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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acinetobacter species are pleomorphic nonfermenting aerobic Gram negative bacilli which are important organisms causing peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). We describe the characteristics and outcome of Acinetobacter peritonitis (AP) over an 18 month study period. There were 13 episodes of AP (9 identified as variant anitratus, 1 as variant calcoaceticus, 1 as variant, 1 woffi and 2 unspecified) in 11 patients (7 females and 4 males, mean age +/- SEM, 50.1 +/- 4.2 years), accounting for 14.3% of the total number of episodes of peritonitis. Technique failure accounted for 8 cases of AP. The duration of CAPD before the onset of AP ranged from 2 to 13 months. Three patients had AP one month after a different episode of peritonitis. Treatment was successful with intraperitoneal (IP) gentamicin alone in 9 episodes, oral perfloxacin alone in 2, and combination IP ceftazidime and oral perfloxacin in 1. Nine patients responded to treatment without interruption of CAPD. Two patients who were treated with IP gentamicin alone had second episodes of AP 2 and 4 months after treatment and 1 patient converted to hemodialysis because of bowel adhesions after his second episode of AP. One patient had Candida superinfection after clearance of AP. In conclusion AP is a common cause of peritonitis and can be treated in most cases without interruption of CAPD and catheter removal. The use of oral quinolones may be more convenient and equally effective. Diabetes mellitus and technique failure may be important factors.
Adv Perit Dial 1991
PMID:Acinetobacter peritonitis in patients on CAPD: characteristics and outcome. 168 Apr 20

To evaluate patient survival among geriatric patients by dialytic treatment of choice we assigned all patients aged 65 years and older treated in Michigan to either CAPD at home or center hemodialysis (HD) according to the treatment used on day 120 of ESRD therapy. Michigan Kidney Registry files on all 308 CAPD and 1244 HD patients who started ESRD therapy during 1980-1987 were used for this study. The Cox proportional hazards model revealed a significantly increased relative death rate (RR) for patients with diabetes (RR = 1.91, p less than 0.001) and hypertension (RR 1.4, p less than 0.01) as cause of ESRD when adjusting for age, sex, race, treatment and year of incidence. White patients had a 51% higher relative death rate overall when compared to black patients (p less than 0.001) and specifically among hypertensive (RR = 1.65, p less than 0.001) and diabetic patients (RR = 1.59, p less than 0.001). Those differences were still significant when taking higher rates of withdrawal from dialysis among white patients into account. The relative death rates for CAPD patients was essentially the same as for HD patients overall, however, diabetic CAPD patients appeared to have a higher than diabetic HD patients (RR = 1.58, p = 0.1). This statistically not significant difference may be related to selection of patients with cardiovascular risk into CAPD. There was no trend in mortality over time. By modality on day 120, CAPD has similar outcomes as HD in geriatric non diabetic patients.
Adv Perit Dial 1991
PMID:Comparison of mortality risk by choice of CAPD versus hemodialysis among elderly patients. 168 Apr 60

We compared a group of 60 insulin-dependent diabetics maintained on CAPD with 60 nondiabetic matched controls to determine if the diabetic patients were at increased risk for catheter-related infections. Although catheter infection rates were 17% higher in the diabetics (1.4/year versus 1.2/year in nondiabetics), time to first catheter infection was not different between the groups (p = 0.6). Rates of peritonitis, peritonitis associated with catheter infection, multiple catheter infection, and catheter removal were also similar among the diabetics and controls. S. aureus caused 52% (42/81) of the catheter infections in the diabetics and 60% (35/58) in the controls. More catheter infections in the nondiabetics versus the diabetics lacked drainage or resulted in sterile cultures (17/75 versus 7/88 respectively, p less than or equal to 0.01), but the significance of this finding is uncertain. In conclusion, we did not find insulin-dependent diabetes mellitus to be a statistically significant risk factor for catheter-related infections.
Perit Dial Int 1991
PMID:Catheter infections in insulin-dependent diabetics on continuous ambulatory peritoneal dialysis. 175 2

Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovascular disease, peripheral vascular disease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.
Perit Dial Int 1991
PMID:A multicenter, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis. 844 87

We compared the survival of 842 patients on centre haemodialysis to 272 patients on continuous ambulatory peritoneal dialysis (CAPD). All patients selected had begun treatment between 1 January 1984 and 30 June 1988 and were from six centres which participate in a regional renal patients registry. Patients on CAPD were older and had a greater proportion of diabetes and other associated diseases. Age, diabetes, and cardiovascular diseases were associated with a shorter survival on treatment in all the patients studied. Without adjustment for risk factors, patient 3-year survival was higher in centre haemodialysis than in CAPD, 80% versus 64% respectively. However, no significant differences could be shown in the survival rates of the two treatment modalities after accounting for the heterogeneity of the patients in the two groups, either by stratification or by multivariate analysis (Cox). Age was the main predictive factor for CAPD patient survival, while the influence of diabetes and cardiovascular diseases was less clear. Technique survival was much better in centre haemodialysis (94% versus 56% in CAPD, 3-year survival). Older age and diabetes mellitus were associated with a greater risk of switching from centre haemodialysis to CAPD and a trend to retain those patients on CAPD.
Nephrol Dial Transplant 1991
PMID:Comparison of survival in continuous ambulatory peritoneal dialysis and hospital haemodialysis: a multicentric study. 187 87

The metabolism of lipids in CAPD has not been fully elucidated. To further clarify the behavior of dyslipidemia in this setting we followed the values of total cholesterol (TC), HDL-cholesterol (HDL-C) and apolipoprotein (apo) parameters over time (12-24 months) in 40 patients and correlated these values and their ratios with clinical (age, gender, race, weight, diabetes, etc.) and biochemical (multiphastic screen) information. Mean HDL-C was lower in men (p less than 0.04), in whites, (p less than 0.03) and in diabetic patients (p less than 0.05), but there were no group differences for mean total cholesterol, mean apolipoprotein values, the atherogenic risk ratio TC/HDL-C, or the anti-atherogenic ratio apo A-I/apo B. Total months on CAPD was found to correlate positively with TC/HDL-C (p less than 0.05), an atherogenic risk factor, and to correlate negatively with HDL-C (p less than 0.02), an anti-atherogenic index. There was also a negative correlation with another anti-atherogenic index, apo A-I/apo B, which did not reach statistical significance (r = -0.41, p = NS). Counterbalancing this apparently increased atherogenic risk is the stability of individual parameters for each patient over time in this study. In fact, the good news appears to be that TC, HDL-C, apolipoproteins and the risk ratios TC/HDL-C and apo A-I/apo B all remained stable over 12-24 months (p = NS by paired t-test for all). Thus, we find no evidence for worsening of the uremic dyslipidemia over time with CAPD treatment.
Adv Perit Dial 1990
PMID:The impact of CAPD treatment on lipid metabolism and cardiovascular risk. 198 15

Platelet activity is closely related to endothelium and could release factors able to influence capillary wall and surrounding tissues. BTG is a protein included in platelet vesicles and a measure of its activation. Some alterations of peritoneum could be partially related to platelet activity. BTG peritoneal transport from blood is weight limited (36000) and consequently, high levels in effluent should represent local production. The aim of this study has been to characterize peritoneal effluent BTG.12 patients, on CAPD 27 +/- 15 mon., 5 diabetics were studied. Previous peritonitis was 0.3 +/- 0.4 e/year. Determinations performed: Plasma (P) (BTG, T. protein, albumin, platelet count, Hcto and Fibrinogen) and Effluent (EF) (BTG, T. protein, Fibrinopeptide A, FDP, Fibrinolytic act., Fibrinogen, Plasminogen and Mitogenic induced capacity on Swiss 3T3 mice fibroblasts). To evaluate peritoneal function we used mass transfer coefficients (MTC) and net UF.R.:BTG levels: P 118 +/- 14 EF 34 +/- 14 ng/ml P/EF (%) 31 +/- 13 (6-54%). Regression analysis: P BTG did not show significant relationship with any of the studied parameters. EF BTG showed direct significant correlation (p less than 0.05) with Creatinine-MTC (r: 0.81) and EF Fibrinogen (0.68) and in the limit of significance with EF T. prot (0.57) and EF Mitogenicity (0.62). P/EF BTF showed significant correlation with creatinine-MTC (0.77). The analysis of these values grouping patients showed: diabetes has no influence on BTG values, hypertensive patients show higher P/EF BTG values than normotensive (39 +/- 9 vs 23 +/- 11%, p less than 0.05) and no influences of peritonitis or CAPD period were found.(ABSTRACT TRUNCATED AT 250 WORDS)
Adv Perit Dial 1990
PMID:Measurement of the peritoneal platelet activity through the effluent betathromboglobulin levels in CAPD patients. 198 20

A retrospective study was done in 86 patients on dialysis in order to evaluate the doses of aluminum hydroxide (OH3 Al) received to achieve a better serum phosphate control. Thirty-seven patients were treated with continuous ambulatory peritoneal dialysis (CAPD) divided in 22 diabetics and 15 non-diabetics. Forty-nine patients were treated with hemodialysis (HD), 12 diabetics and 37 non-diabetics. The doses of 1-25 Dihidroxycholecalciferol (1-25 DOH-D3) were similar in all patients. The serum phosphate levels were similar in CAPD and HD patients with smaller doses of OH3 AL in CAPD patients (p less than 0.001). Diabetics on either technique need less OH3 AL in CAPD (CAPD p less than 0.01; HD p less than 0.05) to achieve the same or better control of serum phosphorus than non-diabetics. The overload of glucose on CAPD and the maintained hyperglycemia on diabetes mellitus would shift phosphorus into the cell and could explain these results. Finally, the less needs of aluminum hydroxide on diabetic patients could contribute to their protection against aluminum deposition and its effects.
Adv Perit Dial 1990
PMID:Diabetic patients on CAPD need less aluminum hydroxide as a phosphate binder than non-diabetics. 198 39

Clinical course, complications and outcome were analyzed in 75 patients (14 women, 61 men) who started CAPD at age 55 years or older (55-81). These patients were separated in three groups. Group A patients had high risk for vascular disease (diabetes, hypertension, N = 45), group B patients had a presumed lower risk for vascular disease (primary renal disease, N = 22), and group C patients had miscellaneous conditions (N = 8). Group A was compared to group B. Patient and technique survival was statistically higher for group B than for group A. The rates of peritoneal dialysis related complications (peritonitis, tissue infections, catheter loss, hernias) were comparable between groups A and B. Hernias were seen frequently in all groups and had severe sequellae, including discontinuation of CAPD. Catastrophic vascular events were also seen in all groups, but the frequency of such events, particularly of catastrophic vascular events of the limbs, was statistically higher in group A than in group B. Vascular disease accounted for the majority of deaths in all groups. Four patients died from cardiovascular instability soon after changing from CAPD to hemodialysis. In conclusion, vascular disease is the major factor limiting survival in older CAPD patients. CAPD is superior to hemodialysis for a relatively small fraction of older patients with severe cardiovascular instability.
Adv Perit Dial 1990
PMID:Vascular disease: the critical risk factor for mortality in older patients on CAPD. 198 41

During continuous ambulatory peritoneal dialysis, solutes capable of stimulating fibroblast activity could be transferred into dialysate; their significance and consequences remain to be established. Sixty-three stable non-selected patients on CAPD were included in this study. Peritoneal transport for water and small solutes was assessed. To explore the mitogenic-induced capacity of peritoneal nocturnal effluent, 50 microliters were added to culture plates of mice and human fibroblasts. Peritoneal effluent alone shows a mitogenic potency slightly greater than insulin and clearly less than bovine fetal serum. When coadjuvants are added, mitogenicity increases but in a variable manner among patients. No differences can be observed in relation to diabetes mellitus, time on CAPD, previous peritonitis, and losses of diffusion capacity. We noted significant inverse linear correlations between mitogenicity value and ultrafiltration, effluent calcium, and creatinine. Neither adrenergic nor calcium-channel blockers influenced these values. We conclude that the peritoneal effluent of CAPD patients has a variable effect on fibroblast growth. Some of the blood components seem to be implicated in this activity. Reduced peritoneal ultrafiltration capacity, probably by a concentration mechanism, is related to a greater mitogenic potency in peritoneal effluent. CAPD patients with impaired ultrafiltration may be at high risk for autoactivation of peritoneal fibroblasts, mainly in mesothelial denudate states.
Nephrol Dial Transplant 1991
PMID:Characterisation of the mitogenic-induced capacity of peritoneal effluent on human and mice fibroblasts in culture. 205 15


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