- 3.9, p less than 0.05), creatinine-MTC (9.4 +/- 3.1 to 7.4 +/- 2.5, p less than 0.05), and a corresponding increase in UF (1.25 +/- 0.4 to 1.4 +/- 0.3, mL/min, p less than 0.05). Age, sex, betablockers and hypertension did not influence the peritoneal parameters followed. After 5 years on CAPD, functional stability of the peritoneum is evident, except for patients who suffer late episodes of peritonitis. We speculate that the peritoneum in patients who have been on long-term CAPD are more susceptible to injuries, such as peritonitis, and that this results in functional deterioration.

Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (DPC), peritoneal glucose absorption (% GA), and drained dialysate volume (VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month). There were no differences in the control (without NP) Curea, Ccr, DPC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and DPC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but DPC with NP was significantly lower in the long-term CAPD patients. The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.

Renal Osteodystrophy and Metastatic Calcification in Long-term Continuous Ambulatory Peritoneal Dialysis

The biochemical data and drug histories related to bone disease were extracted from the case records of 47 patients who had been treated by continuous ambulatory peritoneal dialysis (CAPD) for more than two years. These data were reviewed in conjunction with the skeletal surveys done over the same period in all patients, with particular reference to secondary hyperparathyroidism, osteomalacia and non-visceral metastatic calcification. Paired bone biopsies were available in 20 of these patients and the histology was quantitated. In the majority of our patients secondary hyperparathyroidism was controlled or improved on CAPD. Osteomalacia also improved in two of the three patients in whom it was initially present and did not develop in any patient whilst on CAPD. We did, however, note a high incidence of non-visceral metastatic calcification. Small vessel calcification developed in 19.6 per cent of patients, large vessel calcification developed in 23.9 per cent and soft tissue calcification developed in 21.7 per cent of patients. We conclude that CAPD, as a form of treatment for end-stage renal disease, satisfactorily controls the osteodystrophy associated with renal failure in the majority of patients. The significance of the high incidence of non-visceral metastatic calcification remains to be established.

Secondary hyperparathyroidism in diabetic and nondiabetic patients on long-term continuous ambulatory peritoneal dialysis (CAPD).

Serum values of calcium, phosphate, alkaline phosphatases and parathyroid hormone (PTH) are reported for 24 diabetic and 26 nondiabetic patients treated with continuous ambulatory peritoneal dialysis (CAPD) for a total of 779 months, without the use of vitamin D or calcium supplements. Radiographic data are reported for 25 patients followed on CAPD for at least 12 months. Serum calcium was well maintained and control of hyperphosphataemia acceptable, but phosphate-binding therapy had to be continued in the majority of patients. Diabetic patients had lower serum phosphate levels and higher serum calcium than nondiabetic patients during the first year of CAPD. In nondiabetic patients the institution of CAPD was followed by a fall in PTH, possibly largely reflecting transperitoneal PTH elimination. No patient achieved normalization of serum PTH on CAPD. Although no symptomatic bone disease was observed, radiographic evidence of progressive hyperparathyroid bone disease developed in 3 of the 25 examined patients, all nondiabetic. In summary, long-term CAPD with a dialysate calcium concentration of 1.75 mmol/l seems to be compatible with normocalcaemia and a steady-state situation with regard to secondary hyperparathyroidism in the majority of patients. Despite transperitoneal elimination, serum PTH remains elevated, and definite progression of hyperparathyroidism is observed in some patients, however, probably making a case for vitamin D therapy and/or intraperitoneal or peroral calcium supplementation in these patients.

Glucose absorption and weight change in 18 months of continuous ambulatory peritoneal dialysis

Previous studies have suggested that weight gain is a potential problem for patients using continuous ambulatory peritoneal dialysis (CAPD) due to the influx of glucose from the dialysate. To document the relationship between weight change and glucose absorption, the authors reviewed the medical charts of eight patients from the University of Michigan Hospitals Home Training Dialysis Unit who have used CAPD for at least 18 months. The average daily glucose absorption for each patient was determined by using the equation of Grodstein et al. (y = 11.3(x) -10.9, r = .96, p less than or equal to .001). The mean weight change after 18 months of CAPD was +4.0 +/- 8.9 kg (range = -2.5 to +24.1 kg). Two patients became obese (greater than 120% IBW); one remained obese; four patients maintained desirable weight for height; and one patient became nutritionally depleted (less than 80% IBW). Differences between weights before and after 18 months of CAPD were not significant (p greater than or equal to .05); however, mean weight change was significantly correlated (r = .62, p less than or equal to .05) with average daily amounts of glucose absorbed from the dialysate. This study indicates that nutritional outcomes can be optimized if total energy intake and the passive uptake of significant amounts of glucose across the peritoneal membrane are monitored along with body weight in patients using long-term CAPD.

The Peritoneal Handling of Digoxin during CAPD

We measured digoxin concentrations in serum and dialysate from five digitalized patients on continuous ambulatory peritoneal dialysis (CAPD). Mean peritoneal clearance of digoxin was 3.6 ± 0.4 ml/min (± SEM). Mean mass transfer was 8.6 ± 0.6 μg/min. Our patients lost from 3.7 to 13.3% of their daily oral digoxin intake in dialysate. The mean dialysate over serum (D/S) digoxin ratio was 0.59 and fell between D/S creatinine (0.81) and D/S inulin (0.34). Between patients the range of this ratio was wide (0.25 to 0.90). We also measured serial digoxin dialysate concentrations during a six hour “dwell” in one patient and determined a D/S equilibration curve. After six hours dialysate digoxin approached a plateau near 0.5. Digoxin removal per week from dialysate was two to three times greater during CAPD than that reported from IPD. Peritoneal losses of digo xin cannot be predicted for an individual patient. In four of eight digitalized patients, the cardiac drug could be discontinued suggesting a beneficial effect of long-term CAPD in controlling congestive heart failure.

Ten Years’ Experience with Chronic Peritoneal Dialysis at a Community Hospital

This paper describes the experience of a community hospital in the treatment of chronic renal failure with intermittent (IPD) and continuous ambulatory peritoneal dialysis (CAPD) in 61 adult patients over a 10 year period. In the earlier years of this decade, 14 patients, dialysed through temporary catheters, were transferred to hemodialysis or received a kidney transplant. Later, a long-term IPD and CAPD treatment through permanent peritoneal catheters was instituted in 25 and 22 patients respectively. Over a similar but not simultaneous follow-up period, the patient survival with CAPD was better than with IPD.