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G del Peso

Publications and source records attributed to G del Peso.

26 records · Page 2Linked to original sources
PubMedDate not supplied

Home training experience in peritoneal dialysis patients.

The objective of nursing is to increase health and well being, prevent morbidity and obtain the best physical and social rehabilitation. The nurse's role in Peritoneal Dialysis (PD) consists of promoting and supporting patients to perform self-care. In the'Text Book of Peritoneal Dialysis, published in 2000,the chapter dedicated to the nurses' role says:"Regular home visits are an important part of follow-up care, as the family and patient need to realize that continuing support is available... It is advisable that the first exchange after discharge from hospital is in the presence of a nurse... Early recognition and management of problems will assist in keeping the patient healthy and well rehabilitated, and will hopefully reduce hospital visits and inpatient stays" (1). Home care in Hospital Universitario La Paz has been developed with varying dedication over the years. Firstly, it was offered if significant problems appeared (1979-1990), later, home visits were started for some new PD patients (1990-1994) and follow up visits then ensued (1995-1996). In 1997, a project was undertaken which included home training for the first time in our unit, as well as periodic follow up visits. This project was shown to the Hospital Nurse Direction, and approved immediately. It started during the first term of 1997. There were several reasons which led us to undertake this project including the importance of providing PD at home and making it lifelong and it was felt that the hospital was an unfriendly environment in which to learn PD. The main objective was to establish early on, the patient's social environment and psychological status, and to assess how these influenced aspects of learning and adapting to PD. Most patients expressed a very good opinion about the home training. Only one patient rejected the presence of the nurse at home. The nursing team was very satisfied because early knowledge about the patient's psychosocial conditions and family environment was established. The incidence of peritonitis decreased.

Adult↗
PubMedDate not supplied

[Methods to assess the ex vivo growth capacity of mesothelial cells obtained directly from peritoneal effluent].

The anatomical and functional integrity of mesothelial cells (MC) is necessary for peritoneal membrane stability. At present, there is no satisfactory method to assess MC function and regenerative capacity in individual peritoneal dialysis (PD) patients. MC may be cultured from peritoneal biopsy specimens, but peritoneal biopsy is an invasive procedure that cannot be performed serially. The aim of this study is to explore the feasibility of serial culture of MC from the peritoneal effluent of PD patients. Fifty-two randomly selected PD patients were studied. MC were obtained from the peritoneal effluent of nocturnal 2.27% glucose exchanges and cultured in T25 tissue culture flasks. Subconfluent MC cultures were obtained in 80.7% of patients. At this stage, the percentage of cells in the tissue cultured flask characterized as MC by morphology and immunostaining had increased to 95.5%. MC were then subcultured in multi-well culture plates, where they showed exponential cell growth until day 16. Nine (17%) patients released low numbers of MC into the effluent and MC could not be cultured to subconfluence. One additional patient released and apparently adequate number of MC that repeatedly failed to reach confluence. Patients showed the same behavior in several cultures performed. In conclusion, peritoneal MC released into peritoneal effluent are accessible for profound analysis by a culture technique. This technique opens the possibility of serial follow-up of the biology of MC individual PD patients.

Cell Division↗
PubMedDate not supplied

Risk factors responsible for ultrafiltration failure in early stages of peritoneal dialysis.

OBJECTIVE: To define risk factors for ultrafiltration failure (UFF) during early stages of peritoneal dialysis (PD). DESIGN: Retrospective analysis of a group of patients whose peritoneal function was prospectively followed. SETTING: A tertiary-care public university hospital. PATIENTS: Nineteen of 90 long-term PD patients required a peritoneal resting period to recover UF capacity: 8 had this requirement before the third year on PD (early, EUFF group) and 11 had a late requirement (LUFF group). The remaining 71 patients, those with stable peritoneal function over time, constituted the control group. MAIN OUTCOME MEASURES: Peritoneal UF capacity under standard conditions (monthly) and small solute peritoneal transport (yearly). RESULTS: None of the conditions appearing at the start of PD or during the observation period could be definitely identified as the cause of UFF. There were no differences in characteristics between the EUFF group and the other two groups, except for the higher prevalence of diabetes in the EUFF group. Residual renal function (RRF) declined in all three groups during the first 2 years, with rapid loss during the third year in the EUFF group. This rapid loss in RRF was coincident with UFF. Peritoneal solute and water transport at baseline was similar in the three groups. After 2 years on PD, individuals in the EUFF group showed a significantly lower UF and higher creatinine mass transfer coefficient values than those in the LUFF group. Diabetic patients in the control group showed remarkable stability in UF capacity over time. During the second year on PD, requirement for increases in dialysate glucose concentration was 3.4 +/- 0.5% in the LUFF group, but as high as 25.5 +/- 24.2% in the EUFF group. The accumulated days of active peritonitis (APID, days with cloudy effluent) were similar for the three groups after 1, 2, and 3 years on PD. Interestingly, diabetic patients in the control group showed an APID index significantly lower than the overall EUFF group. Diabetics in the control group also had significantly lower APID versus nondiabetics in the control group (p = 0.016). CONCLUSIONS: Our findings suggest that certain patients develop early UFF type I. Diabetic state and a higher glucose requirement to obtain adequate UF suggest that glucose on both sides of the peritoneal membrane could be responsible. The mechanisms for this higher requirement remain to be elucidated. The identification of a larger cohort of these early UFF patients should lead to a better exploration of the primary pathogenic mechanisms.

Hemodiafiltration↗
PubMedDate not supplied

Icodextrin effluent leads to a greater proliferation than glucose effluent of human mesothelial cells studied ex vivo.

OBJECTIVE: To compare the effect of glucose (Glu) and icodextrin (Ico) dialysate on in vitro culture of mesothelial cells (MC) from peritoneal dialysis (PD) patients. DESIGN: Prospective, controlled comparative study on the effects of two PD solutions. SETTING: A tertiary-care public university hospital. PATIENTS: Sixteen PD patients regularly using Glu dialysate were asked to collect an 8-hour dwell peritoneal effluent on 2 different days, with an interval shorter than 7 days. In the first collection, 2.27% Glu solution and in the last, 7.5% Ico solution was infused. Human MC were isolated from the nocturnal peritoneal effluent bags and grown ex vivo. MAIN OUTCOME MEASURES: Mesothelial cell proliferative capacity ex vivo. RESULTS: Mesothelial cells were present in all patient dialysates except that of a single patient's Glu dialysate. The number of MC drained was similar with both solutions. After the initial culture reached confluence, MC were identified in 14 and 12 patients receiving Ico and Glu, respectively. However, in 1 patient using Ico and in 2 using Glu, the MC count at this stage was so low that further subculture could not be performed. Cells from Ico-derived solutions exhibited a higher degree of proliferation than cells from Glu-derived solutions. The morphology of MC was also different. Cells from drained effluent were typical in 11 patients using Glu solution in contrast with 14 patients using Ico. At confluence, the percentages of typical appearance were 50% and 92.9% (p < 0.05) in Glu and Ico respectively. CONCLUSIONS: Mesothelial cells taken from icodextrin effluent show a greater proliferation ex vivo than those taken from glucose effluent.

Cell Division↗
PubMedDate not supplied

Vascular endothelial growth factor (VEGF) levels in peritoneal dialysis effluent.

BACKGROUND: Long-term peritoneal dialysis (PD) patients who develop peritoneal ultrafiltration failure have an abnormally large number of capillaries and sclerotic changes in peritoneal biopsy. Peritoneal vascular endothelial growth factor (VEGF) production has been suggested to explain the higher levels in peritoneal effluent than in plasma. The high effluent VEGF levels have been related to peritoneal changes consisting of increased permeability to small molecules. To further analyze the relationship between peritoneal neoangiogenesis induced by VEGF and peritoneal transport, we studied peritoneal effluent VEGF levels in active PD patients. METHODS: VEGF levels were determined in serum and plasma, and in peritoneal effluent (PE) after 4, 8 and 15 h dwell times. RESULTS: PE VEGF levels were 58.6+/-33.7 pg/mL, with a mean VEGF D/P ratio of 0.45+/-0.29 (range 0.06-0.93). In low-transport patients (n = 7) this ratio did not differ from high-average ones (n=5) (0.48+/-0.3 and 0.41+/-0.1, NS). In multivariate analysis, the VEGF D/P ratio showed no correlation with the independent variables included in this study. VEGF levels were higher in 15 h than in 8 h effluent; so the VEGF D/P ratios were higher as well. Regression analysis showed a direct correlation between PEVEGF levels and dwell time (r: 0.57, p = 0.03), but not between VEGF D/P ratio and dwell time. PEVEGF levels directly correlated with effluent protein content. Regression analysis showed no correlation between PEVEGF levels and age, time on PD, days of peritonitis, urea and creatinine-mass transfer coefficients, ultrafiltration capacity, and accumulated glucose dose. Multivariate regression analysis showed correlation only between PEVEGF levels and dwell time, but not with the other independent variables. CONCLUSIONS: This study confirms that VEGF is present in fresh PE from PD patients at levels that suggest local production and filtration from plasma. Peritoneal effluent VEGF levels are not significantly associated with peritoneal functional parameters and background, and seem to be influenced by ultrafiltration in a dilution process. We believe that the role of VEGF in peritoneal pathophysiology is part of a complex relationship involving multiple peritoneal structures and other growth factors, including local counteracting factors for VEGF that regulate neoangiogenesis.

Dialysis Solutions↗
PubMedDate not supplied

Diverticular disease and treatment with gastric acid inhibitors do not predispose to peritonitis of enteric origin in peritoneal dialysis patients.

OBJECTIVE: Enteric peritonitis (EP) is an infrequent complication of peritoneal dialysis (PD), with severe consequences for peritoneal membrane viability and patient outcome. Factors such as diverticular disease and gastric acid inhibitors have been implicated in its appearance. We investigated several risk factors, including those mentioned below, that can influence the development of EP. DESIGN: Retrospective cross-sectional study. SETTING: Tertiary-care public university hospital. PATIENTS: Fifty-seven PD patients treated in our PD unit during August 1998. MAIN OUTCOME MEASURES: A barium enema was performed on 50 of the 57 patients (the remaining 7 patients refused it) in order to exclude the presence of diverticulosis. All episodes of peritonitis occurring in those patients, including EP, were registered. Enteric peritonitis was defined as that caused by gram-positive, gram-negative, or fungus micro-organisms that colonized the intestinal tract, excluding episodes secondary to genitourinary tract or peritoneal catheter exit-site infections. RESULTS: Twenty-four patients showed diverticular disease in the barium enema, but only 5 of them (21%) had any EP episode. Five of the 26 patients with no diverticula (19%) had EP. Fifty-five episodes of peritonitis were reported in 21 patients; 15 episodes of EP (27.3% of all) developed in 11 patients. Seven of the 11 patients (64%) required peritoneal catheter removal and 3 of them (27%) finally were transferred to hemodialysis due to consequences of the EP episode. Logistic regression analysis did not find any of the independent variables analyzed (age, sex, time on PD, type of PD, peritoneal transport parameters, presence of polycystic kidney disease, constipation or diverticulosis, or treatment with gastric acid inhibitors, or phosphate-binding agents) to be risk factors for developing EP. CONCLUSIONS: Neither diverticulosis nor treatment with gastric acid inhibitors seem to be risk factors for developing peritonitis of enteric origin in PD patients. This type of peritonitis has to be promptly identified and treated in order to diminish the high frequency of peritoneal catheter removal and PD dropout due to such episodes.

Adolescent↗