25 results on '"Prowant BF"'
Search Results
2. Determining if characteristics of peritoneal dialysis home training programs affect clinical outcomes: not an easy task.
- Author
-
Prowant BF
- Subjects
- Humans, Treatment Outcome, Hemodialysis, Home education, Patient Education as Topic methods, Peritoneal Dialysis
- Published
- 2006
3. Nutritional markers during peritoneal dialysis: data from the 1998 Peritoneal Dialysis Core Indicators Study.
- Author
-
Flanigan MJ, Frankenfield DL, Prowant BF, Bailie GR, Frederick PR, and Rocco MV
- Subjects
- Adult, Aged, Aged, 80 and over, Body Mass Index, Body Weight, Creatinine metabolism, Cross-Sectional Studies, Dietary Proteins administration & dosage, Female, Health Surveys, Humans, Male, Middle Aged, Nutrition Disorders diagnosis, Nutrition Disorders epidemiology, Nutrition Disorders etiology, Peritoneal Dialysis, Continuous Ambulatory, Prevalence, Prospective Studies, Serum Albumin analysis, United States epidemiology, Urea metabolism, Nutritional Status, Peritoneal Dialysis
- Abstract
Objective: This analysis explores the nutritional status of adult U.S. peritoneal dialysis (PD) patients., Design: The Peritoneal Dialysis Core Indicators Study is a prospective cross-sectional prevalence survey describing the care provided to a random sample of adult U.S. PD patients., Methods and Population: Prevalence data were collected from a national random sample of 1381 adult PD patients participating in the United States End Stage Renal Disease (ESRD) program., Results: The median age of these patients was 55 years, 61% were Caucasian; the leading cause of ESRD was diabetes mellitus. Age, sex, size, peritoneal permeability, dialysis adequacy, and nutritional indices did not differ between patients on continuous ambulatory PD and patients on automated PD. The dialysis prescriptions employed achieved mean weekly Kt/V urea (wKt/V) and creatinine clearance (wCCr) values of 2.22 +/- 0.57 and 67.8 +/- 22.5 L/1.73 m2/week, respectively. The PD patients were large, with a mean body weight of 77 +/- 21 kg and body mass index (BMI) of 27 +/- 8.6 kg/m2. The mean serum albumin of these patients was 3.5 +/- 0.51 g/dL, and 43% of values fell below the National Kidney Foundation Dialysis Outcomes Quality Initiative's desired range. The PD patients had a normalized protein equivalent of nitrogen appearance (nPNA) of 1.0 +/- 0.57 g/kg/day, a normalized creatinine appearance rate (nCAR) of 17 +/- 7.3 mg/kg/day, and an estimated lean body mass (%LBM) of 62% +/- 18% of body weight. Serum albumin correlated positively with patient size, nCAR, and nPNA, but negatively with age, the presence of diabetes mellitus, female gender, erythropoietin dose, the creatinine dialysate-to-plasma ratio results of peritoneal equilibration testing, and the dialysis portion of the wCCr. The duration of ESRD experience correlated negatively with both serum albumin and patient size, although these relationships were complex., Conclusion: Peritoneal dialysis patients generally have marginal serum albumin levels, a finding incongruent with alternative measures of nutritional status, such as weight, BMI, and creatinine generation. Serum albumin is reduced in patients with high peritoneal permeability (i.e., rapid transporters) and, because these patients generally have higher than average wCCr values, serum albumin is inversely correlated with the dialysis component of the wCCr. The presumptive nutritional indicators (BMI, %LBM, nPNA, and serum albumin) provide disparate estimates, varying from 10% to 50% for the prevalence of nutritionally stressed PD patients.
- Published
- 2001
4. Six-year experience with Swan neck presternal peritoneal dialysis catheter.
- Author
-
Twardowski ZJ, Prowant BF, Nichols WK, Nolph KD, and Khanna R
- Subjects
- Bacterial Infections etiology, Bacterial Infections mortality, Female, Follow-Up Studies, Humans, Male, Middle Aged, Probability, Prospective Studies, Sternum, Survival Rate, Catheters, Indwelling, Peritoneal Dialysis instrumentation
- Abstract
Background: The presternal peritoneal catheter is composed of two silicone rubber tubes joined by a titanium connector at the time of implantation, and has an exit on the chest., Objective: Comparison of survival and complication rates of Swan neck abdominal catheters with those of the presternal catheter., Design: Nonrandomized study with prospective collection of data between August 1991 and October 1997., Setting: Tertiary referral center., Patients: In 57 patients, 58 presternal catheters and, in 81 patients, 86 abdominal catheters were implanted. Patients chose the type of catheter; however, obese individuals and those with ostomies and previous catheter problems were encouraged to opt for the presternal catheter. Others chose the presternal catheter in order to take tub baths or use a whirlpool., Main Outcome Measures: Life-table analyses of catheter survival censored for transplant, transfer, and death; reasons for catheter removal due to complications; and patient satisfaction., Results: Two-year survival probabilities were 0.95 and 0.75 for presternal and abdominal catheters, respectively. Nine abdominal catheters were removed due to exit/tunnel infections (including five with peritonitis), and four due to peritonitis. External cuff shaving in four presternal catheters has extended survival for more than 1 year. Four presternal catheters were removed due to peritonitis. No catheters in either group were lost due to leakage or obstruction. The peritonitis rate was 1 episode per 37.4 patient-months and 1/20.5 patient-months for presternal and abdominal catheters, respectively. These differences are not significant. Patient acceptance of the presternal catheters was excellent; in the latest period, from January to October 1997, presternal catheters were chosen by 15/24 patients., Conclusions: The trend to improved outcomes in presternal catheters continues to validate the rationale for presternal catheter design. Decreased frequency of exit/tunnel infection may be due to more effective immobilization on the chest, less trauma, and avoidance of submersion in stagnant water. No specific contraindications to use of the presternal catheter have been identified.
- Published
- 1998
5. 1996 Peritoneal Dialysis Core Indicators Study: report on nutritional indicators.
- Author
-
Flanigan MJ, Bailie GR, Frankenfield DL, Frederick PR, Prowant BF, and Rocco MV
- Subjects
- Adult, Body Mass Index, Dietary Proteins pharmacokinetics, Energy Metabolism, Female, Humans, Male, Medical Audit, Medicare statistics & numerical data, Middle Aged, Peritoneal Dialysis methods, Random Allocation, Serum Albumin analysis, United States epidemiology, Nutritional Status, Peritoneal Dialysis statistics & numerical data, Peritoneal Dialysis, Continuous Ambulatory statistics & numerical data
- Abstract
Objective: The 1996 Peritoneal Dialysis Core Indicators Study illustrates the conduct of peritoneal dialysis in the United States during 1996. DESIGN AND PATIENT POPULATION: The survey is a medical records audit of 1317 randomly selected adult U.S.A. Medicare patients using peritoneal dialysis during 1996., Outcome Measures: Abstracted data included basic demographic characteristics, dialysis prescription, delivered dialysis dose, residual renal function, serum albumin, hematocrit, anemia management, and patient status., Results: The survey included 785 patients using continuous ambulatory peritoneal dialysis (CAPD) and 423 using automated peritoneal dialysis (APD) primarily in the form of continuous cycling peritoneal dialysis (CCPD). Except for the prescription mechanics and a greater likelihood that African-Americans would use CAPD, the groups did not differ substantially from one another. Evaluation of patient weight (W), body mass index (BMI), residual renal function, average serum albumin, protein equivalent of nitrogen appearance (nPNA), and dialysis efficiency as weekly fractional urea nitrogen removal (wKt/Vurea) and weekly creatinine clearance (wCrCl) revealed a picture of reasonable dialysis delivery and marginal protein nutrition. Additionally, there was little evidence that "dialysis efficiency," over the range assessed, had a major influence on nutritional status. Despite a tendency toward obesity (body weight = 76.6+/-20.0 kg and BMI = 27+/-7), 47% of patients had an average serum albumin below"normal" (3.5 g/dL by bromcresol green) and 70% had a nPNA below 1.0 g/kg/day., Conclusions: Peritoneal dialysis patients appear to have marginal protein reserves despite surfeit energy stores.
- Published
- 1998
6. Repair of chronic peritoneal dialysis catheter.
- Author
-
Usha K, Ponferrada L, Prowant BF, and Twardowski ZJ
- Subjects
- Adult, Aged, Anti-Infective Agents, Local chemistry, Antibiotic Prophylaxis, Bacterial Infections, Equipment Design, Equipment Failure, Ethanol chemistry, Female, Follow-Up Studies, Humans, Iodine chemistry, Male, Middle Aged, Patient Education as Topic, Peritoneal Dialysis adverse effects, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritonitis prevention & control, Retrospective Studies, Safety, Silicone Elastomers chemistry, Surface Properties, Time Factors, Catheters, Indwelling adverse effects, Peritoneal Dialysis instrumentation, Peritoneal Dialysis, Continuous Ambulatory instrumentation
- Abstract
Background: Damage to the peritoneal dialysis catheter may be due to wear from long-term use, exposure to antibacterial agents (strong oxidants), and accidental injury from sharp objects. Repair of such catheter, if not associated with subsequent complications, would extend catheter life and reduce costs and patient inconvenience related to catheter replacement., Objective and Design: Retrospective analysis of seven peritoneal catheters repaired 11 times over a 15-year period by splicing the old catheter with an extension tube using the Peri-Patch Repair Kit (Quinton Instrument Co., Bothwell, WA, U.S.A.)., Results: The life of these seven catheters was extended by a mean of 26 months (range 1-87 months), without increasing infection rates after splicing. The peritonitis rate after catheter splicing was 0.40 per year, not higher than the overall rate (0.76 per year) in our center during the same time period. Exit-site infections occurred in 6 patients after catheter splicing. Only one infection was related to trauma during the procedure and resulted in chronic exit infection; the catheter was eventually removed. In this patient, damage to the catheter was less than 1.5 cm from the exit site., Conclusions and Recommendations: Splicing of the damaged peritoneal catheter, if properly done, is a safe procedure and can significantly prolong catheter life. We recommend that measures to prevent catheter damage, such as avoiding the use of scissors and other sharp objects, should be emphasized during the initial patient education and training. Alcohol and iodine should not be used on silicone rubber catheters. We suggest that the patient should report catheter damage immediately and come to the clinic within a few hours for catheter splicing (if possible) and prophylactic antibiotic to prevent peritonitis. Finally, we recommend that repair of the catheter should not be attempted if the breakage is less than 2 cm from the exit site, unless done as an emergency procedure if immediate catheter replacement cannot be performed.
- Published
- 1998
7. Toward targets for initiation of chronic dialysis.
- Author
-
Mehrotra R, Saran R, Moore HL, Prowant BF, Khanna R, Twardowski ZJ, and Nolph KD
- Subjects
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Glomerular Filtration Rate, Humans, Kidney physiopathology, Kidney Failure, Chronic metabolism, Kidney Failure, Chronic physiopathology, Male, Middle Aged, Nitrogen metabolism, Nutritional Status, Prospective Studies, Time Factors, Urea metabolism, Kidney Failure, Chronic therapy, Peritoneal Dialysis, Continuous Ambulatory, Renal Dialysis
- Abstract
Objectives: To better define the targets for initiation of chronic dialysis, we compared the relationship between the normalized protein equivalent of nitrogen appearance (nPNA, g/kg standard weight/day) and weekly urea clearance (Kt) normalized to total body water (V) in predialysis chronic renal failure (CRF) patients and in patients on continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD). We also studied the relationships of other nutritional parameters to weekly Kt/Vurea in CRF patients., Design: This cross-sectional study was a prospective observational design meant to study each patient once., Setting: The University Hospital and Clinics and Harry S. Truman VA Medical Center, Columbia, Missouri., Patients: Forty-five consecutive predialysis CRF patients were enrolled and the results compared with patients on CAPD and HD., Results: In CRF, the nPNA calculated from urea appearance correlated with the weekly Kt/Vurea (r = 0.57, p < 0.0001) and, using exponential best-fit, nPNA = 1.217 x (1-e-0.769Kt/V). This exponential relationship was similar to that for CAPD and both were different from that in patients on HD. Likewise, nPNAs, calculated from Kjeldahl nitrogen output, and weekly Kt/Vurea were correlated (r = 0.37, p = 0.014) and, using exponential best-fit, nPNA = 1.102(1-e-0.867Kt/V), similar to the relationship in patients on CAPD. Evidence is presented that these relationships are not explained only by mathematical coupling. There was a significant correlation between the weekly Kt/Vurea and 24-hour urinary creatinine excretion., Conclusions: The findings suggest that in CRF, as in CAPD, a weekly Kt/Vurea less than 2.0 is likely to be associated with a nPNA less than 0.9 g/kg standard weight. In CRF patients, initiation of chronic dialysis should be considered if weekly renal Kt/Vurea falls below 2.0 and a nPNA greater than 0.8 is desired.
- Published
- 1997
8. Calculation of 6-hour D/P creatinine ratio from the 4-hour peritoneal equilibration test. The effect of dwell duration on the results.
- Author
-
Mehrotra R, Khanna R, Yang TC, Kathuria P, Moore HL, Prowant BF, Nolph KD, and Twardowski ZJ
- Subjects
- Adult, Aged, Aged, 80 and over, Biological Transport, Active, Diabetic Nephropathies complications, Dialysis Solutions analysis, Female, Humans, Hypertension complications, Kidney Failure, Chronic etiology, Kidney Failure, Chronic physiopathology, Male, Metabolic Clearance Rate physiology, Middle Aged, Models, Biological, Models, Theoretical, Peritoneal Dialysis, Continuous Ambulatory methods, Peritoneal Dialysis, Continuous Ambulatory standards, Polycystic Kidney Diseases complications, Time Factors, Creatinine blood, Diagnostic Tests, Routine methods, Dialysis Solutions metabolism, Peritoneum metabolism, Reproducibility of Results
- Abstract
Objectives: Since the introduction of the peritoneal equilibration test (PET), the 4-hour dialysate/plasma creatinine (D/P Cr) has been used by several authors for determining continuous ambulatory peritoneal dialysis (CAPD) prescriptions. However, the results have been unsatisfactory because the 4-hr D/P Cr does not accurately reflect the D/P Cr in 24-hr collections. The PET and the 24-hr dialysate collections differ in the duration of dwell and the tonicity and volume of dialysate, all of which influence the equilibrated D/P Cr. It can be assumed that the D/P Cr in 24-hr collections in these patients is closer to a 6-hr D/P Cr. Because a 6-hr PET is inconvenient, we developed a mathematical model to calculate the 5- and 6-hr D/P using the results of a standard PET., Design: In a retrospective analysis, D/P Cr ratios in 24-hr collections and D/P Cr ratios calculated from a mathematical formula were correlated. Using a mathematical model, the data collected fit an exponential relation of the type D/P = a(1-e-t/tau). The values of a and tau are unique for a given patient and were determined using a nonlinear regression technique. The formula performed well on our published data-the true and predicted 6-hr D/P Cr being 0.696 and 0.71, respectively., Setting: The University Hospital and Clinics, Dalton Cardiovascular Research Center and Dialysis Clinic, Inc., Columbia, Missouri., Patients: All CAPD patients on four 2-L exchanges/day at the time of the 24-hr collections were included., Interventions: None., Main Outcome Measures: Closeness of 4-hr and 6-hr D/P Cr values to those of 24-hr ratios., Results: The study group comprised 74 patients (age, mean +/- SEM: 56.4 +/- 1.8 yr) with 80 PETs and 145 (24-hr) collections. The interval between the two tests was 8.3 +/- 0.9 months (0-48.7 months). The median 24-hr D/P Cr of 0.760 did not differ significantly from the predicted median 6-hr D/P Cr of 0.755. A subgroup analysis, based on transport type, showed that this relationship was most precise in the high-average transporters. The predicted 6-hr D/P Cr was within 10% of the 24-hr D/P Cr in 48% of patients and within 20% in 77% of patients. The margin of error was greatest in the low transporters., Conclusions: To conclude, the 4-hr D/P Cr from a PET cannot be used interchangeably with the D/P Cr in the 24-hr dialysate collections, hence, the clearances calculated thereof will be inaccurate. Using the proposed model, it is feasible to use the 4-hr PET results to obtain 5- and 6-hr D/P Cr values. In our study, using this model, the extrapolated 6-hr D/P Cr is similar to the D/P Cr in 24-hr dialysate collections only in the high-average transporters. Hence, the best way to determine clearances in peritoneal dialysis patients is still by collecting 24-hr dialysates.
- Published
- 1997
9. A cluster of gram-negative peritonitis episodes associated with reuse of HomeChoice cycler cassettes and drain lines.
- Author
-
Ponferrada LP, Prowant BF, Rackers JA, Pickett B, Satalowich R, Khanna R, Twardowski ZJ, and Nolph KD
- Subjects
- Disposable Equipment, Humans, Proteus Infections etiology, Serratia Infections etiology, Xanthomonas, Gram-Negative Bacterial Infections etiology, Peritoneal Dialysis instrumentation, Peritonitis etiology
- Published
- 1996
10. Comparisons of the swan neck and Tenckhoff catheters.
- Author
-
Twardowski ZJ, Khanna R, Nolph KD, and Prowant BF
- Subjects
- Equipment Design, Humans, Catheterization adverse effects, Peritoneal Dialysis instrumentation
- Published
- 1996
11. Exit-site study methods and results.
- Author
-
Twardowski ZJ and Prowant BF
- Subjects
- Adult, Aged, Bacterial Infections classification, Bacterial Infections pathology, Bacterial Infections therapy, Cross-Sectional Studies, Female, Humans, Longitudinal Studies, Male, Middle Aged, Peritoneal Dialysis instrumentation, Peritonitis etiology, Bacterial Infections etiology, Catheters, Indwelling adverse effects, Peritoneal Dialysis adverse effects
- Abstract
Contrary to peritonitis, where the clinical presentation is clearly different from that of normal, there is a spectrum of appearances from uninfected to infected exit sites. This led to imprecise definitions of exit-site infection, difficulties in interpreting the results of various studies, and many, varied treatment recommendations. We have performed 565 evaluations of 61 healed exit sites in 56 patients. The exit and the sinus were inspected using a Zeiss prism loupe with 4.5x magnification for the presence, absence, intensity, and/or characteristics of specific attributes such as swelling, color, crust, drainage, granulation tissue, and epithelium in the sinus. Pictures of the external exit and the visible sinus tract were then drawn and photographs of the exit site and visible sinus tract were taken. Visual attributes discerned by loupe inspection were verified by review of photographs. A new classification was developed with six distinct categories of exit appearances: acute infection, chronic infection, external cuff infection, equivocal, good, and perfect. Finally, the category of traumatized exit was established, because trauma may result in various appearances. The outcomes in each category were correlated with treatment measures in a 5-year longitudinal study. The validity of this classification and its applicability to clinical practice was subjected to further investigation in a cross-sectional study. Forty-five patients were evaluated only once by ZJT using a Zeiss prism loupe and by the primary nurse, who used a handheld magnifier. The features were recorded and classification was made. The results of loupe and magnifier evaluations were then compared regarding agreement in discerning features. In 41 evaluations (91%) there was agreement. The new classification may be useful in making treatment decisions, in reporting exit-site infection data, and in designing improved prospective, randomized studies.
- Published
- 1996
12. Recommendations for exit care.
- Author
-
Prowant BF and Twardowski ZJ
- Subjects
- Bacterial Infections etiology, Bacterial Infections therapy, Humans, Peritoneal Dialysis instrumentation, Bacterial Infections prevention & control, Catheters, Indwelling adverse effects, Peritoneal Dialysis adverse effects
- Published
- 1996
13. Appearance and classification of healing peritoneal catheter exit sites.
- Author
-
Twardowski ZJ and Prowant BF
- Subjects
- Bacterial Infections classification, Bacterial Infections etiology, Humans, Peritoneal Dialysis instrumentation, Bacterial Infections pathology, Catheters, Indwelling adverse effects, Peritoneal Dialysis adverse effects, Wound Healing
- Published
- 1996
14. Peritoneal catheter exit-site morphology and pathology: prevention, diagnosis, and treatment of exit-site infections. Case reports for independent study.
- Author
-
Prowant BF, Khanna R, and Twardowski ZJ
- Subjects
- Adult, Aged, Aged, 80 and over, Bacterial Infections etiology, Bacterial Infections therapy, Female, Humans, Male, Middle Aged, Peritoneal Dialysis instrumentation, Bacterial Infections pathology, Catheters, Indwelling adverse effects, Peritoneal Dialysis adverse effects
- Published
- 1996
15. How to monitor and report exit/tunnel infections.
- Author
-
Nolph KD, Twardowski ZJ, Prowant BF, and Khanna R
- Subjects
- Documentation, Humans, Peritoneal Dialysis instrumentation, Peritonitis etiology, Bacterial Infections etiology, Catheters, Indwelling adverse effects, Medical Records, Peritoneal Dialysis adverse effects
- Published
- 1996
16. Classification of normal and diseased exit sites.
- Author
-
Twardowski ZJ and Prowant BF
- Subjects
- Bacterial Infections classification, Bacterial Infections etiology, Humans, Peritoneal Dialysis instrumentation, Skin pathology, Bacterial Infections pathology, Catheters, Indwelling adverse effects, Peritoneal Dialysis adverse effects
- Published
- 1996
17. Exit-site healing post catheter implantation.
- Author
-
Twardowski ZJ and Prowant BF
- Subjects
- Adult, Aged, Aged, 80 and over, Bacterial Infections etiology, Bacterial Infections therapy, Female, Humans, Male, Middle Aged, Peritoneal Dialysis instrumentation, Bacterial Infections pathology, Catheters, Indwelling adverse effects, Peritoneal Dialysis adverse effects, Wound Healing
- Abstract
The study goals were (1) to describe the natural healing process post peritoneal dialysis catheter implantation; (2) to discern factors that predispose to exit infection; (3) to recognize signs of early exit-site infection; and (4) to ascertain the influence, if any, of the healing process on subsequent peritonitis rates and final catheter outcomes. There were 226 evaluations of 43 exits [range 3-6 per exit, mean 5.2 + or - 1.1 (SD)] in 41 patients. Eleven exits were in the parasternal area and 32 exits were in the abdomen. Exit sites and sinus tracts were examined weekly for 6 weeks with a magnifying loupe and macro-photographed. Cultures were taken from sterile saline sinus washouts, periexit smears, and nares. Exit sites were categorized into four types: (1) fast-healing exits had no drainage or minimal moisture deep inside by the third week; epidermis started to enter into the sinus within 2-3 weeks, progressed steadily, and covered at least half the visible sinus tract 4-6 weeks after implantation; (2) in slow-healing exits without infection, epidermis started to enter into the sinus after 3 weeks or progressed slowly and did not cover half the visible sinus by 5 weeks; the sinus might have had serous or serosanguineous, but never purulent, drainage persistent up to 4 weeks; (3) healing interrupted by infection initially looked identical to the fast-healing exit, but within 6 weeks the epidermis did not progress or regress, granulation tissue became soft or frankly fleshy; drainage increased and/or became purulent; (4) in slow-healing exits due to early infection, granulation tissue became soft or fleshy and/or drainage became puru lent by 2-3 weeks; sinus epidermization was delayed or progressed slowly, only after infection was appropriately treated. Compared with patients with fast-healing exits, patients with early infected exits were more likely (although not significantly) to be diabetics, to have an abdominal catheter, wound hematoma, higher body mass index, and higher percentage of positive cultures for Staphylococcus aureus in nares. Early colonization of the exit was the most significant factor in determining the healing pattern: the later the colonization, the better the healing. Positive culture from either washout or periexit smear one week after implantation was associated with early exit infection, a higher peritonitis rate, and a high probability of catheter loss due to an exit/tunnel infection, and higher peritonitis rate; however, the time to the first peritonitis episode was not shorter than in the groups with later exit colonization. We postulate that exit infections and peritonitis rates may be decreased by delaying exit colonization using prophylactic antibiotics for at least 2 weeks after implantation and sterile exit dressing procedure for the entire healing time of approximately 6 weeks.
- Published
- 1996
18. Predicted and measured daily creatinine production in CAPD: identifying noncompliance.
- Author
-
Nolph KD, Twardowski ZJ, Khanna R, Moore HL, and Prowant BF
- Subjects
- Body Mass Index, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Nutritional Status, Serum Albumin analysis, Urea metabolism, Creatinine metabolism, Peritoneal Dialysis, Continuous Ambulatory, Treatment Refusal
- Abstract
Objective: To evaluate the ratio of measured creatinine (Cr) production to predicted creatinine production as an index of noncompliance in patients on continuous ambulatory peritoneal dialysis (CAPD)., Design: A cross-sectional analysis., Patients: One hundred and twenty-one patients on CAPD., Measurements: We have calculated Cr production from measured Cr outputs in 24-hour collections of urine and dialysate. Predicted Cr productions were calculated from standard tables. Weekly KT/V urea and weekly Cr clearances were determined from the same 24-hour urine and dialysate collections. Lean body mass (LBM) was calculated from the Cr production. Serum albumin concentration was measured., Results: The ratio of measured/predicted Cr production correlated positively and significantly with weekly KT/V urea, the protein equivalent of nitrogen appearance (PNA), weekly Cr clearance, and LBM. There was a decline in serum albumin concentration at ratios greater than 1.24, supporting the opinions of previous authors who have suggested that ratios greater than 1.24 are highly suggestive of noncompliance with the dialysis prescription. Defining noncompliance as a ratio greater than 1.24 implied that at least 5% of the female and 17% of the male patients were noncompliant., Conclusions: Declining serum albumin concentrations at higher ratios of measured/predicted Cr production support the opinion that this is an index of noncompliance. However, not all noncompliant patients necessarily have a ratio greater than 1.24. Weekly KT/V urea, weekly Ccr and LBM are all artifactually increased by "washout effects" if all exchanges are done only or mainly on the collection day.
- Published
- 1995
19. How reproducible is daily creatinine recovery in chronic peritoneal dialysis?
- Author
-
Lo WK, Prowant BF, Gamboa SB, Moore HL, and Nolph KD
- Subjects
- Creatinine analysis, Dialysis Solutions analysis, Humans, Peritoneal Dialysis, Continuous Ambulatory, Creatinine urine, Peritoneal Dialysis
- Published
- 1994
20. Peritoneal dialysis catheter exit-site care: results of an international survey.
- Author
-
Prowant BF, Warady BA, and Nolph KD
- Subjects
- Adult, Anti-Bacterial Agents administration & dosage, Child, Data Collection, Humans, Postoperative Care, Catheters, Indwelling, Peritoneal Dialysis nursing
- Abstract
A survey was developed to determine the prevalence of specific components of postoperative and chronic peritoneal catheter exit-site care procedures. Surveys were mailed to approximately 1800 participants of the 1991 Peritoneal Dialysis Conference; 585 surveys (80.6% from the United States and 96% from adult units) were analyzed. The most frequent components of postoperative exit-site care were the use of prophylactic antibiotics, daily dressing changes, procedures limited to specially trained staff, use of sterile technique, povidone iodine and hydrogen peroxide as cleansing agents, and gauze dressings. The most frequent components of chronic exit-site care procedures were daily care done with shower or bathing, antibacterial or pure soap for cleansing, hydrogen peroxide only as needed, catheter stabilization, dressings optional, and gauze dressings when used. Twice daily exit care, change in cleansing agent, and topical antibiotics were recommended for inflamed or infected exit sites. There were significant differences between the United States and other locations, particularly in the type of cleansing agent, use of hydrogen peroxide, and use of dressings for chronic care. Pediatric programs (all located in the United States or Canada) differed somewhat from adult programs in North America. Pediatric patients and their families were significantly more likely to be trained to do postoperative dressing changes and significantly less likely to perform exit-site care at the time of showering or bathing.
- Published
- 1993
21. Staphylococcus aureus nasal carriage is not associated with an increased incidence of exit-site infection with the same organism.
- Author
-
Twardowski ZJ and Prowant BF
- Subjects
- Humans, Staphylococcal Infections microbiology, Staphylococcus aureus classification, Carrier State, Catheters, Indwelling adverse effects, Nasal Cavity microbiology, Peritoneal Dialysis adverse effects, Staphylococcal Infections etiology, Staphylococcus aureus growth & development
- Published
- 1993
22. Six-year experience with swan neck catheters.
- Author
-
Twardowski ZJ, Prowant BF, Nichols WK, Nolph KD, and Khanna R
- Subjects
- Bacterial Infections epidemiology, Catheters, Indwelling adverse effects, Equipment Design, Equipment Failure, Humans, Peritoneal Dialysis, Continuous Ambulatory adverse effects, Peritonitis epidemiology, Prospective Studies, Skin Diseases, Infectious epidemiology, Catheters, Indwelling statistics & numerical data, Peritoneal Dialysis, Continuous Ambulatory instrumentation
- Abstract
From the beginning of our continuous ambulatory peritoneal dialysis (CAPD) program in January 1977 until June 1985, we used Tenckhoff and Toronto Western Hospital catheters. Throughout these years catheter survival probabilities of about 30% at three years persisted unchanged and were similar to survival probabilities reported by the National CAPD Registry special survey for these catheters. The first improvement in catheter results regarding leaks was noted after the adoption of lateral catheter insertion. Malfunction was less using swan neck prototypes from August 1985 to April 1986. The latter catheters were made of 80 degrees arc angle tubing between 8.5 cm spaced cuffs and were inserted in a reversed U-shape tunnel with the incision at the top of the tunnel. The use of these catheters was abandoned because of high cuff extrusion and exit infection rates. The next generation of swan neck catheters, the swan neck Missouri 2 and 3 catheters with straight intraperitoneal segments, improved the results dramatically. These catheters were made of 180 degrees arc angle tubing between 5 or 3 cm spaced cuffs. The estimated survival probability of 61% at three years more than doubled compared to previously used catheters. Recently we modified the intraperitoneal segment of the catheters, replacing the straight segment with a coiled one. These modified catheters, the swan neck Missouri coiled catheters, have been used exclusively since February 1990. In addition to an acceptable survival probability of 88% at one year, there are two major advantages of these catheters, the same as for other coiled catheters: elimination of infusion pain due to a jet effect and pain related to straight catheter tip pressure on the peritoneum experienced by some patients.
- Published
- 1992
23. Hematocrit and residual renal creatinine clearance in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
- Author
-
Nolph KD, Prowant BF, Moore HL, and Reyad SE
- Subjects
- Anemia metabolism, Female, Humans, Kidney Failure, Chronic metabolism, Male, Metabolic Clearance Rate, Regression Analysis, Creatinine metabolism, Hematocrit, Peritoneal Dialysis, Continuous Ambulatory
- Abstract
In a recent report, the relationship between renal creatinine clearance and hematocrit in patients with renal creatinine clearances, ranging from 55 to 8 mL per min. per 1.73 square meters of body surface area, was analyzed. The authors of this study have performed a cross-sectional analysis of the relationship of hematocrit to residual renal creatinine clearance in patients on continuous ambulatory peritoneal dialysis (CAPD). The authors of this study wanted to examine whether or not these hematocrits fall within extrapolations of the published 95% confidence limits for males and females with renal failure prior to end-stage renal disease and dialytic intervention. Authors also compared regression intercepts at residual creatinine clearances of 0. Most of the CAPD patients had hematocrits within the upper half or above the extrapolated 95% confidence limits for the predialysis population. Within the CAPD population, there were no significant correlations of hematocrit with residual creatinine clearance at these lower ranges. The degree of scatter in the CAPD population for hematocrit values was similar to that in the predialysis population. Residual creatinine clearance appears to be a crude index of the increasing severity of multiple factors that may contribute to the anemia. CAPD appears to maintain or improve hematocrit as renal mass and function decline.
- Published
- 1990
24. A simple method of preventing accidental disconnection at the peritoneal catheter adapter junction.
- Author
-
Schmidt LM, Craig PS, Prowant BF, and Twardowski ZJ
- Subjects
- Equipment Failure, Catheters, Indwelling, Peritoneal Dialysis, Continuous Ambulatory instrumentation
- Published
- 1990
25. Tidal peritoneal dialysis with racemic or L-lactate solutions.
- Author
-
Nolph KD, Twardowski ZJ, Khanna R, Prowant BF, Ponferrada LP, Schmidt LM, and Moore HL
- Subjects
- Adult, Evaluation Studies as Topic, Humans, Kidney Failure, Chronic therapy, Lactic Acid, Peritoneum physiology, Dialysis Solutions pharmacokinetics, Lactates pharmacokinetics, Peritoneal Dialysis methods
- Abstract
Unlabelled: To see if rapid lactate absorption on tidal peritoneal dialysis (TPD) would overwhelm D-lactate metabolism using racemic lactate and/or L-lactate metabolism using all L-lactate, five patients underwent 8-h TPD treatments with racemic lactate solution one day and with L-lactate another. Lactate concentrations (total) were 40 mmole/L, flow rates 27.3 L/8 h, tidal and reservoir volumes each 1.5L, tidal cycles 24-26 min, and net ultrafiltration per tidal cycle 70 to 99 mL., Results: Mean absorptions of D and L-lactate were 24.2 and 25.1%, respectively, compared to glucose at 14.6%. Urea clearances averaged 21.4 mL/min. Mean blood D-lactates at baseline were 0.6 +/- 0.5 SD mmole/L and after 8 h of TPD were 0.6 +/- 0.4 and 0.7 +/- 0.3 using L-lactate and racemic solutions, respectively; similar values for L-lactate were 1.2 +/- 0.3 at baseline and 1.2 +/- 0.3 and 1.2 +/- 0.5 after 8 h with L-lactate and racemic solutions. delta blood pH values were + 0.02 +/- 0.01 and + 0.04 +/- 0.03, while delta bicarbonate values were + 1.7 +/- 0.9 and + 0.7 +/- 1.0 for the all L and racemic studies, respectively. The total mmoles of L-lactate absorbed per 8 h of TPD with all L solution (greater than 300 mmoles) are greater than ever reported for peritoneal dialysis, but did not increase blood lactate levels. It would seem that either type of solution is suitable for TPD. Absorptions and metabolic rates are similar for L-Lactate and D-Lactate.
- Published
- 1990
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