Intraperitoneal ciprofloxacin and rifampicin versus cephradine as initial treatment of (C)APD-related peritonitis: a prospective randomized multicenter comparison (CIPPER trial).

Objective: The initial treatment of peritonitis has evolved from single-agent to combination regimens. The initial response rates improved with these newer regimens but relapsing peritonitis continues to occur. For biofilm-embedded or intracellularly sequestrated bacteria, a combination of intracellularly- and biofilm-active agents such as ciprofloxacin and rifampicin might be beneficial.

Low-calcium peritoneal dialysis fluid should not impact peritonitis rates in continuous ambulatory peritoneal dialysis.

It has been suggested that reducing the calcium content of peritoneal dialysis fluid (PDF) to 2.5 mEq/L decreases peritoneal macrophage (PMO) function and increases the incidence of peritonitis (especially Staphylococcus epidermidis peritonitis) in continuous ambulatory peritoneal dialysis patients. We studied the uptake and killing of S epidermidis and Escherichia coli by PMOs and peripheral blood leukocytes incubated in control buffer (Hank's balanced salt solution containing 0.

Does additional treatment with fish oil mitigate the side effects of recombinant human erythropoietin in dialysis patients?

Since fish oil has been reported to reduce platelet aggregability, to reduce blood viscosity by increasing red blood cell deformability and to lower blood pressure, we studied the effect of dietary supplementation with fish oil on the occurrence of adverse effects in patients receiving recombinant human erythropoietin (rHuEPO). In a prospective, randomized, double blind cross-over design we studied the effect of daily ingestion of 3 g fish oil versus 3 g corn oil (placebo) for 5 months, with a wash-out period of 3 months in between. Thirty-two dialysis patients newly treated with rHuEPO participated.

Effect of glucose in dialysis fluid on antibacterial defence in the peritoneal cavity.

To study the effect of glucose concentration and dwell time of dialysis fluid on peritoneal antibacterial defence, an experimental infection with Staphylococcus aureus was induced in rats. For this purpose rats were inoculated intraperitoneally with Staphylococcus aureus at different intervals after the administration of various dialysis fluids. Twenty-four hours later the numbers of bacteria and cells in the peritoneal cavity were determined.

Clinical efficacy and morbidity associated with continuous cyclic compared with continuous ambulatory peritoneal dialysis.

Objective: To assess the clinical efficacy and morbidity of continuous cyclic peritoneal dialysis compared with continuous ambulatory peritoneal dialysis with a Y-connector as renal replacement therapy.

Design: Prospective, randomized study.

Setting: University hospital.

In vitro compatibility of a 1.1% amino acid containing peritoneal dialysis fluid with phagocyte function.

The effects of a recently introduced peritoneal dialysis fluid (PDF) containing amino acids (AA) were compared with those of a glucose-based PDF (G-PDF) on viability and function of donor granulocytes (PMNs) in vitro. After 30 min incubation in the PDF, viability, assessed by trypan blue exclusion, and phagocytosis capacity (PC), tested in two assays using a fluorescein and a 3H-labeled Staphylococcus epidermidis strain, were significantly better in AA-PDF than in G-PDF (p < 0.002 in the 3H-assay).

Non-invasive monitoring of blood volume during hemodialysis: its relation with post-dialytic dry weight.

Hemodialysis has a profound effect on fluid balance. Since fluid is initially withdrawn from the intravascular compartment, blood volume will decrease rapidly. A fluid shift (refill) from the overhydrated interstitium towards the intravascular compartment counteracts hypovolemia.

The adjustment of post dialytic dry weight based on non-invasive measurement of extracellular fluid and blood volumes.

One of the major problems in the clinical practice of hemodialysis is an incorrect estimation of post dialytic (PD) dry weight. Underestimation of dry weight leads to hypovolemia induced hypotension, and overestimation to hypertension, pulmonary edema, and left ventricular hypertrophy. Because of the insensitivity of clinical variables to estimate dry weight, a more accurate technique is warranted.

Biocompatibility of a glucose-polymer-containing peritoneal dialysis fluid.

The currently available glucose-containing peritoneal dialysis fluids (PDF), which are all hyperosmolar, are toxic to the cells present in the peritoneal cavity. However, glucose-polymer solutions, being isosmolar, may have improved biocompatibility in this respect. We therefore compared in vitro the effects of PDF containing glucose-polymers with that of glucose solutions on the function of donor granulocytes and monocytes (MN), and on the viability of mesothelial cells.

The impact of hydration status on the assessment of lean body mass by body electrical impedance in dialysis patients.

The impact of hydration status on body composition analysis in hemodialysis (HD) and peritoneal dialysis (PD) patients was assessed. Twenty-seven HD patients and 42 PD patients were divided into three groups according to their (postdialytic) hydration status as measured by segmental bioelectrical impedance analysis (BIA): normohydrated, dehydrated, or overhydrated. Fifty-six percent of the PD patients and 74% of the HD patients appeared to be normohydrated.

Peritoneal defense in continuous ambulatory versus continuous cyclic peritoneal dialysis.

Several centers have reported a lower rate of peritonitis among adult patients on continuous cyclic peritoneal dialysis (CCPD) as compared to those undergoing continuous ambulatory peritoneal dialysis (CAPD). Preliminary results of our ongoing prospective randomized study comparing CAPD-Y with CCPD also suggest a lower peritonitis incidence among CCPD-treated patients. To investigate whether the two dialysis regimens could result in differences in local host defense, we studied peritoneal macrophage (PMO) function and effluent opsonic activity in eight patients established on CAPD-Y matched with eight chronic CCPD patients.

Effect of glucose concentration and dwell time of dialysis fluid on the antibacterial defense in the peritoneal cavity of rats.

To study the influence of dialysis fluid on the antibacterial defense in the peritoneal cavity of rats, especially glucose concentration and dwell time, an experimental infection was developed. Rats were injected intraperitoneally with dialysis fluid with a glucose concentration of 1.36%, 2.

Pharmacokinetics of ciprofloxacin after intraperitoneal administration in uninfected patients undergoing CCPD.

Ciprofloxacin is increasingly used to treat peritoneal dialysis related peritonitis. We studied the pharmacokinetics of intraperitoneally administered ciprofloxacin in six uninfected CCPD patients. In a randomized cross-over setting ciprofloxacin was added either to a long dwell exchange (lastbag) or to four short dwell exchanges (dwell time 1.

Adipose tissue fatty acid composition and its relations to diet and plasma lipid concentrations in hemodialysis patients.

Adipose tissue fatty acid composition, serum lipid profile, and dietary intake of 37 patients on maintenance hemodialysis were studied. In August 1982, 1984, and 1986, analyses were carried out in 15 normotriglyceridemic (NTG) and 22 hypertriglyceridemic (HTG; type IV hyperlipidemia) patients. No correlations were found between dietary intake of polyunsaturated fatty acids (PUFAs), ratio of polyunsaturated to saturated fatty acids (P-S ratio), and carbohydrate content on the one hand and serum lipid concentrations on the other in the two groups.

Short dwell times reduce the local defence mechanism of chronic peritoneal dialysis patients.

The effect of different intraperitoneal dwell times on the phagocytic capacity of the effluent-derived macrophages in 6 peritoneal dialysis patients was studied. The number of peritoneal cells increased after longer dwell times, and a significant increase in the percentage of macrophages phagocytosing opsonized sheep red blood cells [( IgG]SRBC) and unopsonized latex beads was determined when the dwell time increased from 1.5 to 15 h.

The influence of dialysate sodium and variable ultrafiltration on fluid balance during hemodialysis.

An important factor in the development of hypotension during hemodialysis (HD) is a decrease in blood volume, due to ultrafiltration (UF) and an insufficient refill of the intravascular compartment. This insufficient refill might be caused by a transcellular fluid shift from the extracellular to the intracellular compartment. We studied the influence of dialysate sodium concentration and UF rate on the refill rate, blood volume, intracellular (ICV) and extracellular fluid volume (ECV).

Doxazosin in the treatment of patients with mild or moderate hypertension and mild or moderate renal insufficiency.

The antihypertensive efficacy and safety of doxazosin, a selective alpha 1-inhibitor, were assessed in 23 hypertensive patients with renal insufficiency. The study involved three phases: (1) a 2-week baseline period, (2) a 10-week period during which patients received doxazosin, 1 to 16 mg, once daily, and (3) a 4-week maintenance period. After 14 weeks of active treatment, systolic/diastolic blood pressures of efficacy evaluable patients were reduced by 8.

Changes in blood parameters during hemodialysis as determined by conductivity measurements.

Hypotension is one of the complications frequently seen during hemodialysis. The decrease in intravascular volume caused by ultrafiltration plays an important role in its pathogenesis. A transcellular fluid shift from the extracellular to the intracellular compartment may aggravate this depletion.