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Ambulatory Peritoneal Dialysis
Name: Ambulatory Peritoneal Dialysis
Author: m. m. avram
Pages: 342
Year: 1990
Language: English
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Ambulatory Peritoneal Dialysis Edited by Morrell M. Avram, M.D., F.A.C.P. The Long Island College Hospital SUNY Health Science Center at Brooklyn New York and Carmelo Giordano, M.D. Universita Degli Studi di Napoli Instituto Di Medicina Interna E. Nefrologia Napoli, Italy Co editors: Natale G. DeSanto, M.D. Cattedra di Nefrologia Pediatrica Prima Facolta di Medicina Universita Napoli, Italy Neal Mittman, M.D. The Long Island College Hospital SUNY Health Science Center at Brooklyn Brooklyn, New York and Giorgio Bazzato Servizio di Nefrologia ed Emodialisi Umberto I, Mestre Venice, Italy Associate Editors: Paul A. Fein, M.D. The Long Island College Hospital SUNY Health Science Center at Brooklyn Brooklyn, New York Philip Goldwasser, M.D. The Long Island College Hospital SUNY Health Science Center at Brooklyn Brooklyn, New York and Amado Gan, M.D. The Long Island College Hospital SUNY Health Science Center at Brooklyn Brooklyn, New York Paul A. Slater, M.D. The Long Island College Hospital SUNY Health Science Center at Brooklyn Brooklyn, New York Plenum Medical Book Company New York and London

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Library of Congress Cataloging In Publication Data AMbulatory peritoneal dialysis I edited by Morrell M. Avrn and CarMela Giordano; co editors. Natale G. DeSanto. Neal Mittman. and Giorgio Bazzato ; associate editors. Paul A. Fein . ret al.1. p. CM. Proceedings of the Fourth Congress of the International Society for Peritoneal Dialysis. held In Venice. Italy. Sept. 1988. Includes bibliographical references. Includes Index. ISBN 13: 978 1 4615 9557 1 e ISBN 13: 978 1 4615 9555 7 DOl: 10.1 007/978 1 4615 9555 7 1. Continuous aMbulatory peritoneal dlalysls Congresses. I. Avraa. Morrell M. (Morrell Michael). 1929 II. Giordano. Caraelo. III. International Society for Peritoneal Dialysis. Congress (4th : 1988 : Ven 1 ce. Ita 1 y) [DNLM: 1. Peritoneal Dialysis. Continuous Aabulatory congresses. 378 A497 19881 RC901.7.P48A43 1990 617'.461059 dc20 DNLM/DLC for Library of Congress 90 7241 1990 Plenum Publishing Corporation Softcover reprint of the hardcover 1st edition 1990 233 Spring Street, New York, N.Y, 10013 CIP Plenum Medical Book Company is an imprint of Plenum Publishing Corporation All .rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise, without written permission from the Publisher

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Foreword The Fourth International Congress of Peritoneal Dialysis was held in Venice, Italy, June 29 to July 2, 1987. By this time peritoneal dialysis had emerged as a treatment for a substantial fraction of patients with end stage renal disease and countless numbers of patients with acute renal failure. This treatment is now practiced worldwide and is the life sustaining treatment for about 40,000 patients with chronic renal failure, representing 15 to 20% of dialysis therapy in about 1000 centers. It is not surprising, therefore, that the number of health professionals engaged in the investigation and the application of the treatment has also grown exponen tially. The First International Symposium on Peritoneal Dialysis, organized by Dr. A. Treviiio Be cerra in Chapala, Mexico, in 1978, brought together a group of pioneers when continuous ambulatory peritoneal dialysis was in its infancy. In 1981, Dr. G. M. Gahl chaired the Second Symposium, in West Berlin, when the technique and professional interest were growing con siderably. By 1984, when Dr. 1. F. Winchester and I organized the Third Symposium, the pre sented papers exceeded 100 and there were about 1000 attendees. At that time, it was deemed appropriate to form a more organized group and the International Society for Peritoneal Dialy sis was founded. One of the first actions of the Society was to choose from among several applicants Dr. Carmelo Giordano to organize this Fourth Congress. He was ably assisted by Dr. N. DeSanto and Dr. G. Bazzato, and by committees that included professional leadership in the new disci pline throughout Italy and the world. A committee of peers undertook the arduous task of choosing a program from the abundance of abstracts submitted in the spring of 1987. The final program chosen attempted to recog nize investigative excellence internationally. An abundance of high quality presentations on the cutting edge of clinical and research advances in peritoneal dialysis were included in this excellent program amid the warm Italian hospitality in Venice. Manuscripts were welcomed by the organizers, but all submitted papers could not be accommodated for publication. The Society is pleased that Dr. M. M. Avram was appointed as a co editor of the proceedings, and his excellent untiring efforts are appreciated, as is the work of Plenum Publishing. At the Congress in Venice, the Society elected Dr. G. LaGreca as the new President, Dr. K. Nolph as Vice President, and reelected Dr. Winchester as Secretary Treasurer. The Society con firmed that Dr. K. Ota will chair the next meeting in 1990, which is to be held in Kyoto, Japan, immediately after the International Congress of Nephrology in Tokyo. Further details about the Society, membership applications, and Congress information can be obtained from Dr. James Winchester, Georgetown University Hospital, Washington, D.C. 20007, USA. The International Society for Peritoneal Dialysis was established to promote knowledge about peritoneal dialysis. It achieves this purpose by endorsing and supporting scientific symposia and publications. Accordingly, the Society thanks not only the editors but also all the investigators whose presentations made the Congress so successful, most of whom appear as authors in this publication. v John F. Maher President, 1984 1987 International Society for Peritoneal Dialysis

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Preface Peritoneal dialysis delivered as continuous ambulatory peritoneal dialysis (CAPD) has emerged worldwide as the most utilized dialysis treatment perfonned at home surpassing home he modialysis in the United States in 1987 as well as the mainstay therapy for about 15 to 20% of all patients who develop end stage renal disease (ESRD) as we enter the 1990s. The evolu tion of CAPD to its present incarnation as a major option in uremia therapy reflects stepwise advances in technology and understanding, including enhanced catheters and connectors, plas tic soft dialysate containers, and comprehension of the pathogenesis and optimal treatment of peritonitis. Clinicians and investigators concerned with improving the lot of patients treated by CAPD met and helped write this volume to share their problems and innovations. Success ful conferences in Gennany and the United States underscored the need for a fonnal organiza tion devoted to peritoneal dialysis, resulting in the establishment of the International Society for Peritoneal Dialysis. It is fitting that Professor Giordano and his organizing committee were selected to host the Fourth Congress in Italy, the proceedings and updates of which are presented in this volume. Indeed, Italian investigators using an ingenious modification of the outflow tubing set have attained the lowest reported rate of peritonitis in CAPD. This book is divided naturally into seven parts: Status of the Art; Physiology, Pharmacol ogy, and Morphology; Nutrition Metabolism; Technology; Peritonitis; Clinical Experience; and Experience in Infants and Children. What is evident from the manuscripts is the exciting evidence that CAPD can be largely freed from peritonitis, its most consistent serious compli cation. Additionally, the early impression that CAPD is a preferred treatment for diabetics in renal failure is supported by reports from three countries. For children and diabetic adults, CAPD must be classed as the best means of sustaining life after onset of ESRD. At the Avram Center for Kidney Diseases in Brooklyn's Long Island College Hospital, CAPD is sufficiently appreciated to cause its rise as the most rapidly growing fonn of dialysis. It may be antici pated that due to its simplicity, potential lower cost, and patient satisfaction (preference), CAPD will continue its encroachment on maintenance hemodialysis for routine uremia therapy. Before this century ends (1) pharmacologic manipulation of the rate of peritoneal solute ex change should improve daily metabolic condition of CAPD patients; (2) disposable connector sets should further reduce the frequency of peritonitis to under 1 episode per 3 years; (3) lipid modulating drugs and diet should eliminate the threat of accelerated atherosclerosis in CAPD patients (see the Long Island College Hospital experience reported in this text); (4) use of subcutaneous erythropoietin will prove a promising new therapy for anemia correction and is first reported in this text from Columbia University; and (5) greatly improved patient and graft survival in kidney transplant recipients coupled with nearly effortless CAPD will blend into a routinized, standard regimen for most ESRD patients. Thanks are due to co editors, Drs. DeSanto, Bazzato, and Mittman, and our associate edi tors, Drs. Fein, Gan, Goldwasser, and Slater. The team effort to edit this work reflects the composition and growing friendships promoted by the Society. A special note of appreciation is extended to our President, Dr. John F. Maher, who contributed a lucid Foreword. New York and Naples vII Morrell M. Avram Carmelo Giordano

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Contents I. STATUS OF THE ART 1 . The Role of Cholesterol and Lipids in the Atherogenicity of Continuous Ambulatory Peritoneal Dialysis Patients: Update 1990 . . . . . M. M. Avram, D. Burrell, P. A. Slater, P. A. Fein, A. Antignani, N. Mittman, D. Tan, M. H. Lapuz, H. Zaharowitz, S. Chow, and P. Goldwasser 2. Erythropoietin in Continuous Ambulatory Peritoneal Dialysis Patients, 1990: 3 Benefits of the Subcutaneous Route in the First U. S. Experience . . .. 10 L. Stem, L. Vemocchi, L. Monstroski, and G. B. Appel 3 . Solving the Major Problems of Continuous Ambulatory Peritoneal Dialysis 15 1. F. Maher 4. Functional and Histological Changes of Peritoneal Membrane in Long Term Continuous Ambulatory Peritoneal Dialysis 18 G. Bazzato, M. L. Valente, U. Coli, S. Landini, A. Fracasso, P. Morachiello, F. Righetto, F. Scanferla, P. Toffoletto, S. Calabrese, and R. Genchi 5. Where Are We Going? D. G. Oreopoulos II. PHYSIOLOGY, PHARMACOLOGY, AND MORPHOLOGY 6 . Peritoneal Ultrafiltration: Less Efficient with Prolonged Dwell or Excessive 24 Dialysate Dextrose . . . . . . . . . . . . . . . .., .. 3 1 P. Hirszel, J. F. Maher, B. DiPaolo, and E. Chakrabarti 7. Neostigmine Increases Net Ultrafiltration and Solute Clearances in Peritoneal Dialysis by Reducing Lymphatic Absorption. . . . . . . . . .. 3 6 R. A. Mactier, R. Khanna, H. L. Moore, Z. J. Twardowski, and K. D. Nolph 8. Phosphatidylcholine Increases Ultrafiltration in Continuous Ambulatory Peritioneal Dialysis Patients . . . . . . . . . . . . . . . 39 N. Dombros, E. Balaskas, N. Savidis, A. Tourkantonis, and K. Sombolos 9. Effect of Cationic Molecules on the Permeability of the Mesothelium in Vitro ................ . 42 A. Breborowicz, H. Rodela, 1. Bargman, and D. G. Oreopoulos Ix

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x Contents 10. Phosphatidylcholine: A Physiological Modulator of the Peritoneal Membrane .................. . N. DiPaolo, L. Capotondo, L. E. Gaggiotti, P. Rossi, and E. Sansoni 11 . Ultrafiltration Loss in Continuous Ambulatory Peritoneal Dialysis Patients: Effects of Intraperitoneal Therapy with Calcium Anliagonists .... S. Lamperi, S. Carozzi, and M. G. Nasini 12. A Chemoattractant in Peritoneal Effluent from Continuous Ambulatory Peritoneal Dialysis Patients .. . . . . . . . . . . . . . H. J. Bos, D. M. Boorsma, J. C. de Veld, E. C. M. Hoefsmit, H. van Bronswijk, P. L. Oe, and R. H. J. Beelen 13. The Isolation and Culture of Human Mesothelial Cells: Characterization of Cyclooxygenase Products . . . . . . . . . . . . . . E. Stylianou, L. A. Jenner, M. D. Davies, R. K. Mackenzie, G. A. Coles, and J. D. Williams 14. Beta Blockers Induce Functional Changes That Potentially Injure the Peritoneum 44 48 52 56 in Continuous Ambulatory Peritoneal Dialysis Patients. . . . . . . .. 60 R. Selgas, J. Munoz, E. Huarte, F. Esculin, A. Sanz, K. L. Revuelta, P. Ramos, and L. Sicilia 15. Loss of Mesothelial and Microvascular Fixed Anionic Charges during Murine Experimentally Induced Septic Peritonitis . . . . . . . . . . .. 63 L. Gotloib, A. Shustack, and J. Jaichenko 16. Role of Blood Osmolality in the Regulation of Vasopressin Secretion in Continuous Ambulatory Peritoneal Dialysis Patients. S. Bertoli, A. Genderini, M. T. Barone, D. Scorza, D. S. Milani, S. M. Bevilacqua, G. Norbiato, and G. Barbiano di Belgiojoso 17. Lymphatic Absorption in Continuous Ambulatory Peritoneal Dialysis Patients 66 with Normal and High Transperitoneal Glucose Transport. . . . . .. 71 R. A. Mactier, R. Khanna, Z. J. Twardowski, and K. D. Nolph 18. The Kinetics of Ultrafiltration during Peritoneal Dialysis in Rats: The Role of Lymphatics. . . . . . . . . . . . . . . . . . . .. 76 K. D. Nolph, R. A. Mactier, R. Khanna, Z. J. Twardowski, and H. L. Moore 19. Dihydroergotamine Lowers Peritoneal Transfer Rates: A Hypovolemic Transport Decrease. . . . . . . . . . . . . . . . . . A. Shostak, P. Hirszel, E. Chakrabarti, and J. F. Maher 20. Ultrafiltration Patterns of Dextran and Hydroxyethylstarch during Long Dwell 79 Peritoneal Dialysis Exchanges in Nonuremic Rats. . . . . . . . .. 83 H. Hain, D. Kampf, P. Schnell, G. Gahl, and M. Kessel 21. Peritoneal Clearances, Ultrafiltration, and Diuresis in Long Term Continuous Ambulatory Peritoneal Dialysis. . . . . . . . . . . . . . . 87 E. Bordoni, V. Lombardo, L. Bibiano, P. Carletti, E. Franciulli, G. Gaffi, A. Perilli, and V. Mioli

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Contents xl 22. Effect of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis on the Transport of Inhibitory Factors of Lymphocyte Proliferation Present in Uremic Senun . . . . . . . . . . . . . . . . . 91 23. 24. M. Gonzalez, A. L. M. de Francisco, E. Canga, P. Morales, L. Ruiz, A. Zubimendi, and M. Arias Methotrexate Influences Peritoneal Permeability K. Czytewska, C. Ramlau, and I. Knapowski, High Doses of Intraperitoneal Furosemide in Long Dwell Exchange . A. Grzegorzewska, M. Krzymanskt, and K. Baczyck 25. Calcium Peritoneal Mass Transfer in Continuous Ambulatory Peritoneal Dialysis . . . . . . . . . . . . . . . . . . . A. Lupo, V. Bedogna, R. Panebianco, A. Fabris, and G. Maschio 26. Structural Changes in Peritoneal Vessels during Continuous Ambulatory 93 97 101 Peritoneal Dialysis: A Model for the Study of Diabetic Microangiopathy . 103 N. DiPaolo, G. Sacchi, and L. Capotondo 27. Mesothelial Hyperplasia after Chronic Intraperitoneal Fluid Administration: A Light Microscopy Study in the Rat . . . . . . . . . . . . 11 0 N. D. Slater, G. H. Cope, and A. T. Raftery 28. Mitogenic Effect of the Peritoneal Effluent on Mice Fibroblast Cultures in Continuous Ambulatory Peritoneal Dialysis Patients. . . . . 112 R. Selgas, A. Lopez Rivas, I. Munoz, M. V. Cuesta, K. L. Reveulta, P. Ramos, and A. Sanz 29. Oxygen Metabolism of Peritoneal Phagocytes. . . . . . . . 115 H. M. M. Alobaidi, M. D. Davies, N. Topley, G. A. Coles, and D. Lloyd ITI. NUTRITION METABOLISM 30. The Nutritional Status of Long Term CAPD Patients . S. E. Bennett, B. A. Smith, G. 1. Russell, and 1. Walls 31. Renal Osteodystrophy: Bone Mineral Density Loss and Recovery with Treatment. . . . . . . . . . . . . . . . . C. Colbert, R. Bachtell, F. X. Schloeder, H. A. Feller, Z. I. Twardowski, and K. D. Nolph 32. Bone Mineralization Defect in Continuous Ambulatory Peritoneal Dialysis 121 124 Patients .. .................. 129 33. I. Vlachojannis, P. Kurz, U. Ewald, D. Hoppe, P. Roth, and E. Werner Faster Energy Turnover in Peritoneal Dialysis. . H. Lange, W. Berweclc, H. Ebel, and H. G. MUller 133

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xII Contents IV. TECHNOLOGY 34. One Year Experience with Swan Neck Missouri 2 Catheter. . . . . . 139 Z. J. Twardowski, R. Khanna, W. K. Nichols, K. D. Nolph, B. F. Prowant, L. P. Ryan, and J. Russ 35. Thallium 201 Myocardial Imaging in Continuous Ambulatory Peritoneal Dialysis Patients at High Risk of Coronary Artery Disease.. . . 142 N. P. Vites, R. Gokal, N. P. Mallick, M. C. Prescott, and H. J. Testa 36. Tidal Peritoneal Dialysis. . . . . . . . . . . . . . . 145 Z. J. Twardowski, K. D. Nolph, R. Khanna, B. F. Prowant, J. T. Frock, J. W. Dobbie, R. S. Kenley, K. D. Serkes, D. A. Witsoe, and J. W. Garber 37. Absorption of Inulin and High Molecular Weight Gelatin Isocyanate Solutions from Peritoneal Cavity of Rats. . . . . . . . . . . . . . .. 149 T. R. Cheek, Z. J. Twardowski, H. L. Moore, and K. D. Nolph 38 . Technical Developments in Continuous Ambulatory Peritoneal Dialysis: Summary of Personal Experiences. . . . . . . . . . . . . 152 U. Binswanger and G. Bichsel 39. The Use of Hyposmolar Glucose Polymer Solution in Continuous Ambulatory Peritoneal Dialysis: A Seven Day Study. . . . . . . . . . . .. 155 C. D. Mistry and R. Gokal 40. Loss of Ultrafiltration Capacity: Role of Plasticizers . . . . . . .. 159 41. 42. A. Fracasso, U. Coli, S. Landini, P. Morachiello, F. Righetto, F. Scanferla, P. Toffoletto, M. L. Valente, and G. Bazzato Chronic Peritoneal Dialysis Using Curled Catheters. . . . . . R. D. Swartz, L. L. Rocher, B. Stannann, J. Reynolds, and P. Lees V. PERITONITIS Immune Defense and Peritonitis in Continuous Ambulatory Peritoneal Dialysis. . . . . . . . . . . . . . S. Lamperi and S. Carozzi 43. Peritoneal Macrophages of Patients on Continuous Ambulatory Peritoneal Dialysis Show Alterations in Sensitivity and Secretion of Prostaglandins during Peritonitis . . . . . . . . . . . . . . . . . . . M. W. J. A. Fieren, M. J. P. Adolfs, and I. L. Bonta 44. Interferon Abnormalities and Peritonitis in Continuous Ambulatory Peritoneal 166 173 175 Dialysis ...................... 181 S. Lamperi, S. Carozzi, and M. G. Nasini 45. Association of Staphylococcus aureus Nasal Carriage with Staphylococcus aureus Catheter Exit Site Infections . . . . . . . . . . . . . E. Ahrens, F. Wiedenhoeft, J. Leggett, M. O'Brien, J. Feyzi, C. A. Johnson, S. W. Zimmerman, and W. Craig 186

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Contents 46. Survival and Growth of Staphylococcus epidermidis within Phagocytes in Relation to Recurrent Peritonitis in Continuous Ambulatory Peritoneal xIII Dialysis Patients . 189 H. van Bronswijk, H. A. Verbrugh, P. L. Oe, R. H. J. Beelen, J. Verhoef, and A. J. M. Donker 47. Does Viral Infection Predispose to Peritonitis in Continuous Ambulatory Peritoneal Dialysis? . 193 J. S. Tapson, H. Mansy, R. Freeman, and R. Wilkinson 48. Peritonitis: The Most Serious Complication of Continuous Ambulatory Peritoneal Dialysis: Results of a Multi Center Study. . 196 R. Gokal, C. Jakubowski, J. King, L. Hunt, S. Bogle, R. Baillod, F. Marsh, C. S. Ogg, D. Oliver, M. Ward, and R. Wilkinson 49. Generation and Release of Eicosanoids and Proteolytic Enzymes by Human Peritoneal Macrophages in Response to Staphylococcus epidermidis and the Calcium Ionophore A23187. . 199 R. K. Mackenzie, M. Petersen, G. A. Coles, and J. D. Williams 50. Humoral and Cellular Host Defense Factors and Peritonitis in Continuous Ambulatory Peritoneal Dialysis Patients. . 204 N. Dolivo, M. Markert, R. Peitrequin, Ph. Frei, and J. P. Wauters 51. Continuous Ambulatory Peritoneal Dialysis Host Defenses and Staphylococcus aureus: Role of Opsonins, Fibronectin, Fibrinogen, and Fibrin. 209 S. J. Davies, V. M. A. Yewdall, C. S. Ogg, and J. S. Cameron 52. Long Term Experience with the Y Connector in Peritonitis Prevention in Continuous Ambulatory Peritoneal Dialysis Patients. . 213 L. Catizone, A. Zucchelli, R. Gagliardini, and P. Zucchelli 53. Inhibition of Binding of Escherichia coli to Human Peritoneal Macrophages by Peritoneal Effluent from Patients on Peritoneal Dialysis 217 G. Boner, M. Rodriguez Ortega, and N. Sharon 54. Use of Exudate Smears for Diagnosis of Peritoneal Catheter Exit Site Infection B. F. Prowant, L. M. Schmidt, Z. J. Twardowski, H. M. Taylor, L. P. Ryan, R. J. Satalowich, C. K. Griebel, and L. M. Burrows 55. Early Bacteriological Diagnosis of Continuous Ambulatory Peritoneal Dialysis 220 Peritonitis with the Use of a Cytocentrifuge . 223 P. Durrego, E. Bellorin Font, J. R. Weisinger, V. Paz Martinez, M. Boissiere, and P. Amair VI. CLINICAL EXPERIENCE 56. USA CAPD Registry: 1987 Report Highlights 229 K. D. Nolph, A. S. Lindblad, J. W. Novak, S. J. Cutler, and D. M. Stablein 57. Multi Center Study of Outcome of Continuous Ambulatory Peritoneal Dialysis and Hemodialysis Patients: A 4 Year Analysis. . 232 R. Gokal, C. Jakubowski, J. King, L. Hunt, S. Bogle, R. Baillod, F. Marsh, C. S. Ogg, D. Oliver, M. Ward, and R. Wilkinson

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