You have accessJournal of UrologyStone Disease: Surgical Therapy IV (PD54)1 Sep 2021PD54-04 THE MICHIGAN UROLOGICAL SURGERY IMPROVEMENT COLLABORATIVE APPROPRIATENESS CRITERIA FOR URETERAL STENT OMISSION FOLLOWING UNCOMPLICATED URETEROSCOPY FOR URINARY STONE DISEASE Spencer C. Hiller, Stephani Daignault-Newton, S. Mohammad Jafri, Ronald Rubenstein, Mazen Abdelhady, C. Peter Fischer, Elena Gimenez, Richard Sarle, William W. Roberts, Conrad Maitland, Rafid Yousif, Robert Elgin, Laris Galejs, Jeremy Konheim, David Leavitt, Eric Stockall, J. Rene Frontera, J. Stuart Wolf, John M. Hollingsworth, Casey A. Dauw, Khurshid R. Ghani, and for the Michigan Urological Surgery Improvement Collaborative Spencer C. HillerSpencer C. Hiller More articles by this author , Stephani Daignault-NewtonStephani Daignault-Newton More articles by this author , S. Mohammad JafriS. Mohammad Jafri More articles by this author , Ronald RubensteinRonald Rubenstein More articles by this author , Mazen AbdelhadyMazen Abdelhady More articles by this author , C. Peter FischerC. Peter Fischer More articles by this author , Elena GimenezElena Gimenez More articles by this author , Richard SarleRichard Sarle More articles by this author , William W. RobertsWilliam W. Roberts More articles by this author , Conrad MaitlandConrad Maitland More articles by this author , Rafid YousifRafid Yousif More articles by this author , Robert ElginRobert Elgin More articles by this author , Laris GalejsLaris Galejs More articles by this author , Jeremy KonheimJeremy Konheim More articles by this author , David LeavittDavid Leavitt More articles by this author , Eric StockallEric Stockall More articles by this author , J. Rene FronteraJ. Rene Frontera More articles by this author , J. Stuart WolfJ. Stuart Wolf More articles by this author , John M. HollingsworthJohn M. Hollingsworth More articles by this author , Casey A. DauwCasey A. Dauw More articles by this author , Khurshid R. GhaniKhurshid R. Ghani More articles by this author , and for the Michigan Urological Surgery Improvement Collaborative More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002081.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Ureteral stents are associated with pain and urinary symptoms. Despite guidelines recommending stent omission following uncomplicated ureteroscopy (URS), they are frequently placed. We sought to define clinical scenarios suitable for stent omission by use of the RAND/UCLA Appropriateness Methodology. METHODS: We convened a panel of 15 urologists representing diverse practices from the Michigan Urological Surgery Improvement Collaborative (MUSIC). Panelists defined uncomplicated URS and agreed on 7 variables that influence stent decision-making: stone size, location, pre-stenting, urinalysis/culture result, ureteral dilation, ureteral access sheath, fragment status. Over 2 rounds, panelists scored 144 clinical scenarios for stent omission appropriateness based on all combinations of variables, from 1 (highly inappropriate) to 9 (highly appropriate). Median scores 1 to 3 were inappropriate; 4 to 6, uncertain; and 7 to 9, appropriate. Multivariable analysis was used to determine the odds of each variable being scored appropriate for omission. Panel findings were then applied to prior stenting practices for uncomplicated URS within MUSIC. RESULTS: Of the 144 scenarios, 88 (61%) were inappropriate for omission and 26 (18%) were appropriate for omission (Fig. 1). All variables impacted stent omission decision-making (Fig. 2). Stenting rates in MUSIC correlated with panel results (Fig. 3). Among cases highly appropriate for omission, stents had been placed in 55%. CONCLUSIONS: We identified 26 clinical scenarios appropriate for stent omission. Implementation of these results into real-world practice will help reduce stenting rates, with the goal to decrease patient morbidity and improve the quality of care. Source of Funding: Blue Cross Blue Shield of Michigan © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e923-e924 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Spencer C. Hiller More articles by this author Stephani Daignault-Newton More articles by this author S. Mohammad Jafri More articles by this author Ronald Rubenstein More articles by this author Mazen Abdelhady More articles by this author C. Peter Fischer More articles by this author Elena Gimenez More articles by this author Richard Sarle More articles by this author William W. Roberts More articles by this author Conrad Maitland More articles by this author Rafid Yousif More articles by this author Robert Elgin More articles by this author Laris Galejs More articles by this author Jeremy Konheim More articles by this author David Leavitt More articles by this author Eric Stockall More articles by this author J. Rene Frontera More articles by this author J. Stuart Wolf More articles by this author John M. Hollingsworth More articles by this author Casey A. Dauw More articles by this author Khurshid R. Ghani More articles by this author for the Michigan Urological Surgery Improvement Collaborative More articles by this author Expand All Advertisement Loading ...

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy (PD26)1 Apr 2019PD26-11 QUALITY INDICATORS FOR SHOCKWAVE LITHOTRIPSY IN THE STATE OF MICHIGAN: ARE WE FOLLOWING THE GUIDELINES? Casey Dauw*, Kavya Swarna, Tae Kim, Jaya Telang, David Leavitt, Mazen Abdelhady, Elena Gimenez, Karla Witzke, John Hollingsworth, and Khurshid Ghani Casey Dauw*Casey Dauw* More articles by this author , Kavya SwarnaKavya Swarna More articles by this author , Tae KimTae Kim More articles by this author , Jaya TelangJaya Telang More articles by this author , David LeavittDavid Leavitt More articles by this author , Mazen AbdelhadyMazen Abdelhady More articles by this author , Elena GimenezElena Gimenez More articles by this author , Karla WitzkeKarla Witzke More articles by this author , John HollingsworthJohn Hollingsworth More articles by this author , and Khurshid GhaniKhurshid Ghani More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555967.03963.55AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Recent guidelines from the American Urological Association (AUA) provides a clinical framework for the surgical management of patients with kidney stones. The extent to which these guidelines are followed in clinical practice for patients undergoing shockwave lithotripsy (SWL) has not been studied. To better understand quality indicators for SWL, we assessed adherence to AUA recommendations for the treatment of renal stones using data from a statewide clinical registry. METHODS: We used the Michigan Urologic Surgery Improvement Collaborative Reducing Operative Complications for Kidney Stones (MUSIC ROCKS) registry to understand SWL use in the state of Michigan. This prospectively maintained registry includes data from community and academic practices and contains detailed clinical and operative data for patients undergoing SWL and ureteroscopy. We identified all patients undergoing SWL from 2016 to 2018. In accordance with AUA guidelines, we evaluated practice patterns in relation to recommendations on (1) antibiotic administration at the time of SWL, (2) ureteral stent placement at the time of SWL, (3) SWL utilization for large renal stones (>2cm) and lower pole stones >1cm, and (4) post-procedural alpha-blocker use. RESULTS: 3,545 SWL procedures performed across 34 practices were analyzed. Perioperative antibiotics were administered to 64.9% percent of patients undergoing SWL with substantial variation across practices (range 14.8% to 100%, p<0.01; Figure). A ureteral stent was placed at the time of SWL in 2.8% of patients. Of all large (>2cm) or lower pole renal stones >1cm in the registry, 36.7% and 58.6% of patients, respectively, underwent SWL, while the remainder were treated with ureteroscopy. Postoperatively, 41.9% of patients were prescribed an alpha-blocker with substantial variability seen amongst practices (range 0% to 98.75%, p<0.01). CONCLUSIONS: Substantial variation exists amongst urology practices with regard to perioperative and postoperative optimization for SWL, with high rates of utilization for large and lower pole renal stones. These data serve to better inform future quality improvement efforts regarding appropriateness criteria for SWL in the state of Michigan. Source of Funding: Blue Cross/Blue Shield of Michigan Ann Arbor, MI; Detroit, MI; Ann Arbor, MI; Midland, MI; Ann Arbor, MI© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e478-e479 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Casey Dauw* More articles by this author Kavya Swarna More articles by this author Tae Kim More articles by this author Jaya Telang More articles by this author David Leavitt More articles by this author Mazen Abdelhady More articles by this author Elena Gimenez More articles by this author Karla Witzke More articles by this author John Hollingsworth More articles by this author Khurshid Ghani More articles by this author Expand All Advertisement PDF downloadLoading ...

Although the idea of transurethral radical prostatectomy has been studied by others previously (Kavoussi et al.); this report of 2 patients with localized prostate cancer with negative margins using this novel NOTES approach may have been possible due to the great experience of the authors with laser prostate enucleation and new instrumentation for suturing endoscopically.I am certain longer follow-up will determine the validity of this novel technique but undoubtedly, this innovating work has to be recognized as breaking ground.

In 2007, Rane presented the first single port nephrectomy for a small non-functioning kidney at the World Congress of Endourology. Since that time, the use of single port surgery for nephrectomy has expanded to include donor nephrectomy. Over the next two years the technique was adopted for many others types of nephrectomies to include donor nephrectomy. We present our technique for single port donor nephrectomy using the Gelpoint device. We have successfully performed this surgery in over 100 patients and add this experience to our experience of over 1000 laparoscopic nephrectomies. With the proper equipment and technique, single port donor nephrectomy can be performed safely and effectively in the majority of live donors. We have found that our operative times and most importantly our transplant outcomes have not changed significantly with the adoption of the single port donor nephrectomy. We believe that single port donor nephrectomy represents a step forward in the care of living donors.

Purpose: We present our initial experience in 40 patients undergoing laparoendoscopic single site donor nephrectomy.Materials and Methods: We prospectively collected data on 40 consecutive patients. A single access GelPOINT (TM) device was inserted into the abdomen through a 4 to 5 cm periumbilical incision. We used a bariatric camera with a right angle attachment for the light cord to maximize triangulation. Parameters analyzed included warm ischemia time, operative time, estimated blood loss, visual analog pain score, time to recipient creatinine less than 3 mg/dl, and recipient creatinine at discharge home, and 3 and 6 months.Results: A total of 38 left and 2 right donor nephrectomies were performed. Complete laparoendoscopic single site donor nephrectomy was successful in 38 cases. One left and 1 right case were converted to a hand assisted approach. Average +/- SD body mass index was 26.1 +/- 5.2 kg/m(2). Mean operative time to allograft extraction was 93.5 +/- 27.5 minutes and mean total operative time was 166.7 +/- 33.8 minutes. Average estimated blood loss was 106.7 +/- 93.5 cc. Mean warm ischemia time was 3.96 +/- 0.72 minutes. Mean hospital stay was 1.77 +/- 0.43 days and median time to recipient creatinine less than 3.0 mg/dl was 54.2 +/- 110.3 hours. Mean recipient creatinine at discharge home, and at 3 and 6 months was 1.48 +/- 0.67, 1.29 +/- 0.38 and 1.19 +/- 0.34 mg/dl, respectively. Complications included hyponatremia in 1 patient, wound infection in 1, and a grade III laceration in an allograft that was sustained during extraction.Conclusions: Our initial experience with laparoendoscopic single site donor nephrectomy is encouraging. This approach to kidney donation without an extra-umbilical incision could become particularly relevant to minimize morbidity in young, healthy organ donors.

You have accessJournal of UrologyTransplantation, Urolithiasis & Hydronephrosis1 Apr 2010V1993 LAPAROENDOSCOPIC SINGLE SITE DONOR NEPHRECTOMY: AN ILLUSTRATION OF TECHNIQUE James Wysock, Elena Gimenez, Casey Ng, Eric Kaufman, Gerald Wang, Abhishek Srivastava, David Leeser, Sandip Kapur, and Joseph J. Del Pizzo James WysockJames Wysock More articles by this author , Elena GimenezElena Gimenez More articles by this author , Casey NgCasey Ng More articles by this author , Eric KaufmanEric Kaufman More articles by this author , Gerald WangGerald Wang More articles by this author , Abhishek SrivastavaAbhishek Srivastava More articles by this author , David LeeserDavid Leeser More articles by this author , Sandip KapurSandip Kapur More articles by this author , and Joseph J. Del PizzoJoseph J. Del Pizzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2005AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this video is to provide a stepwise illustration and explanation of our approach to laparoendoscopic single site donor nephrectomy (LESS DN) using a Gel Point™ device. METHODS A single access Gel Point™ device (Applied Medical, Rancho Santa Margarita, CA) was inserted into the abdomen through a 5 cm periumbilical incision. Apart from standard laparascopic instruments, a bariatric camera with a right angle attachment for the light cord was used to maximize triangulation. Data was collected prospectively for 20 consecutive patients undergoing the described procedure. Parameters analyzed were warm ischemia time, operative time, EBL, pain scores, time to recipient creatinine less than 3mg/dL, and recipient creatinine at discharge. RESULTS Complete LESS DN was successful in 19 cases. One case was converted to hand assisted laparascopy for failure to maintain pneumoperitoneum. Patient characteristics are noted in Table 1. Table 2 describes the operative parameters analyzed. Visual analog pain scores were 0/10 in all cases at two weeks post-operatively. One patient developed a wound infection treated with antibiotics. Table 1. Patient Characteristics Male: Female 7:13 Age (years) 44.85(range21-64) BMI kg/m2 27.77(range19.5–37) Preoperative Cr mg/dL 0.77(range0.4–1) Renal Artery Single: Double 12:6 Table 2. Parameters analyzed for laparaendoscopic single port donor nephrectomy Mean operative time 96.68min(range62–187) EBL 114.47ml(range25–450) Warm Ischemia Time 4.49min(+/-2.33) Mean time to recipient Cr <3.0 mg/dL 31.74hrs(range8-72) Mean recipient Cr at discharge 1.41mg/dL(+/-0.34) Mean incision length 5.13cm(+/-0.48) Hospital LOS 1.82days(+/-0.48) CONCLUSIONS This video demonstrates a stepwise technique for performing LESS DN. Our early prospective data for this approach is encouraging and supports additional work to validate LESS DN as a potential method for improving cosmetic and post-operative pain outcomes for living donor nephrectomies. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e774 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Wysock More articles by this author Elena Gimenez More articles by this author Casey Ng More articles by this author Eric Kaufman More articles by this author Gerald Wang More articles by this author Abhishek Srivastava More articles by this author David Leeser More articles by this author Sandip Kapur More articles by this author Joseph J. Del Pizzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation, Vascular Surgery II1 Apr 20102169 LAPAROENDOSCOPIC SINGLE SITE (LESS) VERSUS CONVENTIONAL LAPAROSCOPIC DONOR NEPHRECTOMY: PROSPECTIVE COMPARISON OF PERIOPERATIVE AND EARLY GRAFT OUTCOMES Gerald Wang, Elena Gimenez, James Wysock, Casey Ng, David Leeser, Sandip Kapur, and Joseph Del Pizzo Gerald WangGerald Wang More articles by this author , Elena GimenezElena Gimenez More articles by this author , James WysockJames Wysock More articles by this author , Casey NgCasey Ng More articles by this author , David LeeserDavid Leeser More articles by this author , Sandip KapurSandip Kapur More articles by this author , and Joseph Del PizzoJoseph Del Pizzo More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2272AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoendoscopic single site (LESS) surgery is a recent advance in minimally invasive surgery that may have particular relevance to living donor nephrectomy (DN). While the benefits of laparoscopic DN (LDN) are well established and may have reduced some barriers to graft donation, kidney donors remain in short supply. Therefore, LESS-DN represents an important development with the potential to further reduce barriers to kidney donation. Here, we present a matched comparison of LESS-DN versus conventional LDN using a new single-port access system. METHODS From August to October 2009, we performed 20 consecutive cases of LESS-DN using the new GelPoint™ system (Applied Medical, Rancho Santa Margarita, CA). A transumbilical approach was used through a 4-5 cm incision and no extra-umbilical incisions or punctures were made. Data was collected prospectively and compared to a matched cohort of 20 LDN performed by the same surgeons (JJD, DBL). RESULTS LESS-DN was performed successfully in all 20 patients and each allograft demonstrated immediate function. There was no difference between the cohorts with regard to age, gender, BMI, anatomic complexity and surgical date. There was one conversion from LESS to conventional hand-assisted LDN for inability to maintain pneumoperitoneum. Operative time was longer in the LESS cohort (92 vs 78 min, p=0.8) and mean blood loss was lower in the LESS group (111 vs 122 mL, p=0.7) but neither was statistically significant. Warm ischemia time was longer in the LESS cohort (4 vs 3 min, p=0.3). There was a trend towards decreased visual analogue pain score in the LESS group but this was not statistically significant (1.4 vs 3.4, p=0.1). Length of stay was similar between the 2 groups (LESS 1.5 vs 1.8 days, p=0.2). There was one postoperative complication in the LESS cohort (wound infection). There was no difference in graft function between the 2 groups. Mean time to recipient creatinine < 3.0 mg/dL was 31 hrs for LESS-DN and 33 hrs for LDN (p=0.9). At time of discharge, recipient creatinine was 1.40 mg/dL for LESS-DN and 1.35 mg/dL for LDN (p=0.9). CONCLUSIONS LESS-DN was performed successfully in 20 patients without additional extra-umbilical port sites and with one conversion to hand-assisted LDN. While the benefits of LESS-DN may be limited to decreased postoperative pain and improved cosmesis, this approach using the new GelPoint™ system demonstrates equivalent graft function and may nevertheless prove beneficial to further reduce barriers to kidney donation. New York, NY© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e844 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Gerald Wang More articles by this author Elena Gimenez More articles by this author James Wysock More articles by this author Casey Ng More articles by this author David Leeser More articles by this author Sandip Kapur More articles by this author Joseph Del Pizzo More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of Urology1 Apr 2009REAL-TIME PCR ANALYSIS DETECTION OF AZF MICRODELETIONS: A RAPID AND ACCURATE METHOD FOR INFERTILITY SCREENING Anna Mielnik, Elena Gimenez, Peter N Schlegel, and Darius A Paduch Anna MielnikAnna Mielnik More articles by this author , Elena GimenezElena Gimenez More articles by this author , Peter N SchlegelPeter N Schlegel More articles by this author , and Darius A PaduchDarius A Paduch More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)62189-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "REAL-TIME PCR ANALYSIS DETECTION OF AZF MICRODELETIONS: A RAPID AND ACCURATE METHOD FOR INFERTILITY SCREENING." The Journal of Urology, 181(4S), p. 786 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 786 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Anna Mielnik More articles by this author Elena Gimenez More articles by this author Peter N Schlegel More articles by this author Darius A Paduch More articles by this author Expand All Advertisement PDF DownloadLoading ...

The present study aimed to establish embryonic stem (ES) cell lines, i.e., ntES cells, using rabbit blastocyst stage embryos cloned by somatic cell nuclear transfer. First, we investigated the development of cloned rabbit embryos reconstructed with normal fibroblasts and fibroblasts transfected with enhanced green fluorescence protein (eGFP). Blastocyst rates were 27.4% and 23.9%, respectively, for the embryos reconstructed with normal fibroblasts and fibroblasts transfected with eGFP compared with that from the parthenogenetic group (43.1%). One ntES cell line was established from embryos reconstructed with eGFP-transfected fibroblasts (1 of 17, 5.9%), and three ntES cell lines were derived from those with normal fibroblasts (3 of 17, 17.6%). All the ntES cell lines retained alkaline phosphatase activity and expressed ES cell–specific markers SSEA-4, Oct-4, TRA-1-60, and TRA-1-81. The pluripotency was further confirmed by reverse transcription–polymerase chain reaction analyses of Oct-4, Nanog, and Sox-2 expressions in ntES cell lines. The differentiation capacity of ntES cells was also examined in vitro and in vivo, by which these ntES cell lines were able to differentiate into all three germ layers through embryoid bodies and teratomas. In conclusion, it is apparent that the efficiency of ntES cells derived using eGFP-transfected donor cells is lower than that with nontransfected, normal fibroblasts donor cells. Similar to those from parthenogenetic embryos, all ntES cell lines derived from cloned rabbit embryos are able to express pluripotency markers and retain their capability to differentiate into various cell lineages both in vitro and in vivo.

You have accessJournal of Urology1 Apr 2009INFERTILITY, OBESITY, AND HYPOGONADISM ARE SIGNIFICANT FACTORS FOR OSTEOPOROSIS IN YOUNG MEN Elena Gimenez, Alex Bolyakov, Michael Herman, Joseph Kiper, and Darius A Paduch Elena GimenezElena Gimenez More articles by this author , Alex BolyakovAlex Bolyakov More articles by this author , Michael HermanMichael Herman More articles by this author , Joseph KiperJoseph Kiper More articles by this author , and Darius A PaduchDarius A Paduch More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(09)62185-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "INFERTILITY, OBESITY, AND HYPOGONADISM ARE SIGNIFICANT FACTORS FOR OSTEOPOROSIS IN YOUNG MEN." The Journal of Urology, 181(4S), p. 785 © 2009 by American Urological AssociationFiguresReferencesRelatedDetails Volume 181Issue 4SApril 2009Page: 785 Advertisement Copyright & Permissions© 2009 by American Urological AssociationMetricsAuthor Information Elena Gimenez More articles by this author Alex Bolyakov More articles by this author Michael Herman More articles by this author Joseph Kiper More articles by this author Darius A Paduch More articles by this author Expand All Advertisement PDF downloadLoading ...

Management of advanced renal cell carcinoma remains a persistent clinical challenge with high morbidity and mortality for a large proportion of patients. Until recently, available medical immunotherapy regimens yielded a therapeutic response in only 20% of patients. Advances in the understanding of molecular mechanisms of renal cell carcinoma have led to a rapidly expanding body of work exploring biomarkers for the disease and targeted therapeutics. We review current investigations into biomarkers and novel therapies for renal cell carcinoma, discuss the concept of anticancer vaccines, and propose a novel target for anticancer vaccine development.

The aim of studies was an evaluation of the peritoneal permeability in standard PET performed before introduction, during administration and after discontinuation of PG-DS in patients treated with CAPD.In 14 patients (11 M., 3 F; age 45.1 ± 8.5 years) treated with CAPD for 17.5 ± 9.9 months, 7.5% PG-DS was applied for the overnight exchange replacing 3.86 or 2.27% glucose dialysis solution.Standard PET was carried out at 1.6 ± 0.8 months before PG-DS introduction (study period I, n = 14), after 1.2 ± 0.6 months of PG-DS administration (study period II, n = 14), after 4.4 ± 0.8 months of PG-DS administration (study period III, n = 11), after 8.8 ± 2.2 months of PG-DS administration (study period IV, n = 9) and at 2.0 ± 0.6 months after PG-DS discontinuation (study period V, n = 11).D/P urea and creatinine as well as D/ D 0 glucose were calculated at 0, 2 and 4 hours of PET.The control group was retrospectively selected taking into account both CAPD duration and the peritoneal permeability comparable to those in the PG-DS group at the study beginning.Patients of the control group underwent PET at the similar time intervals (control periods I -V).In the PG-DS group, an increasing tendency of D/P urea and D/P creatinine was shown during the consecutive study periods.This tendency continued after PG-DS discontinuation.D/D 0 glucose was significantly higher only in PET performed during PG-DS administration (periods III and IV) as compared to results obtained in the preceding periods (I and II).In the control group, both D/ P urea and D/P creatinine remained unchanged, but D/D 0 glucose was lower at 0 and 2 hour of PET in control period V as compared to respective values in the preceding control periods.The use of PG-DS in CAPD patients causes the prolonged increase in the peritoneal permeability from the vascular to the mesothelial side of the peritoneal membrane and reversibly decreases peritoneal permeability in the opposite direction.

Background/Aim: Sodium and water retention is common in peritoneal dialysis patients and contributes to cardiovascular disease. As peritoneal sodium removal depends partly on dwell time, and automated peritoneal dialysis (APD) often uses short dwell time exchanges, the aim of this study was to compare the 24-hour peritoneal sodium removal in APD and standard continuous ambulatory peritoneal dialysis (CAPD) patients and to analyze its possible influence on blood pressure control. Methods: A total of 53 sodium balance studies (30 in APD and 23 in CAPD) were performed in 36 stable peritoneal dialysis patients. The 24-hour net removal of sodium was calculated as follows: M = ViCi – VdCd, where Vd is the 24-hour drained volume, Cd is the solute sodium concentration in Vd, Vi is the amount of solution used during a 24-hour period, and Ci is the sodium concentration in Vi. Peritoneal sodium removal was compared between APD and CAPD patients. Residual renal function, serum sodium concentration, daily urinary sodium losses, weekly peritoneal Kt/V and creatinine clearance, 4-hour dialysate/plasma creatinine ratio, proportion of hypertonic solutions, net ultrafiltration, systolic and diastolic blood pressures, and need for antihypertensive therapy were also compared between the groups. Results: Peritoneal sodium removal was higher (p < 0.001) in CAPD than in APD patients. There were no significant differences in residual renal function, serum sodium concentration, urinary sodium losses, peritoneal urea or creatinine clearances, 4-hour dialysate/plasma creatinine ratio, or proportion of hypertonic solutions between groups. The net ultrafiltration was higher in CAPD patients and correlated strongly (r = 0.82; p < 0.001) with peritoneal sodium removal. In APD patients, peritoneal sodium removal increased significantly only in those patients with a second daytime exchange. The systolic blood pressure was higher (p < 0.05) in APD patients, and the proportion of patients with antihypertensive therapy was also higher in APD patients, although no significant relationship between blood pressure values and amount of peritoneal sodium removal was found. Conclusions: The 24-hour sodium removal is higher in CAPD than in APD patients, and there is a trend towards better hypertension control in CAPD patients. As hypertension control and volume status are important indices of peritoneal dialysis adequacy, our results have to be considered in the choice of the peritoneal dialysis modality.

Impaired phosphate excretion resulting in hyperphosphatemia is one of the earliest consequences of chronic renal failure. To control serum phosphate levels, we can use the following therapies: 1) Restriction of dietary phosphate (but on CAPD, obligatory protein losses via peritoneal fluid makes impractical any reduction of phosphate diet 2) Reduction of phosphate absorption, using phosphate binders. 3) Peritoneal phosphate removal. Object: 1) To evaluate the factors affecting peritoneal phosphate removal such as plasma phosphate, peritoneal membrane transport type, peritoneal dialysis modality prescription (CAPD or APD) and daily dialysate volume. 2) To test the best calcium concentration in the peritoneal dialysis fluid (5, 6 or 7 mg/dl) in order to permit the use of calcium carbonate or acetate without the risk of hypercalcemia or hyperparathyroidism. Method: Phosphate was measured in seventy 24-hour dialysate collections, 33 from patients on CARD and 37 from patients on APD. 24-hour peritoneal phosphate removal (mg/24 hours) and weekly peritoneal phosphate clearance was calculated (L/week). The peritoneal membrane was studied by the peritoneal equilibrium test (PET), using a 2.27% glucose. We calculated also the peritoneal calcium balance in 25 daily peritoneal fluid collections from patients using a calcium dialysate concentration of 5 6 or 7 mg/dl each one. IPTH levels and doses of vitamin D were compared at 6 months in patients using a calcium concentration of 5 6 or 7 mg/dl from the beginning of peritoneal dialysis (5 patients of each calcium dialysate concentration). Results: Weekly peritoneal phosphate clearance (WPC) were higher or APD than on CARD (57 +/- 21 vs 47 +/- 14, p < 0.005). Daily dialysate volume was also higher on APD (14 +/- 4 vs 7.8 +/- 7.8 L/day, p < 0.001). WPC was higher on APD when a mild-day exchange was done (61 +/- 23 vs 45 +/- 15, p < 0.005). instead an equal total daily volume of the dialysate. Peritoneal calcium balance was significantly more negative in patients using a calcium in the dialysis fluid of 5 than 6 or 7 mg/dl (-125 +/- 7 vs -18 47 vs -11 +/- 49, p < 0.001). At 6 months, patients using a calcium fluid concentration of 5 mg/dl increased iPTH levels (from 160 +/- 101 to 332 +/- 153, p < 0.001) and vitamin D needs (from 0 to 1.87 +/- 0.37 mcg/week, p < 0.001). In summary, peritoneal phosphate clearance depends on plasma phosphate levels, daily volume of dialysate prescribed and peritoneal membrane transport characteristics. It can be improved by increasing the total peritoneal fluid. On APD, a mild-day exchange may improve phosphate clearance, without total volume increase. The risk of secondary hyperparathyroidism can be decreased with a calcium fluid concentration of 6 mg/dl, which was shown to be better than 5 mg/dl when calcium phosphate binders are not correctly taken.

UNLABELLED:Impaired phosphate excretion resulting in hyperphosphatemia is one of the earliest consequences of chronic renal failure. To control serum phosphate levels, we can use the following therapies: 1) Restriction of dietary phosphate (but on CAPD, obligatory protein losses via peritoneal fluid makes impractical any reduction of phosphate diet. 2) Reduction of phosphate absorption, using phosphate binders. 3) Peritoneal phosphate removal.OBJECTIVE:1) To evaluate the factors affecting peritoneal phosphate removal such as plasma phosphate, peritoneal membrane transport type, peritoneal dialysis modality prescription (CAPD or APD) and daily dialysate volume. 2) To test the best calcium concentration in the peritoneal dialysis fluid (5, 6 or 7 mg/dl) in order to permit the use of calcium carbonate or acetate without the risk of hypercalcemia or hyperparathyroidism.METHOD:Phosphate was measured in seventy 24-hour dialysate collections, 33 from patients on CAPD and 37 from patients on APD. 24-hour peritoneal phosphate removal (mg/24 hours) and weekly peritoneal phosphate clearance was calculated (L/week). The peritoneal membrane was studied by the peritoneal equilibrium test (PET), using a 2.27% glucose. We calculated also the peritoneal calcium balance in 25 daily peritoneal fluid collections from patients using a calcium dialysate concentration of 5, 6 or 7 mg/dl each one. IPTH levels and doses of vitamin D were compared at 6 months in patients using a calcium concentration of 5, 6 or 7 mg/dl from the beginning of peritoneal dialysis (5 patients of each calcium dialysate concentration).RESULTS:Weekly peritoneal phosphate clearance (WPC) were higher or APD than on CAPD (51 +/- 21 vs 41 +/- 14, p < 0.005). Daily dialysate volume was also higher on APD (14 +/- 4 vs 7.8 +/- 1.8 L/day, p < 0.001). WPC was higher on APD when a mild-day exchange was done (61 +/- 23 vs 45 +/- 15, p < 0.005), instead an equal total daily volume of the dialysate. Peritoneal calcium balance was significantly more negative in patients using a calcium in the dialysis fluid of 5 than 6 or 7 mg/dl (-125 +/- 7 vs -18 +/- 41 vs -11 +/- 49, p < 0.001). At 6 months, patients using a calcium fluid concentration of 5 mg/dl increased iPTH levels (from 160 +/- 101 to 332 +/- 153, p < 0.001) and vitamin D needs (from 0 to 1.87 +/- 0.37 mcg/week, p < 0.001). In summary, peritoneal phosphate clearance depends on plasma phosphate levels, daily volume of dialysate prescribed and peritoneal membrane transport characteristics. It can be improved by increasing the total peritoneal fluid. On APD, a mild-day exchange may improve phosphate clearance, without total volume increase. The risk of secondary hyperparathyroidism can be decreased with a calcium fluid concentration of 6 mg/dl, which was shown to be better than 5 mg/dl when calcium phosphate binders are not correctly taken.