Influence of dialysate temperature on creatinine peritoneal clearance in peritoneal dialysis patients: a randomized trial

Background: Patients on continuous ambulatory peritoneal dialysis (PD) are encouraged to warm dialysate to 37 \ub0C before peritoneal infusion; main international PD guidelines do not provide specific recommendation, and patients generally warm dialysate batches partially or do not warm them at all. Warming of dialysate is a time-consuming procedure, not free from potential risks (i.e. degradation of glucose), and should be justified by a clear clinical benefit. Methods: We designed a single blind randomized controlled trial where 18 stable PD patients were randomized to receive a peritoneal equilibration test either with dialysate at a controlled temperature of 37 \ub0C (intervention group) or with dialysate warmed with conventional methods (control group). Primary end-point was a higher peritoneal creatinine clearance in patients in the intervention group. Results: Patients in the intervention group did not show a significantly higher peritoneal creatinine clearance when compared to the control group (6.38 \ub1 0.52 ml/min vs 5.65 \ub1 0.37 ml/min, p = 0.2682). Similar results were obtained for urea peritoneal clearance, mass transfer area coefficient of creatinine and urea. There were no significant differences in total abdominal discomfort questionnaire score, blood pressure and body temperature between the two groups. Conclusions: Using peritoneal dialysate at different temperatures without causing significant side effects to patients appears feasible. We report a lack of benefit of warming peritoneal dialysate to 37 \ub0C on peritoneal clearances; future PD guidelines should not reinforce this recommendation. Trial registration: NCT04302649, ClinicalTrials.gov; date of registration 10/3/2020 (retrospectively registered)

On the Neutral Gas Content and Environment of NGC 3109 and the Antlia Dwarf Galaxy

As part of a continuing survey of nearby galaxies, we have mapped the neutral gas content of the low surface brightness, Magellanic-type galaxy NGC 3109 --- and its environment, including the Antlia dwarf galaxy --- at unprecedented velocity resolution and brightness sensitivity. The HI mass of NGC 3109 is measured to be (3.8 +/- 0.5) x 10^8 Msun. A substantial warp in the disk of NGC 3109 is detected in the HI emission image in the form of an extended low surface brightness feature. We report a positive detection in HI of the nearby Antlia dwarf galaxy, and measure its total neutral gas mass to be (6.8 +/- 1.4) x 10^5 Msun. We show the warp in NGC 3109 to lie at exactly the same radial velocity as the gas in the Antlia dwarf galaxy and speculate that Antlia disturbed the disk of NGC 3109 during a mild encounter ~1 Gyr in the past. HI data for a further eight galaxies detected in the background are presented.Comment: Accepted for publication in A

Evidence on continuous flow peritoneal dialysis: A review

Clinical application of continuous flow peritoneal dialysis (CFPD) has been explored since the 1960s, but despite anticipated clinical benefits, CFPD has failed to gain a foothold in clinical practice, among others due to the typical use of two catheters (or a dual-lumen catheter) and large dialysate volumes required per treatment. Novel systems applying CFPD via the existing single-lumen catheter using rapid dialysate cycling may solve one of these hurdles. Novel on-demand peritoneal dialysate generation systems and sorbent-based peritoneal dialysate regeneration systems may considerably reduce the storage space for peritoneal dialysate and/or the required dialysate volume. This review provides an overview of current evidence on CFPD in vivo. The available (pre)clinical evidence on CFPD is limited to case reports/series with inherently nonuniform study procedures, or studies with a small sample size, short follow-up, and no hard endpoints. Small solute clearance appears to be higher in CFPD compared to conventional PD, in particular at dialysate flows ≥100 mL/min using two single-lumen catheters or a double-lumen catheter. Results of CFPD using rapid cycling via a single-lumen catheter are too preliminary to draw any conclusions. Continuous addition of glucose to dialysate with CFPD appears to be effective in reducing the maximum intraperitoneal glucose concentration while increasing ultrafiltration efficiency (mL/g absorbed glucose). Patient tolerance may be an issue since abdominal discomfort and sterile peritonitis were reported with continuous circulation of the peritoneal dialysate. Thus, well-designed clinical trials of longer duration and larger sample size, in particular applying CFPD via the existing catheter, are urgently required

Characterization of immune response to neurofilament light in experimental autoimmune encephalomyelitis

PMCID: PMC3856490This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.PMCID: PMC385649

In vitro efficacy and safety of a system for sorbent-assisted peritoneal dialysis

In vitro efficacy and safety of a system for sorbent-assisted peritoneal dialysis. Am J Physiol Renal Physiol 319: F162-F170, 2020. First published June 1, 2020; doi:10.1152/ajprenal. 00079.2020.-A system for sorbent-assisted peritoneal dialysis (SAPD) was designed to continuously recirculate dialysate via a tidal mode using a single lumen peritoneal catheter with regeneration of spent dialysate by means of sorbent technology. We hypothesize that SAPD treatment will maintain a high plasma-to-dialysate concentration gradient and increase the mass transfer area coefficient of solutes. Thereby, the SAPD system may enhance clearance while reducing the number of exchanges. Application is envisaged at night as a bedside device (12 kg, nighttime system). A wearable system (2.0 kg, daytime system) may further enhance clearance during the day. Urea, creatinine, and phosphate removal were studied with the daytime and nighttime system (n = 3 per system) by recirculating 2 liters of spent peritoneal dialysate via a tidal mode (mean flow rate: 50 and 100 mL/min, respectively) for 8 h in vitro. Time-averaged plasma clearance over 24 h was modeled assuming one 2 liter exchange/day, an increase in mass transfer area coefficient, and 0.9 liters ultrafiltration/day. Urea, creatinine, and phosphate removal was 33.2 ± 4.1, 5.3 ± 0.5, and 6.2 ± 1.8 mmol, respectively, with the daytime system and 204 ± 28, 10.3 ± 2.4, and 11.4 ± 2.1 mmol, respectively, with the nighttime system. Time-averaged plasma clearances of urea, creatinine and phosphate were 9.6 ± 1.1, 9.6 ± 1.7, and 7.0 ± 0.9 mL/min, respectively, with the nighttime system and 10.8 ± 1.1, 13.4 ± 1.8, and 9.7 ± 1.6 mL/min, respectively, with the daytime and nighttime system. SAPD treatment may improve removal of uremic toxins compared with conventional peritoneal dialysis, provided that peritoneal mass transport will increase

Cosmological Feedback from High-Redshift Dwarf Galaxies

We model how repeated supernova explosions in high-redshift dwarf starburst galaxies drive superbubbles and winds out of the galaxies. We compute the efficiencies of metal and mass ejection and energy transport from the galactic potentials, including the effect of cosmological infall of external gas. The starburst bubbles quickly blow out of small, high-redshift, galactic disks, but must compete with the ram pressure of the infalling gas to escape into intergalactic space. We show that the assumed efficiency of the star formation rate dominates the bubble evolution and the metal, mass, and energy feedback efficiencies. With star formation efficiency f*=0.01, the ram pressure of infall can confine the bubbles around high-redshift dwarf galaxies with circular velocities v_c>52 km/s. We can expect high metal and mass ejection efficiencies, and moderate energy transport efficiencies in halos with v_c~30-50 km/s and f*~0.01 as well as in halos with v_c~100 km/s and f*>>0.01. Such haloes collapse successively from 1-2 sigma peaks in LambdaCDM Gaussian density perturbations as time progresses. These dwarf galaxies can probably enrich low and high-density regions of intergalactic space with metals to 10^-3-10^-2 Zsun as they collapse at z~8 and z<5 respectively. They also may be able to provide adequate turbulent energy to prevent the collapse of other nearby halos, as well as to significantly broaden Lyman-alpha absorption lines to v_rms~20-40 km/s. We compute the timescales for the next starbursts if gas freely falls back after a starburst, and find that, for star formation efficiencies as low as f*<0.01, the next starburst should occur in less than half the Hubble time at the collapse redshift. This suggests that episodic star formation may be ubiquitous in dwarf galaxies.Comment: Accepted for ApJ v613, 60 pages, 15 figure

The mass surface density in the local disk and the chemical evolution of the Galaxy

We have studied the effect of adopting different values of the total baryonic mass surface density in the local disk at the present time in a model for the chemical evolution of the Galaxy. We have compared our model results with the G-dwarf metallicity distribution, the amounts of gas, stars, stellar remnants, infall rate and SN rate in the solar vicinity, and with the radial abundance gradients and gas distribution in the disk. This comparison strongly suggests that the value of the total baryonic mass surface density in the local disk which best fits the observational properties should lie in the range 50-75 Msun pc-2, and that values outside this range should be ruled out.Comment: 6 pages, LaTeX, 3 figures, accepted for publication in the Astrophysical Journal, uses emulateapj.st

Simplified Iohexol-Based Method for Measurement of Glomerular Filtration Rate in Goats and Pigs

SIMPLE SUMMARY: To improve the treatment of patients with kidney disease, new therapies are being developed. Before being used on humans, such therapies need to be tested on animals with kidney disease because reduced kidney function may influence the safety and efficacy of the treatment. Using large animals for this purpose is important because they tolerate frequent blood sampling, which allows for repeated monitoring. Goats seem particularly suitable for the evaluation of novel hemodialysis therapies since they are docile, have easily accessible neck veins to obtain blood access and body weights comparable with humans. Currently, no simple method is available to measure kidney function in goats (with or without impaired kidney function). Therefore, we developed a simple method to measure the kidney function in goats and pigs, which is based on a single injection of iohexol and requires three blood samples. Subsequently, kidney function can be calculated using a formula derived from pharmacokinetic modelling. The measurement of kidney function using our simplified method is relatively easy to perform, reduces total blood sampling and eliminates the need for an indwelling bladder catheter as compared to existing methods that require continuous infusion of a substance and timed urine collection. ABSTRACT: The preclinical evaluation of novel therapies for chronic kidney disease requires a simple method for the assessment of kidney function in a uremic large animal model. An intravenous bolus of iohexol was administered to goats (13 measurements in n = 3 goats) and pigs (23 measurements in n = 5 pigs) before and after induction of kidney failure, followed by frequent blood sampling up to 1440 min. Plasma clearance (CL) was estimated by a nonlinear mixed-effects model (CL(NLME)) and by a one-compartmental pharmacokinetic disposition model using iohexol plasma concentrations during the terminal elimination phase (CL(1CMT)). A simple method (CL(SM)) for the calculation of plasma clearance was developed based on the most appropriate relationship between CL(NLME) and CL(1CMT). CL(SM) and CL(NLME) showed good agreement (CL(NLME)/CL(SM) ratio: 1.00 ± 0.07; bias: 0.03 ± 1.64 mL/min; precision CL(SM) and CL(NLME): 80.9% and 80.7%, respectively; the percentage of CL(SM) estimates falling within ±30% (P30) or ±10% (P10) of CL(NLME): 53% and 12%, respectively). For mGFR(NLME) vs. mGFR(SM), bias was −0.25 ± 2.24 and precision was 49.2% and 53.6%, respectively, P30 and P10 for mGFR based on CL(SM) were 71% and 24%, respectively. A simple method for measurement of GFR in healthy and uremic goats and pigs was successfully developed, which eliminates the need for continuous infusion of an exogenous marker, urine collection and frequent blood sampling

English in product advertisements in non-english speaking countries in western europe: Product image and comprehension of the text

Although English has been shown to be the most frequently used foreign language in product advertisements in countries where it is not the native language, little is known about its effects. This article examines the response to advertisements in English compared to the response to the same ad in the local language in Western Europe on members of the target group for which the ad was intended: 715 young, highly educated female consumers. The use of English in a product ad does not appear to have any impact on image and price of the product, but it does affect text comprehension: the meaning of almost 40% of the English phrases was not understood. These results were the same for all countries involved in the study, irrespective of whether the respondents\u27 (self-) reported proficiency in English is high or low. © Taylor & Francis Group, LLC