Months Of Continuous Ambulatory Peritoneal Dialysis Research Articles

Minimally invasive surgery for pleuroperitoneal communication complicating peritoneal dialysis.

Pleuroperitoneal communication (PPC) is an uncommon but serious complication of continuous ambulatory peritoneal dialysis (CAPD). At present, there are many kinds of treatment options, with different effects. We describe our single-institutional experiences in the minimally invasive surgery of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis in detail. Our study consecutively enrolled 12 pleuroperitoneal communication patients complicating CAPD. All patients underwent direct closure of the defective diaphragm and mechanical rub pleurodesis under video-assisted thoracoscopy. What is more, pseudomonas aeruginosa injection was infused into the thoracic cavity postoperatively to further promote pleural adhesion, which was the innovation of our study. After 1.0-8.3months of CAPD, all 12 patients presented hydrothorax in the right side. All these patients received surgery 7-179days (18.0 ± 49.5days) after onset. Bleb-like lesions situated on the diaphragm were discovered in all patients and three patients also had obvious hole on the surface of diaphragm. Pseudomonas aeruginosa injection was infused into the thoracic cavity postoperatively, and three cases showed fever with remission after 2-3days of symptomatic treatment. The time from surgery to restarting CAPD ranged from 14 to 47days, with a median of 20days. There was no recurrence of hydrothorax and transformation to hemodialysis during the follow-up period (median: 7.5months). Video-assisted thoracoscopic direct closure of the defective diaphragm and mechanical rub pleurodesis plus chemical pleurodesis using pseudomonas aeruginosa injection postoperatively is a safe and effective option for the treatment of pleuroperitoneal communication complicating continuous ambulatory peritoneal dialysis with 100% success rate.

Experience of Continuous Ambulatory Peritoneal Dialysis in Children with Chronic Kidney Disease Stage” V

The lifespan and outcome of End Stage Kidney Failure (ESKF) children have dramatically improved since the development of continuous ambulatory peritoneal dialysis (CAPD), it offers several advantages over hemodialysis. This study was done to evaluate the efficacy, outcome and to find out the complication profile of CAPD. This prospective longitudinal study was carried out in the department of Pediatric Nephrology, Dhaka Medical College Hospital (DMCH), Bangladesh, over a period of 3 year. A total of 8 children with ESKF were included. (Age 5-14 year, M:F=1:1), All underwent CAPD. Average duration of CAPD 40.6 months with a total of 185 patient months of CAPD. The rate of complications was recorded. Common complications being observed were peritonitis 1 episode per 13.9 patient months, catheter obstruction by omental capture was in 4. Catheter tip dislocation was found in 3 children and all needed laparotomy and omentectomy. Satisfactory level of improvement of mean weight, mean serum albumin and declining of serum creatinine has been found after CAPD in all 8 study children. At the end of the study, 3 out of 8 are still on CAPD, 2 transferred to haemodialysis and 3 expired due to uncontrolled hypertension with congestive heart failure and sepsis. So, CAPD is an effective modality of renal replacement therapy for children. Early detection of complications and prompt therapy is essential for a favourable outcome. Placement of catheter by surgical method with elective omentectomy will reduce catheter related complications.J Dhaka Medical College, Vol. 25, No.1, April, 2016, Page 32-38

Glucose Dialysate Induces Mitochondrial DNA Damage in Peritoneal Mesothelial Cells

It is known that peritoneal mesothelial cells (PMCs) are denuded in patients undergoing long-term continuous ambulatory peritoneal dialysis (CAPD); the mechanism of damage is not well known. A high quantity of glucose loaded onto PMCs in these patients may generate toxic radicals during the mitochondrial metabolism, leading to mitochondrial DNA damage that accumulates due to the incomplete repair system of this DNA. To study damage to the PMCs of long-term CAPD patients, and to examine whether glucose overload accelerates this damage in vitro. Descriptive clinical and in vitro study. Stable CAPD patients and nonuremic patients undergoing elective abdominal surgery. (1) Clinical Samples: 13 peritoneal tissue samples from CAPD patients and 5 omental tissue samples from patients with normal renal function were investigated. PMCs in dialysate effluent were collected from another 13 stable CAPD patients. (2) In Vitro Samples: Primary PMCs were incubated for up to 144 hours in medium containing one of the following: 5.6 mmol/L glucose (control), 56 mmol/L glucose (G), 222 mmol/L glucose (high G), or 222 mmol/L mannitol (high M; osmolar control for high G). The tissues and cells of clinical and in vitro samples were stained for light and immunoelectron microscopy with anti-8-hydroxy-2'-deoxyguanosine (anti-8-OH-dG) antibody, a marker of oxidative DNA damage. In vitro cells were also studied using transmission electron microscopy. Cellular ATP content, mitochondrial membrane potential, and intracellular generation of reactive oxygen species (ROS) were analyzed by luciferase-luciferin system, or by flow cytometry using rhodamine 123 and 2',7'-dichlorodihydrofluorescein diacetate (DCFH-DA). Biopsy specimens showed strong cytoplasmic staining with 8-OH-dG in patients on long-term CAPD, but only faint staining in patients with end-stage renal disease before the initiation of CAPD, and no staining in patients with normal renal function. Dialysate effluent showed strong granular staining with 8-OH-dG in most PMCs in all long-term CAPD patients, but only faint and focal staining in patients at the start and after 3-5 months of CAPD. In vitro experiments also showed strong granular staining by 8-OH-dG in most PMCs cultured in high G, weak staining in G and high M, and no staining in the control. Immunoelectron microscopy revealed the localization of 8-OH-dG to mitochondria. Transmission electron microscopy showed swelling of mitochondria, with decreased cristae, in PMCs cultured in high G. However, only partial expansion of mitochondria was seen in G and high M, and no changes were seen in the control. Cellular ATP content and mitochondrial membrane potential were reduced early, followed by an increase when cultured in high G. Intracellular ROS production was also increased in PMCs cultured in high G and high M. These data suggest that high-glucose peritoneal dialysate may promote oxidative mitochondrial DNA damage in PMCs in CAPD patients.

Expression of heat shock proteins 47 and 70 in the peritoneum of patients on continuous ambulatory peritoneal dialysis

Peritoneal sclerosis, characterized by collagen accumulation, is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) therapy. Heat shock protein 47 (HSP47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis. We determined the expression of HSP47 and HSP70 (nonspecific for collagen synthesis) by immunohistochemistry in peritoneal tissues of patients on CAPD. The tissue for collagen III, alpha-smooth muscle actin (alpha-SMA), and CD68 (a marker for macrophages) were also stained. Thirty-two peritoneal samples were divided into three groups (group A1, 11 patients who had no ultrafiltration loss; group A2, 9 patients who had ultrafiltration loss; and group B, 12 specimens who had end-stage renal disease prior to induction of CAPD. In group B, staining for HSP47, HSP70, and collagen III in peritoneal tissues was faint, and only a few cells were positive for alpha-SMA and CD68. In contrast, HSP47, HSP70, and collagen III were expressed in areas of thickened connective tissues in fibrotic peritoneal specimens of CAPD patients. The expression level of HSP47, HSP70, collagen III, and alpha-SMA and the number of CD68-positive cells in group A2 were significantly higher than those in groups A1 and B. HSP47/HSP70-positive cells were mesothelial cells, adipocytes, and alpha-SMA-positive myofibroblasts. Furthermore, the expression level of HSP47 was significantly higher in peritoneal specimens from patients with refractory peritonitis than without it and was significantly higher in patients with more than 60 months of CAPD therapy than that in patients with less than 60 months of CAPD. Our results indicate that CAPD therapy may induce HSPs in the peritoneal tissue, and that peritonitis in CAPD patients may be associated with the progression of peritoneal sclerosis at least through HSP47 expression and chronic macrophage infiltration. Our data also suggest that the progression of peritoneal sclerosis in such patients is associated with deterioration of peritoneal ultrafiltration function.

Expression of heat shock proteins 47 and 70 in the peritoneum of patients on continuous ambulatory peritoneal dialysis

Expression of heat shock proteins 47 and 70 in the peritoneum of patients on continuous ambulatory peritoneal dialysis.BackgroundPeritoneal sclerosis, characterized by collagen accumulation, is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) therapy. Heat shock protein 47 (HSP47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis.MethodsWe determined the expression of HSP47 and HSP70 (nonspecific for collagen synthesis) by immunohistochemistry in peritoneal tissues of patients on CAPD. The tissue for collagen III, α-smooth muscle actin (α-SMA), and CD68 (a marker for macrophages) were also stained. Thirty-two peritoneal samples were divided into three groups (group A1, 11 patients who had no ultrafiltration loss; group A2, 9 patients who had ultrafiltration loss; and group B, 12 specimens who had end-stage renal disease prior to induction of CAPD.ResultsIn group B, staining for HSP47, HSP70, and collagen III in peritoneal tissues was faint, and only a few cells were positive for α-SMA and CD68. In contrast, HSP47, HSP70, and collagen III were expressed in areas of thickened connective tissues in fibrotic peritoneal specimens of CAPD patients. The expression level of HSP47, HSP70, collagen III, and α-SMA and the number of CD68-positive cells in group A2 were significantly higher than those in groups A1 and B. HSP47/HSP70-positive cells were mesothelial cells, adipocytes, and α-SMA–positive myofibroblasts. Furthermore, the expression level of HSP47 was significantly higher in peritoneal specimens from patients with refractory peritonitis than without it and was significantly higher in patients with more than 60 months of CAPD therapy than that in patients with less than 60 months of CAPD.ConclusionOur results indicate that CAPD therapy may induce HSPs in the peritoneal tissue, and that peritonitis in CAPD patients may be associated with the progression of peritoneal sclerosis at least through HSP47 expression and chronic macrophage infiltration. Our data also suggest that the progression of peritoneal sclerosis in such patients is associated with deterioration of peritoneal ultrafiltration function. Expression of heat shock proteins 47 and 70 in the peritoneum of patients on continuous ambulatory peritoneal dialysis. Peritoneal sclerosis, characterized by collagen accumulation, is a serious complication in continuous ambulatory peritoneal dialysis (CAPD) therapy. Heat shock protein 47 (HSP47) is a collagen-specific molecular chaperon and is closely associated with collagen synthesis. We determined the expression of HSP47 and HSP70 (nonspecific for collagen synthesis) by immunohistochemistry in peritoneal tissues of patients on CAPD. The tissue for collagen III, α-smooth muscle actin (α-SMA), and CD68 (a marker for macrophages) were also stained. Thirty-two peritoneal samples were divided into three groups (group A1, 11 patients who had no ultrafiltration loss; group A2, 9 patients who had ultrafiltration loss; and group B, 12 specimens who had end-stage renal disease prior to induction of CAPD. In group B, staining for HSP47, HSP70, and collagen III in peritoneal tissues was faint, and only a few cells were positive for α-SMA and CD68. In contrast, HSP47, HSP70, and collagen III were expressed in areas of thickened connective tissues in fibrotic peritoneal specimens of CAPD patients. The expression level of HSP47, HSP70, collagen III, and α-SMA and the number of CD68-positive cells in group A2 were significantly higher than those in groups A1 and B. HSP47/HSP70-positive cells were mesothelial cells, adipocytes, and α-SMA–positive myofibroblasts. Furthermore, the expression level of HSP47 was significantly higher in peritoneal specimens from patients with refractory peritonitis than without it and was significantly higher in patients with more than 60 months of CAPD therapy than that in patients with less than 60 months of CAPD. Our results indicate that CAPD therapy may induce HSPs in the peritoneal tissue, and that peritonitis in CAPD patients may be associated with the progression of peritoneal sclerosis at least through HSP47 expression and chronic macrophage infiltration. Our data also suggest that the progression of peritoneal sclerosis in such patients is associated with deterioration of peritoneal ultrafiltration function.

Prevalence of histological β2-microglobulin amyloidosis in CAPD patients compared with hemodialysis patients

The prevalence of beta2-microglobulin amyloidosis (Abeta2m) in patients on continuous ambulatory peritoneal dialysis (CAPD) is unknown. We prospectively obtained a median of 2 (range 1 to 4) joint samples from 26 CAPD patients aged 44 to 93 (median 73) years at post-mortem evaluation after 4.5 to 126 (median 27) months solely on CAPD (N = 19) or primarily on CAPD (that is, < or = 10% and < or = 1 year of renal replacement therapy time on other modalities; N = 7). The diagnosis of Abeta2m rested on Congo red staining (typical birefringence) and positive immunostaining of amyloid deposits by a monoclonal anti-beta2m antibody. Abeta2m was diagnosed in 8 of 26 patients (31%). Prevalence ranged from 20% (2 of 10 patients) within < or = 24 months CAPD to 30% (3 of 10 patients) after 24 to 48 months and 50% (3 of 6 patients) after 49 to 126 months (P = 0.11). The prevalence of Abeta2m was similar in patients without or with one or more peritonitis episodes. No significant difference in prevalence (P = 0.118) was found between CAPD patients (8+/26; 31%) and hemodialysis patients (13+/26; 50%) carefully matched for time on dialysis and age at the onset of dialysis. The prevalence of histological Abeta2m reaches 31% after a median duration of 27 months of CAPD. This prevalence is not significantly different from that observed in a group of HD patients matched for age and dialysis duration.

REFRACTORY CHF AND MODEST RENAL FAILURE: I

A 56‐year‐old white male had longstanding insulin‐requiring diabetes mellitus and diffuse vascular disease. At age 50, he underwent coronary artery bypass grafting and placement of a permanent cardiac pacemaker. Four years later, he required bilateral above‐knee amputations for severe peripheral arterial disease. Over the next two years, he was hospitalized fifteen times for angina pectoris and congestive heart failure (CHF). In September 1990, six years following his cardiac surgery, Swan‐Ganz catheter data confirmed low cardiac performance. He required dopamine, dobutamine, angiotensin‐converting enzyme inhibitors, and high dose parenteral diuretics. Blood urea nitrogen (BUN) was 30 mg/dl, serum creatinine was 1.8 mg/dl, serum albumin was 3.9 g/dl and total serum protein was 7.1 g/dl. Fractional urinary sodium excretion was 0.36. Endogenous creatinine clearance was 20 ml/min. Urine protein excretion was 640 mg/day. Anasarca was attributed to CHF, and renal insufficiency was felt to be due to a combination of nephrosclerosis and low renal perfusion. Conservative management proved futile with development of worsening edema, progressive azotemia, and hyponatremia. At the time of nephrologic consultation, BUN was 159 mg/dl, serum creatinine was 4.5 mg/dl and serum sodium was 114 mEq/l. Pulmonary capillary wedge pressure was 22 mmHg and chest X ray confirmed the presence of large bilateral pleural effusions. Blood pressure had remained surprisingly normal at 126/70 mmHg. A Tenckhoff peritoneal dialysis catheter was placed and peritoneal dialysis begun using 1 l volume exchanges. Over the next several days, dialysis fluid volume was increased to 2 l, with dwell time and dextrose concentration being adjusted to allow for gradual fluid loss. Dialysis was continued on a daily basis for two weeks with a 40 pound weight loss and total resolution of CHF. He was discharged home, but required intermittent peritoneal dialysis over the next six weeks. He was trained to perform peritoneal dialysis using the technique of continuous ambulatory peritoneal dialysis (CAPD). His regimen consisted of 4 two‐liter exchanges daily with variable use of 1.5% and 4.25% dextrose‐containing solutions and intraperitoneal insulin. Over the ensuing months he required only 24 days of hospitalization. He regained use of his lower extremity prostheses and was able to drive his truck. He had no episodes of peritonitis, but required short‐term oral antibiotics for peritoneal catheter exit‐site infection. He expired of acute myocardial infarction after 14 months of CAPD.

Catheter infections as a factor in the transfer of continuous ambulatory peritoneal dialysis patients to hemodialysis.

The effect of peritoneal catheter infections on the transfer of continuous ambulatory peritoneal dialysis (CAPD) patients to hemodialysis over a 9-year period were examined. Twenty-seven percent (68/247) of all patients were transferred permanently to hemodialysis after a mean of 15 +/- 14 months of CAPD. An additional 29% transferred temporarily one or more times during the study period (mean time of peritoneal dialysis, 35 +/- 23 months). The reasons for permanent transfer to hemodialysis were catheter infections (15/68, 22%), peritonitis (13/68, 19%), catheter infections associated with peritonitis (10/68, 15%), patient preference (9/68, 13%), mechanical problems (4/68, 6%), noncompliance (7/68, 10%), inadequate clearance or ultrafiltration (6/68, 9%), with other reasons for the remainder (4/68, 6%). Temporary transfers to hemodialysis were also mainly due to catheter infections (32%), peritonitis (23%), and simultaneous catheter infections and peritonitis (24%). Catheter infection rates were much higher in the groups that permanently and temporarily were transferred to hemodialysis in comparison with those patients who remained on peritoneal dialysis. We conclude that catheter infections are a leading cause of both temporary and permanent transfer of CAPD patients to hemodialysis.

Glycan microheterogeneity of α1-acid glycoprotein in sera and dialysates of patients on continuous ambulatory peritoneal dialysis

Total concentration and concanavalin (Con A) dependent microheterogeneity of α 1-acid glycoprotein (AGP) were studied in sera of eight chronic renal failure patients before the start of continuous ambulatory peritoneal dialysis (CAPD), and in sera and dialysate fluids for up to 6 months of CAPD. The glycan heterogeneity of AGP in the samples was expressed as a reactivity coefficient, i.e. the ratio of the Con A-reactive AGP components to the Con A non-reactive AGP component. Concentrations of AGP in serum and reactivity coefficients were markedly elevated in non-dialysed uraemic patients. AGP concentrations in serum increased further during the first week on CAPD, and then gradually decreased to pre-dialysis values, which were reached after 1 to 6 mth. The reactivity coefficients did not change significantly during the CAPD treatment. Dialysate AGP concentrations were low in comparison to those in serum, and there was a good correlation between the reactivity coefficients in the dialysate fluids and those in the corresponding sera. The effect of peritonitis was evaluated in a separate group of eight CAPD patients. Serum and dialysate AGP concentrations were significantly higher during than after peritonitis while the corresponding reactivity coefficients were only slightly elevated.

Continuous Ambulatory Peritoneal Dialysis (CAPD) in a Patient with Glucose-6-Phosphatase Deficiency

The metabolic disturbances in glucose-6-phosphatase deficiency (von Gierke's disease) are the consequence of hypoglycemia, occurring mostly during the night. Continuous provision of glucose is the aim of every recently introduced treatment procedure. We studied the influence of continuous ambulatory peritoneal dialysis (CAPD) on the metabolic disturbances in a 42-year-old female patient with von Gierke's disease and end-stage renal disease. During six months of CAPD, there were no dialysis-related complications. The metabolic acidosis didn't worsen: arterial bicarbonate and lactate were not changed. Mean glycemia was 118.6 +/- 14.4 mg%. Total lipemia, cholesterol and triglycerides were not different from those before CAPD, despite the fact that all hypolipidaemic drugs were stopped. Three different exchange procedures were compared during the night: no dialysis, one exchange with a 2 L solution without buffer containing glucose 15 g/L and containing glucose 42.5 g/L. The results show that the 4.25% glucose solution prevents hypoglycaemia, and diminishes the increase in lactate and pyruvate concentration. Intraperitoneal glucose normalizes the plasma free fatty acid concentration. A very important result is the disappearance of hypo-insulinism. We conclude that, from a clinical point of view, CAPD is a well-tolerated treatment in von Gierke's disease. The limited results provide some evidence that the use of a 4.25% glucose solution as an overnight exchange, instead of the usual 1.5% solution, can prevent at least partly the glycogenolysis and consequently the metabolic disturbances of von Gierke's disease.

Peritoneal Vascular Changes in Continuous Ambulatory Peritoneal Dialysis (CAPD): An in Vivo Model for the Study of Diabetic Microangiopathy

Replication of the basement membrane of the peritoneal capillaries and the mesothelium is observed in all uremic patients after a period of continuous ambulatory peritoneal dialysis (CAPD). Biopsy specimens of the parietal peritoneum were taken in diabetic and non-diabetic patients on insertion or repositioning of the CAPD catheter. The basement membrane of the capillaries and mesothelium was normal in non-diabetics on insertion of the catheter, but after 2 to 66 months of CAPD, multiple replication was found. In nearly all the diabetics there was already replication of the basement membrane of the peritoneal capillaries before CAPD was begun but the basement membrane of the mesothelium was intact. After several months of CAPD thickening of the basement membrane of the capillaries was found in 36% of diabetics, sometimes to the point of occlusion. After CAPD, replication of the basement membrane of the mesothelium has been observed in both diabetics and non-diabetics although it is initially perfectly normal in both. CAPD is proposed as an experimental model for diabetic microangiopathy in man.

Red-Cell Survival in Patients on Continuous Ambulatory Peritoneal Dialysis

An early rise in hematocrit due to an increase in red cell mass (RCM) and a decrease in plasma volume (PV) has been noted after six months of continuous ambulatory peritoneal dialysis (CAPD). The present study measured red-cell survival (RCS) together with RCM and PV at the beginning and after six months of CAPD in paired observations in 15 patients. RCM increased from 890 ± 98 to 1089 ± 142 ml (p &lt; 0.05) and plasma volume decreased from 3026 ± 295 to 2936 ± 178 ml. Mean red-cellsurvival half life at the start was 22.3 ± 1.06 days and rose to 25.2 ± 1.15 days after six months (p &lt; 0.05). The same results were observed in four diabetic patients on a non-glucose, glycerol-containing dialysate. This study demonstrates that, after six months of CAPD, not only do hematocrit and red cell mass improve but also the red-cell survival is prolonged. However, a correlation could not be demonstrated between the increase in red-cell mass and prolongation of red-cell survival.

Serum Lipids and Lipoproteins during Continuous Ambulatory Peritoneal Dialysis

The effects of continuous ambulatory peritoneal dialysis (CAPD) on serum lipids and lipoproteins over the initial year of therapy were studied in 23 uremic patients. Lipoprotein abnormalities typical for the uremic dyslipoproteinemia were present at the start of CAPD. During the first months of CAPD these abnormalities were accentuated. The concentrations of very low density lipoprotein (VLDL)-cholesterol (CHOL), low density lipoprotein (LDL)-CHOL, serum CHOL and serum triglycerides (TG) increased significantly. However, after one year of CAPD only the VLDL-CHOL and serum CHOL levels remained significantly higher than the baseline values. VLDL-TG, VLDL-CHOL and serum TG, and the changes of these variables over the study period, correlated with the amount of glucose in the dialysates. We conclude that the continuous peritoneal absorption of glucose (100-200 g/24 h) during CAPD contributes to potentially atherogenic changes in serum lipids and lipoproteins. However, some of the changes are transitory, indicating an adaptation to the peritoneal glucose load.

Morphology of the peritoneal membrane during continuous ambulatory peritoneal dialysis.

In the last 3 years we performed 52 peritoneal biopsies (PB) in 31 patients on continuous ambulatory peritoneal dialysis (CAPD). Samples of the parietal peritoneum were obtained either during insertion of the catheter or while it was being repositioned or removed. PB was performed in 13 patients before initiating CAPD and in 27 after 7-49 months of CAPD while 7 had PB during peritonitis, and, again, in 5 of these cases, PB was repeated after 1-4 months for light, electron transmission, and scanning electron microscopy. BP after CAPD showed that mesothelial cells were irregularly spaced, and at times we observed alterations in the cellular structure. Rarely were these cells degenerating, while rarefaction and in many cases complete absence of microvilli were observed. In some cases the submesothelial layers showed rarefaction of the connective tissue and sclerosis. During peritonitis, PB showed more alterations with marked degeneration and in some cases necrosis of the mesothelium and alterations of connective tissue. PB performed some months after peritonitis showed only a partial regression of these alterations and sclerotic patches, and no microvilli were noted in the mesothelium.

Effects of Continuous Ambulatory Peritoneal Dialysis (CAPD) on Renal Osteodystrophy

The authors performed a metabolic and morphologic investigation of calcium metabolism in 22 patients on continuous ambulatory peritoneal dialysis (CAPD), selected as the first procedure. The patients were kept on a diet containing about 30 Kcal/ kg, 1 g/kg of protein, 950 mg of phosphate and 1500 mg of calcium per day. They showed normal mean values of serum calcium, phosphate, alkaline phosphatase, total protein and albumin at the start and after six, 12 and 21 months of CAPD. Serum PTH levels showed a progressive decrease over 21 months. Serum 25-OH-D3 were low at start and showed a further decrease after 12 months of CAPD. Before and during CAPD, serum 1,25 (OH)2D3 levels were undetectable. The bone mineral content was within normal range at start and showed a slight decrease after 12 months of CAPD. In 64% of the patients, bone biopsies, obtained from the iliac crest at the start showed osteomalacia, either isolated or associated with hyperparathyroidism. After 12 months, osteomalacia was still evident in 71% of this group. The authors concluded that dietary restriction of phosphate is important in preventing secondary hyperparathyroidism in patients on CAPD. However, prevalence of osteomalacia is due to defective vitamin D metabolism and its management requires administration of vitamin D metabolites. In its morphological aspects and clinical features, renal osteodystrophy (RO) may differ significantly between patients on CAPD and those on hemodialysis (1–3). In addition, workers have reported conflicting opinions concerning the incidence and severity of bone lesions in CAPD patients (4–6). We undertook this investigation in order to evaluate the evolution and clinical, biochemical and morphologic aspects of RO in 22 ESRD patients treated with CAPD after long-term restriction of dietary protein and phosphate.

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.

Clinical and metabolic aspects of continuous ambulatory peritoneal dialysis (CAPD)

Experience with CAPD in 14 patients, treated for periods of 2-10 months, is presented. Clinical and biochemical control of uremia appeared adequate in all patients except one. Control of extracellular volume and hypertension was easier with CAPD than with intermittent peritoneal dialysis (IPD). Nine episodes of peritonitis occurred in 5 patients (one peritonitis/8 patients months). Mean protein loss was 9.7 +/- 2.7 g per day. In 6 patients on IPD oral glucose tolerance test resulted in a paradoxical rise of HGH, whereas this was not observed after 4 months of CAPD.