Comparison of Quality of Life in Patients Undergoing Hemodialysis and Peritoneal Dialysis: a Systematic Review and Meta-Analysis

Health-Related Quality of Life Sleep Score Predicts Transfer to Hemodialysis among Patients on Peritoneal Dialysis

Despite the superiority of peritoneal dialysis (PD) over hemodialysis (HD) regarding health-related quality of life (HRQOL), the specific HRQOL domain(s) that predict unplanned HD transfer remains uncertain. In this cohort study, we assessed the HRQOL of 50 outpatients undergoing PD using the Japanese version 1.3 Kidney Disease Quality of Life-Short Form from March 2017 to March 2018 and prospectively analyzed the association of each HRQOL component with HD transfer until June 2021. During the follow-up (41.5 (13.0–50.1) months), 21 patients were transferred to HD. In a multivariate Cox proportional hazards model adjusted for age, sex, PD vintage, urine output, Charlson comorbidity index, and incremental shuttle walking test, a higher sleep score was significantly associated with lower HD transfer rates (HR 0.70 per 10, p = 0.01). An adjusted subdistribution hazard model where elected transition to HD, death, and transplantation were considered competing events of unintended HD transfer that showed sleep score as an exclusive predictor of HD transfer (HR 0.70 per 10, p = 0.002). Our results suggest that sleep score among the HRQOL subscales is instrumental in predicting HD transfer in patients undergoing PD.

A Quality Improvement Process to Increase and Sustain a Peritoneal Dialysis Programme in the United Kingdom

INTRODUCTION

Peritoneal dialysis (PD) remains underutilised in the West. The proportion of patients in the UK starting renal replacement therapy (RRT) with PD fell from 7.2% in 2011 to 6.0% in 2016. At our centre, 8.4% of dialysis patients received PD in April 2014. Evidence suggests that home dialysis improves patient clinical outcomes; therefore, a target was agreed to achieve 25% of dialysis patients receiving PD by 2018.

METHODS

A rapid improvement process was introduced, as a quality improvement tool, to increase and sustain the PD programme. With multidisciplinary team support for PD growth, a nephrologist was trained to insert PD catheters. Nurses were trained to provide patients with balanced pre-dialysis information and discuss alternative dialysis modalities with haemodialysis (HD) patients. The "Acceptance, Choice and Empowerment" project raised awareness of home therapy choices, using a peer educator model specifically for ethnic minority patients. Lean methodologies were used to ensure continuous quality improvement.

RESULTS

PD uptake increased from 37 to 84 patients, giving a PD penetration increase from 8.4% to 19.1% between April 2014 and March 2018. Catheter insertions increased from 94 at the end of QI Period 1 to 185 at the end of QI Period 2, representing a 97% increase, with the medical/surgical split remaining stable. Peritonitis rates remained stable, and PD drop off to HD reduced from 52% to 41% during the same period.

CONCLUSIONS

By implementing a rapid improvement process and embedding a quality improvement programme, the number of incidents and prevalent PD patients increased and was sustained.

The association between sense of coherence and quality of life: a cross-sectional study in a sample of patients on hemodialysis

Background

Patients on hemodialysis universally experience detriments in their general quality of life (QOL). Sense of coherence (SOC) is a long-standing factor that affects QOL. Nevertheless, the association between SOC and QOL in patients on hemodialysis was seldom investigated. Our research aims to study this association in a sample of Lebanese adult patients on hemodialysis.

Methods

In this cross-sectional study, SOC was measured using the short version of the “Orientation of Life" scale (SOC-13). QOL was assessed using the Kidney Disease Quality of Life- Short Form (KDQOL-SF). The association between SOC and QOL and its submodalities was first explored using Pearson Correlation and multivariate linear regression analyses, controlling for sociodemographic variables and medical variables.

Results

157 patients on hemodialysis (mean(SD) age: 62.1(13.81) years; 58.6% males) were included. Mean QOL score was 51.65 and that of SOC was 48.06. SOC was strongly corrected with the total QOL (r = 0.832; p value < 0.001), as well as its physical functioning (r = 0.767; p value < 0.001), emotional functioning (r = 0.757; p value < 0.001), cognitive functioning (r = 0.740; p value < 0.001), and social functioning (r = 0.773; p value < 0.001) submodailties. SOC was moderately correlated with professional functioning submodality of QOL (r = 0.618; p value < 0.001), but not correlated with the satisfaction with the quality of care (r = 0.052; p = 0.520). Within the regression models accounting for sociodemographic and medical variables, SOC was significantly associated with the total QOL (unstandardized B = 0.803; 95% CI 0.714, 0.893), physical functioning (unstandardized B = 0.761; standardized B = 0.763; 95% CI 0.661, 0.861), emotional functioning (unstandardized B = 1.205; standardized B = 0.757; 95% CI 1.037, 1.372), professional functioning (unstandardized B = 1.142; standardized B = 0.498; 95% CI 0.843, 1.442), cognitive functioning (unstandardized B = 1.239; standardized B = 0.739; 95% CI 1.058, 1.420), and social functioning (unstandardized B = 0.912; standardized B = 0.768; 95% CI 0.790, 1.034).

Conclusions

In a sample of adult patients on hemodialysis, SOC was positively significantly associated with QOL and its submodalities, expect the satisfaction with the quality of care. The confirmation of the general hypothesis that relates the SOC with the QOL encourages more salutogenic research among this patient population.

Burden of kidney disease among patients with peritoneal dialysis versus conventional in-centre haemodialysis: A randomised, non-inferiority trial

BACKGROUND

Little is known about the impact of haemodialysis (HD) and peritoneal dialysis (PD) on health-related quality of life (HRQoL). We compared HRQoL between conventional in-centre HD and home-based PD in 1082 newly diagnosed kidney failure patients.

METHODS

This was an open-label, randomised, non-inferiority trial of adult patients with a diagnosis of end-stage kidney disease (estimated glomerular filtration rate ≤ 15 mL/min/1.73 m²) requiring maintenance dialysis from 36 sites in China randomised 1:1 to receive PD or conventional in-centre HD. The primary outcome was the 'Burden of Kidney Disease' assessed using the Kidney Disease Quality of Life-Short Form (KDQoL-SF) survey over 48 weeks and the main secondary outcomes were the remaining scales of KDQoL-SF and all-cause mortality. The effect of PD versus HD on the primary outcome was compared by their geometric mean (GM) ratio, and non-inferiority was defined by the lower bound of a one-sided 95% confidence interval (CI) >0.9.

RESULTS

A total of 725 subjects completed the trial per protocol (395 PD and 330 HD, mean age 49.8 (standard deviation (SD) 14.4) years, 41.4% women). For the primary outcome, the mean (SD) change in 'Burden of Kidney Disease' over 48 weeks was 2.61 (1.27) in PD group and 2.58 (1.35) in HD group, and the GM ratio (95% CI) was 1.059 (0.908-1.234), exceeding the limit for non-inferiority. For the secondary outcomes, the PD and HD groups were similar in all scales. There were 17 and 31 deaths in PD and HD groups, respectively. Patients receiving PD had more adverse events, adverse event leading to hospitalisation and serious adverse events compared to those allocated to HD, but adverse events leading to death and discontinuation of the trial were not different between PD and HD.

CONCLUSIONS

In this trial, PD may be non-inferior to HD on the 'Burden of Kidney Disease' among Chinese kidney failure patients who are of younger age and have lower comorbidity after 48 weeks' follow-up.

The availability of support and peritoneal dialysis survival: A cohort study

BACKGROUND

Providing support is important to maintain a patient on peritoneal dialysis (PD), though its impact on outcomes has not been investigated thoroughly. We examined the association between having support and risk of a transfer to hemodialysis.

METHODS

In this retrospective observational cohort study, we used data captured in the Dialysis Measurement Analysis and Reporting system about patients who started PD in Alberta, Canada, between 1 January 2013 and 30 September 2018. Support was defined as the availability of a support person in the home who was able, willing and available to provide support for PD in the patient's residence. The outcome of interest was a transfer to hemodialysis for at least 90 days. We estimated the cumulative incidence of a transfer over time accounting for competing risks and hazard ratios to summarise the association between support and a transfer. We split follow-up time as hazard ratios varied over time.

RESULTS

Six hundred and eighty-three incident PD patients, median age 58 years (IQR: 47-68) and 35% female, were followed for a median of 15 months. The cumulative incidence of a transfer to hemodialysis at 24 months was 26%. Having support was associated with a reduced risk of a transfer between 3 and 12 months after the start of dialysis (HR_3-12mo: 0.44; 95% CI: 0.25-0.78), but not earlier (hazard ratio (HR)_<3mo: 0.96; 95% confidence interval (CI): 0.55-1.69) or later (HR_>12mo: 1.19; 95% CI: 0.65-2.17).

CONCLUSIONS

A transfer to hemodialysis is common. Having a support person at home is associated with a short-term protective effect after the initiation of PD.

The Peritoneal Membrane—A Potential Mediator of Fibrosis and Inflammation among Heart Failure Patients on Peritoneal Dialysis

Peritoneal dialysis is a feasible, cost-effective, home-based treatment of renal replacement therapy, based on the dialytic properties of the peritoneal membrane. As compared with hemodialysis, peritoneal dialysis is cheaper, survival rate is similar, residual kidney function is better preserved, fluid and solutes are removed more gradually and continuously leading to minimal impact on hemodynamics, and risks related to a vascular access are avoided. Those features of peritoneal dialysis are useful to treat refractory congestive heart failure patients with fluid overload. It was shown that in such patients, peritoneal dialysis improves functional status and quality of life, reduces hospitalization rate, and may decrease mortality rate. High levels of serum proinflammatory cytokines and fibrosis markers, among other factors, play an important part in congestive heart failure pathogenesis and progression. We demonstrated that those levels decreased following peritoneal dialysis treatment in refractory congestive heart failure patients. The exact mechanism of beneficial effect of peritoneal dialysis in refractory congestive heart failure is currently unknown. Maintenance of fluid balance, leading to resetting of neurohumoral activation towards a more physiological condition, reduced remodeling due to the decrease in mechanical pressure on the heart, decreased inflammatory cytokine levels and oxidative stress, and a potential impact on uremic toxins could play a role in this regard. In this paper, we describe the unique characteristics of the peritoneal membrane, principals of peritoneal dialysis and its role in heart failure patients.

Exploring the Mechanism of Astragalus propinquus Schischkin and Panax Notoginseng (A&P) Compounds in the Treatment of Renal Fibrosis and Chronic Kidney Disease Based on Integrated Network Analysis

Astragalus propinquus Schischkin and Panax notoginseng (A&P) has been widely used in clinical practice to treat chronic kidney disease (CKD) for many years and achieved a remarkable improvement of these outcomes. However, its mechanisms for ameliorating CKD are still poorly obscure. In the current study, integrated network analysis was carried out to analyze the potential active ingredients and molecular mechanism of A&P on CKD, and 39 active ingredients and a total of 570 targets were obtained. Furthermore, the potential disease-related genes were obtained from the NCBI GEO database by integrating 2 microarray datasets, and 24 significant genes were utilized for subsequent analysis. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis displayed that pathways including cell oxidative stress and Akt signaling pathway are medicated by A&P. Of note, Heat Shock Transcription Factor 1 (HSF1) and RELA Proto-Oncogene (RELA) were regarded as hub genes considering their central roles in the gene regulatory network. What's more, the effect of A&P and potential genes was furthermore verified by using unilateral ureteral ligation (UUO) in rodent model. The results showed that the expression of HSF1 and RELA both at transcript and protein level was significantly upregulated in UUO model, but the expression was markedly reversed after A&P intervention. To further guide the interpretation of active ingredients from A&P on the effect of HSF1 and RELA, we performed a molecular docking assay and the results showed that active ingredients such as coptisine docked well into HSF1 and RELA. In total, these results suggest that A&P may improve RF in CKD by regulating HSF1 and RELA, which provides a basis for further understanding the mechanism of A&P in the treatment of RF and CKD.

Cognitive Dysfunction and Health-Related Quality of Life in Patients with End-Stage Renal Disease Undergoing Hemodialysis in Comparison with Patients Undergoing Peritoneal Dialysis: A Cross-Sectional Study

Background

This study compared the effects of peritoneal dialysis and hemodialysis on cognitive dysfunction and health-related quality of life (HRQOL) in end-stage renal disease (ESRD) patients and analyzed other potential influencing factors.

Material/Methods

A total of 265 patients who received dialysis at our hospital were included and divided into the hemodialysis group (n=115) and the peritoneal dialysis group (n=150). The cognitive performance was assessed by the Beijing version of the Montreal Cognitive Assessment. The Kidney Disease Quality of 36-Item Short Form Survey and a kidney disease-related quality of life assessment were used for evaluating HRQOL. Univariate and multivariate linear regression analyses were used to explore the effects of dialysis on cognitive dysfunction and HRQOL.

Results

As compared with the hemodialysis group, the peritoneal dialysis group had lower scores on the Montreal Cognitive Assessment (β=−8.35, 95% CI: −9.85 to −6.86), 36-Item Short Form Survey (β=−10.20, 95% CI: −11.94 to −8.45), and kidney disease-related quality of life assessment (β=−8.67, 95% CI: −10.10 to −7.23). After adjustment for sex, age, BMI, marital status, educational level, income level, presence of diabetes, duration of kidney disease, duration of dialysis, and dialysis frequency, the results were consistent with that of the crude model.

Conclusions

In the present study, patients receiving peritoneal dialysis had worse cognitive dysfunction and worse HRQOL compared to patients receiving hemodialysis, which might lead to poorer outcomes of ESRD patients. The related factors affecting cognitive dysfunction and HRQOL were also explored, which could help clinicians to determine the optimal treatment for ESRD patients.

Chronic Kidney Disease Education Class Improves Rates of Early Access Creation and Peritoneal Dialysis Enrollment

Background

Most patients with end-stage kidney disease begin hemodialysis (HD) in an unplanned fashion at a late stage, necessitating the commencement of HD with a temporary venous catheter, the least favorable option. Alternative modalities of kidney replacement therapy (KRT), peritoneal dialysis (PD), and preemptive transplant offer similar or better outcomes than HD at a lower overall cost, and yet they remain underutilized in Saudi Arabia. Early education may help prepare patients with advanced chronic kidney disease (CKD IV and V) to accept their disease and choose a KRT modality that minimizes complications and matches their lifestyle.

The aim of the study is to assess the impact of a pilot educational class on therapy choices and outcomes.

Methodology

In a cross-sectional study, we conducted phone interviews and reviewed medical records of 81 attendees of the multidisciplinary monthly educational class about KRT that was held at the King Abdulaziz Medical City (KAMC) from January 2017 to October 2021. The interview was conducted at least one year after the participants attended the class. The study proposal, consent, and questionnaire were approved by the King Abdulaziz International Medical Research Center. Patient data was retrieved from KAMC electronic medical record system.

Results

Volunteer participation in the survey was high (62/81). For the respondents, a preemptive kidney transplant was the most preferred (48/62, 77%) option for KRT. Among the preferred fallback options, HD was the most frequently chosen (29/62, 47%) compared to PD (26/62, 41.9%). At the time of the interview, a great majority of the patients (54/62, 87%) was already on KRT, including about half (26/54, 48%) on HD via a catheter, and the rest about equally divided between those on HD via an arteriovenous (AF) fistula (13/54, 24%) and those on PD (15/54, 28%). Thus, half of the respondents on KRT (28/54, 51%) avoided urgent HD catheter commencement. However, because of an unfortunate shortage of donors, only a small minority (2/62, 3%) of patients received preemptive transplantation.

Conclusion

The KAMC CKD education class helped boost the fraction of patients, significantly above the national average, who accepted the diagnosis of kidney failure and pursued preemptive native HD access or enrolled in PD.

Quality of life assessment in patients on chronic dialysis: Comparison between haemodialysis and peritoneal dialysis at a national hospital in Vietnam

OBJECTIVES

End-stage renal disease (ESRD) is a chronic disease that can adversely affect the patient's quality of life (QoL) in terms of functional limitation and cognitive impairment. This study aimed to identify the factors associated with QoL in patients with ESRD undergoing dialysis at a national hospital in Vietnam.

METHODS

A descriptive cross-sectional study was conducted among outpatients aged ≥18 years who underwent haemodialysis (HD) or peritoneal dialysis (PD) for at least 3 months at Thong Nhat Hospital, Ho Chi Minh City, Vietnam from May 2020 to July 2021. QoL was measured using the validated Vietnamese version of the EuroQol-5 Dimensional-5 Level (EQ-5D-5L). The factors associated with the QoL of patients with ESRD undergoing dialysis were identified using multiple linear regression analysis.

RESULTS

In total, 131 (73.6%) and 47 (26.4%) patients underwent HD and PD, respectively. Overall, 178 (55.6%) patients were men (median age, 66 [56-79] years). The mean EQ-5D-5L score was significantly higher in patients undergoing PD than in those undergoing HD (0.848 ± 0.183 vs. 0.766 ± 0.231; p = 0.030). Older age (β = -0.006; p < 0.001) and peptic ulcer disease (β = -0.083; p = 0.029) were associated with lower QoL scores. PD treatment was associated with higher QoL scores (β = 0.065; p = 0.046).

CONCLUSIONS

It is necessary to improve the QoL of patients undergoing dialysis, especially of elderly patients and patients with peptic ulcer disease. PD may be a better method for maintenance dialysis, if applicable, in terms of QoL.

Kidney Supportive Care in Peritoneal Dialysis: Developing a Person-Centered Kidney Disease Care Plan

Individuals receiving peritoneal dialysis (PD)—similar to those receiving hemodialysis —may experience high mortality coupled with a high symptom burden and reduced health-related quality of life. In this context, a discussion of the risks, benefits, and tradeoffs of PD and/or other kidney treatment modalities should be explored based on individual goals and preferences. Through these principles, kidney supportive care provides a person-centered approach to kidney disease care throughout the spectrum of kidney failure and earlier stages of chronic kidney disease. Kidney supportive care is offered in conjunction with life-prolonging therapies, including dialysis and kidney transplants, and is increasingly recognized as an integral part of advancing the care of PD patients. Using “My Kidney Care Roadmap” for shared decision making, kidney supportive care guides patients undergoing PD and their clinicians to (1) elicit patient goals, values, and priorities; (2) convey medical prognosis and suitable treatment options; and (3) ask “Which of these kidney treatment options will best help me achieve my goals and priorities?” to inform both current and future decisions, including choice of dialysis modalities, time-limited trials, and/or nondialysis management. Recognizing that patient priorities and choices may evolve, this framework ultimately allows patients to continually reassess their PD care to better achieve goal-directed dialysis.

Implantation of a peritoneal dialysis catheter in patients with ESRD using local anesthesia and Remifentanil

Study objective

The main objective of this study is to test the feasibility of the local anesthetic (LA) Mepivacaine 1% and sedation with Remifentanil as the primary anesthetic technique for the insertion of a peritoneal dialysis (PD) catheter, without the need to convert to general anesthesia.

Methods

We analyzed 27 consecutive end-stage renal disease (ESRD) patients who underwent the placement of a peritoneal catheter at our center between March 2015 and January 2019. The procedures were all performed by a general or vascular surgeon, and the postoperative care and follow-up were all conducted by the same peritoneal dialysis team.

Results

All of the 27 subjects successfully underwent the procedure without the need of conversion to general anesthesia. The catheter was deemed prone to usage in all patients and was found to be leak-proof in 100% of the patients.

Conclusion

This study describes a safe and successful approach for insertion of a PD catheter by combined infiltration of the local anesthetic Mepivacaine 1% and sedation with Remifentanil. Hereby, ESRD patients can be treated without general anesthesia, while ensuring functionality of the PD catheter.

Comparison of quality of life in end-stage renal disease patients undergoing hemodialysis and peritoneal dialysis in a Moroccan city

PURPOSE

End-stage renal disease patients (ESRD) generally complain about a poor quality of life (QOL). The current study aims to describe and compare ESRD patients' QOL according to dialysis modalities (hemodialysis [HD] and peritoneal dialysis [PD]).

METHODS

This is a cross-sectional study, conducted in dialysis facilities of a Moroccan university hospital, during October 2018. All adult ESRD patients, treated either by HD or PD for more than 3 months and agreeing to participate, were included. Medical data were collected using a questionnaire, whereas the QOL data were collected using the Kidney Disease Quality of Life Short Form (KDQOL SF v 1.3) scale previously validated in dialectal Arabic. The patients' characteristics and QOL data were compared between dialysis modalities (HD vs. PD), using a linear regression, before and after adjustment on several demographic and medical factors as well as a propensity score created to reduce the effect of confounding factors related to the choice of the treatment.

RESULTS

Out of the 91 included patients (50.5% of men, median age 52.0 (IQR [36.5; 62.0]) years), 71 were on HD and 20 were on PD. The highest subscale score, for all participants, was the social support's one with a median of 83.3 (IQR [66.7; 100]), and the lowest one was the kidney disease burden with a median of 25.0 (IQR [0.00; 46.9]). The univariate analysis showed that the Physical Component Score (PCS), the cognitive function, and the dialysis staff encouragement were better in PD patients (p = 0.03, p = 0.04, and p = 0.007, respectively), while the multiple linear regression indicates that the PCS, the dialysis Staff encouragement, and the patient's satisfaction subscores decreased within patients on HD compared with those on PD (p = 0.01, p = 0.03, and p = 0.02, respectively) and that the burden of the kidney disease and the work status subscores increased within patients on HD against those on PD (p = 0.007 and p = 0.04, respectively).

CONCLUSION

This study showed a significant difference between dialysis modalities in some sides of quality of life.

Comparative survival of elderly renal transplant recipients with a living donor versus a deceased donor: A retrospective single center observational study

Increasing numbers of elderly (≥65 years) patients are listed for kidney transplantation. This study compares the survival outcome between living (LDK), regularly allocated (ETKAS), and Eurotransplant Senior Program (ESP) donor kidneys in elderly recipients. This is a single-center retrospective cohort study of elderly kidney transplant recipients transplanted between 2005 and 2017. Primary outcome measures were nondeath-censored graft, death-censored graft, and patient survival. In total, 348 patients were transplanted, 109 recipients (31.3%) received an LDK, 100 (28.7%) an ETKAS, and 139 (40%) an ESP kidney. 62.5% were male, and median age was 68 years. LDK recipients had significantly better 5-year nondeath-censored graft survival compared with ETKAS and ESP (resp. 71.0% vs. 66.1% vs. 55.6%, P = 0.047). Death-censored graft survival after 1 year was significantly better in LDK recipients (99.1%) (ETKAS 90.8%; ESP 87.7%, P < 0.001). After 5 years, the difference remained significant (P < 0.001) with little additional graft loss (97.7% vs. 88.1% vs. 85.6). There was no significant difference in patient survival after 5 years (71.7% vs. 67.4% vs 61.9%, P = 0.480). In elderly recipients, the patient survival benefits of an LDK are limited, but there is decreased death-censored graft loss for LDK recipients. Nevertheless, graft survival in ETKAS and ESP remains satisfactory.

[Prevalence, Costs of Medical Treatment and Modalities of Dialysis-dependent Chronic Renal Failure in Germany: Comparison of Dialysis Care of Nursing Home Residents and in Outpatient Units]

STUDY OBJECTIVES

Current estimates on the prevalence of chronic renal failure and the costs of dialysis in Germany's population are not available. The aim of this study was to assess the prevalence of dialysis-dependent chronic renal failure and treatment costs of dialysis-dependent patients in Germany as well as differences between those residing in nursing homes and those treated in outpatient units.

METHODS

Health insurance claims from 4.5 million anonymized patients in the WIG2 research database were analyzed. Patients of all ages who had received outpatient dialysis treatment for chronic renal failure in 2017 (using uniform value scale code 13602) were included. These insurance claims were extrapolated to the German statutory health insurance population and, using official statistics, further to the entire population of Germany. Data on comorbidities, use of health resources, and costs were compared among patients residing in nursing homes and those treated in outpatient units.

RESULTS

In 2017, there were 87,255 dialysis-dependent statutory health insurance patients (≙1,054 person/1 million population, pmp), and 100,202 in Germany's whole population (≙1,210 pmp). About 8% of dialysis-dependent patients (n=7,676) were living in nursing homes. Our analyses predict an increase in dialysis-dependent patients of about 20-23% (up to 120,000-123,000), with an increase of dialysis-dependent nursing home residents of 37-44% (up to 10,500-11,000) by 2040. Almost all dialysis-dependent patients were treated with hemodialysis; peritoneal dialysis was rarely observed. The average annual treatment costs for dialysis-dependent patients residing in nursing homes amounted to 57,205 Euro and 53,996 Euro per patient respectively, with total annual statutory health insurance treatment costs amounting to about 4.73 billion Euro in 2017.

CONCLUSION

This study presents current estimates for dialysis-dependent chronic renal failure in Germany. Our findings on prevalence are comparable to data from other European countries and suggest a considerable increase in dialysis dependency by 2040, particularly for nursing home residents, resulting in a further increase in dialysis care costs. Hemodialysis was the most commonly used dialysis modality in patients living both in and out of nursing care facilities, with peritoneal dialysis rarely being used.

Utilization of CMS pre-ESRD Kidney Disease Education services and its associations with the home dialysis therapies

BACKGROUND

Kidney Disease Education (KDE) has been shown to improve informed dialysis selection and home dialysis use, two long-held but underachieved goals of US nephrology community. In 2010, the Center for Medicare and Medicaid Services launched a policy of KDE reimbursements for all Medicare beneficiaries with advanced chronic kidney disease. However, the incorporation of KDE service in real-world practice and its association with the home dialysis utilization has not been examined.

METHODS

Using the 2016 US Renal Data System linked to end-stage renal disease (ESRD) and pre-ESRD Medicare claim data, we identified all adult incident ESRD patients with active Medicare benefits at their first-ever dialysis during the study period (1 January 2010 to 31 December 2014). From these, we identified those who had at least one KDE service code before their dialysis initiation (KDE cohort) and compared them to a parsimoniously matched non-KDE control cohort in 1:4 proportions for age, gender, ESRD network, and the year of dialysis initiation. The primary outcome was home dialysis use at dialysis initiation, and secondary outcomes were home dialysis use at day 90 and anytime through the course of ESRD.

RESULTS

Of the 369,968 qualifying incident ESRD Medicare beneficiaries with their first-ever dialysis during the study period, 3469 (0.9%) received KDE services before dialysis initiation. African American race, Hispanic ethnicity, and the presence of congestive heart failure and hypoalbuminemia were associated with significantly lower odds of receiving KDE services. Multivariate analyses showed that KDE recipients had twice the odds of initiating dialysis with home modalities (15.0% vs. 6.9%; adjusted odds ratio (aOR):95% confidence interval (CI) 2.0:1.7-2.4) and had significantly higher odds using home dialysis throughout the course of ESRD (home dialysis use at day 90 (17.6% vs. 9.9%, aOR:CI 1.7:1.4-1.9) and cumulatively (24.7% vs. 15.1%, aOR:CI 1.7:1.5-1.9)).

CONCLUSIONS

Utilization of pre-ESRD KDE services is associated with significantly greater home dialysis utilization in the incident ESRD Medicare beneficiaries. The very low rates of utilization of these services suggest the need for focused systemic evaluations to identify and address the barriers and facilitators of this important patient-centered endeavor.

Study on the Application and Efficacy of Responsibility Nursing in Dialysis Care

Providing high-quality care to patients undergoing hemodialysis (HD) is a priority for nurses. The present study was conducted to explore the experiences of the quality of nursing care among patients, nurses, and caregivers in Yanghu Branch of Changzhou Second People's Hospital, China. A total of 120 hemodialysis patients consecutively admitted to Yanghu Branch of Changzhou Second People's Hospital were enrolled and divided into two groups according to the nursing method they received: control group (routine nursing) and experimental group (responsibility nursing). The two cohorts were observed and compared for alterations of adverse emotions and inflammatory factors, the incidence of complications, pre-and post-nursing sleep quality, life quality, and patients' satisfaction with nursing. After nursing, the Self-Rating Anxiety/Depression Scale (SAS/DS) scores were lower in the experimental group (EG) than in the control group (CG) (both P < 0.05). Serum IL-6, hs-CRP, and TNF-α were decreased in both groups after nursing and were even lower in EG (both P < 0.05). EG had significantly improved sleep quality and life quality than CG, with a higher nursing satisfaction (all P < 0.05). This validates that the responsibility nursing for dialysis patients can validly mitigate patients' negative emotions, improve their quality of life, and ensure high-quality dialysis effect, which is feasible for wide popularization and application in clinics.

Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis

BACKGROUND

Randomized trials can provide evidence to inform decision-making but this may be limited if the outcomes of importance to patients and clinicians are omitted or reported inconsistently. We aimed to assess the scope and heterogeneity of outcomes reported in trials in peritoneal dialysis (PD).

METHODS

We searched the Cochrane Kidney and Transplant Specialized Register for randomized trials in PD. We extracted all reported outcome domains and measurements and analyzed their frequency and characteristics.

RESULTS

From 128 reports of 120 included trials, 80 different outcome domains were reported. Overall, 39 (49%) domains were surrogate, 23 (29%) patient-reported and 18 (22%) clinical. The five most commonly reported domains were PD-related infection [59 (49%) trials], dialysis solute clearance [51 (42%)], kidney function [45 (38%)], protein metabolism [44 (37%)] and inflammatory markers/oxidative stress [42 (35%)]. Quality of life was reported infrequently (4% of trials). Only 14 (12%) trials included a patient-reported outcome as a primary outcome. The median number of outcome measures (defined as a different measurement, aggregation and metric) was 22 (interquartile range 13-37) per trial. PD-related infection was the most frequently reported clinical outcome as well as the most frequently stated primary outcome. A total of 383 different measures for infection were used, with 66 used more than once.

CONCLUSIONS

Trials in PD include important clinical outcomes such as infection, but these are measured and reported inconsistently. Patient-reported outcomes are infrequently reported and nearly half of the domains were surrogate. Standardized outcomes for PD trials are required to improve efficiency and relevance.

Preliminary safety study of the Automated Wearable Artificial Kidney (AWAK) in Peritoneal Dialysis patients

BACKGROUND

Regeneration of peritoneal dialysis (PD) fluid using sorbent technology can provide flexibility and improve quality of life. This study examined the safety and efficacy of the automated wearable artificial kidney (AWAK) device in PD patients.

METHODS

This pilot study included prevalent PD patients from a single center in Singapore between 2016 and 2018. Participants underwent up to nine AWAK therapies over 72 h and were followed up for 1 month. Primary outcomes were serious adverse events (SAEs) and completion of nine therapies without device deficiency. Secondary outcomes were weekly peritoneal Kt/V _urea, solutes clearance and adverse events (AEs).

RESULTS

Twenty-one patients were screened and 15 were included in the study. Device alterations were required to overcome issues including flow occlusions initially, which resulted in three cohorts (n = 2, 2 and 11 respectively). No SAEs were observed during the study and at the follow-ups. Common AEs were abdominal pain/discomfort (60%) and bloatedness (47%). The median estimated peritoneal weekly Kt/V _urea was 3.0 (interquartile range: 2.2-4.8). There were significant reductions in pre- and post-study median serum urea (20.8 vs. 14.9 mmol/L; p = 0.001), creatinine (976.0 vs. 667.5 µmol/L; p = 0.001), phosphate (1.7 vs. 1.5 mmol/L; p = 0.03), and β2-microglobulin (29114.0 vs. 26339.0 µg/L; p = 0.048). Fluid reabsorption occurred among patients with residual kidney function. However, median body weights were not significantly different pre- and post-study (66.4 vs. 65.7 kg; p = 0.83).

CONCLUSIONS

This preliminary study demonstrated that no SAEs were observed with the AWAK-PD device; however, 60% of participants developed abdominal pain/discomfort. Further device enhancements are needed to improve ultrafiltration and reduce AEs.

The effects of dialysis modality choice on cognitive functions in patients with end-stage renal failure: A protocol for systematic review and meta-analysis

BACKGROUND

There is no published meta-analysis comparing the effects of dialysis modality choice on cognitive functions in patients with end-stage renal disease . Therefore, we perform a protocol for systematic review and meta-analysis to evaluate cognitive function in peritoneal dialysis versus hemodialysis patients.

METHODS

This protocol is conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P) statement guidelines. Related articles were identified by searching Web of Science, Embase, PubMed, Wanfang Data, Medline, Science Direct, and Cochrane Library. The risk of bias assessment of the included articles was performed by two authors independently using the tool recommended in the Cochrane Handbook for Systematic Reviews of Interventions. All calculations were carried out with Stata 11.0 (The Cochrane Collaboration, Oxford, United Kingdom).

RESULTS

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

CONCLUSION

We hypothesized that patients on peritoneal dialysis demonstrated a lower odd of cognitive dysfunction compared to those on hemodialysis.

OPEN SCIENCE FRAMEWORK REGISTRATION NUMBER

10.17605/OSF.IO/NWCZK.

Home Versus Facility Dialysis and Mortality in Australia and New Zealand

RATIONALE & OBJECTIVE

Mortality is an important outcome for all dialysis stakeholders. We examined associations between dialysis modality and mortality in the modern era.

STUDY DESIGN

Observational study comparing dialysis inception cohorts 1998-2002, 2003-2007, 2008-2012, and 2013-2017.

SETTING & PARTICIPANTS

Australia and New Zealand (ANZ) dialysis population.

EXPOSURE

The primary exposure was dialysis modality: facility hemodialysis (HD), continuous ambulatory peritoneal dialysis (CAPD), automated PD (APD), or home HD.

OUTCOME

The main outcome was death.

ANALYTICAL METHODS

Cause-specific proportional hazards models with shared frailty and subdistribution proportional hazards (Fine and Gray) models, adjusting for available confounding covariates.

RESULTS

In 52,097 patients, the overall death rate improved from ~15 deaths per 100 patient-years in 1998-2002 to ~11 in 2013-2017, with the largest cause-specific contribution from decreased infectious death. Relative to facility HD, mortality with CAPD and APD has improved over the years, with adjusted hazard ratios in 2013-2017 of 0.88 (95% CI, 0.78-0.99) and 0.91 (95% CI, 0.82-1.00), respectively. Increasingly, patients with lower clinical risk have been adopting APD, and to a lesser extent CAPD. Relative to facility HD, mortality with home HD was lower throughout the entire period of observation, despite increasing adoption by older patients and those with more comorbidities. All effects were generally insensitive to the modeling approach (initial vs time-varying modality, cause-specific versus subdistribution regression), different follow-up time intervals (5 year vs 7 year vs 10 year). There was no effect modification by diabetes, comorbidity, or sex.

LIMITATIONS

Potential for residual confounding, limited generalizability.

CONCLUSIONS

The survival of patients on PD in 2013-2017 appears greater than the survival for patients on facility HD in ANZ. Additional research is needed to assess whether changing clinical risk profiles over time, varied dialysis prescription, and morbidity from dialysis access contribute to these findings.

Comparison of the health-related quality of life of end stage kidney disease patients on hemodialysis and non-hemodialysis management in Uganda

Background

Health-related quality of life is recognized as a key outcome in chronic disease management, including kidney disease. With no national healthcare coverage for hemodialysis, Ugandan patients struggle to pay for their care, driving families and communities into poverty. Studies in developed countries show that patients on hemodialysis may prioritize quality of life over survival time, but there is a dearth of information on this in developing countries. We therefore measured the quality of life (QOL) and associated factors in end stage renal disease (ESRD) patients in a major tertiary care hospital in Uganda.

Methods

Baseline QOL measurement in a longitudinal cohort study was undertaken using the Kidney Disease Quality of Life Short Form Ver 1.3. Patients were recruited from the adult nephrology unit if aged > 18 years with an estimated glomerular filtration rate ≤ 15mls/min/1,73m². Clinical, demographic and micro-financial information was collected to determine factors associated with QOL scores.

Results

Three hundred sixty-four patients (364) were recruited, of whom 124 were on hemodialysis (HD) and 240 on non-hemodialysis (non-HD) management. Overall, 94.3% of participants scored less than 50 (maximum 100). Mean QOL scores were low across all three principal domains: physical health (HD: 33.14, non-HD: 34.23), mental health (HD: 38.01, non-HD: 38.02), and kidney disease (HD: 35.16, non-HD: 34.00). No statistically significant difference was found between the overall quality of life scores of the two management groups. Breadwinner status (p < 0.001), source of income (p0.026) and hemodialysis management type (p0.032) were the only factors significantly associated with QOL scores, and this was observed in the physical health and kidney disease principal domains only. No factors were significantly associated with scores for the mental health principal domain and/or overall QOL score.

Conclusion

The quality of life of Ugandan patients with ESRD has been found to be lower across all three domains of the Kidney Disease Quality of Life Short Form than reported anywhere in the world, with no difference observed between the non-HD and HD management groups. Interventions targeting all domains of QOL are needed among patients with ESRD in Uganda and, potentially, in other resource limited settings.

Ice-Cream Substitute for Patients With Kidney Failure

OBJECTIVE

Quality of life for patients with kidney failure is less than similar-aged, general population counterparts. A large part of the decrease in quality of life is from the change of diet and nutritional restrictions. One way to combat this decrease in quality of life is through oral nutrition supplements.

METHODS

An ice-cream substitute product was developed for patients with kidney failure on peritoneal dialysis. The product consisted of an ice-cream-like base of rice milk, egg whites, evaporated coconut milk, sugar, and vanilla bean paste. Two flavors were then created: cinnamon and lemon. Both flavors were tested subjectively and objectively. Sensory taste testing was with peritoneal dialysis patients using a Likert scale ballot with a comment section. Texture analysis was completed using a CT3 Brookfield texture analyzer. The results from the sensory testing (taste, texture, overall acceptability) and the texture analysis were analyzed using paired-samples t-tests. Nutritional analysis for the product was calculated.

RESULTS

The sensory test of taste, texture, and overall acceptability between the two flavors was not found to be statistically different between the cinnamon and lemon. Similarly, the objective results were also not statistically significant between the two flavors.

CONCLUSION

Based on the nutritional analysis, both the lemon and the cinnamon flavors were found to be "good" sources of protein when compared with the Food and Drug Administration's definition of a "good" source of protein. In addition, patients found the sensory aspects of both flavors to be slightly to moderately likable.

Evaluating Self-Efficacy among Patients Undergoing Dialysis Therapy

(1) Background: Perceived disease-related self-efficacy is considered a fundamental component of the successful self-management of chronic diseases. Prior studies have found that self-efficacy is associated with improvements in health behaviors and health status among people with chronic kidney disease (CKD). However, few studies have evaluated self-efficacy among patients undergoing dialysis. (2) Methods: This study was performed to evaluate CKD patients’ self-efficacy and to determine the factors that significantly affect self-efficacy among dialysis patients. This was a cross-sectional study using a convenience sample of 190 patients undergoing dialysis. The patients’ self-efficacy was measured using the CKD Self-Efficacy Scale. Inferential statistics were used to analyze the data. (3) Results: The mean age of the participants was 49.24 ± 13.15 years. Almost half of them were males (48.4%), and 75.3% were married. The majority of the patients (83%) were undergoing hemodialysis. The total score for self-efficacy was 192.57 ± 39.23. Only occupational status and the type of dialysis were significantly and positively correlated with patients’ perceived self-efficacy scores. (4) Conclusions: This study provides primary evidence of the perceived self-efficacy among CKD patients who are on dialysis. The results of this cross-sectional study showed that greater self-efficacy was associated with employment and peritoneal dialysis. Strategies to enhance self-efficacy among dialysis patients, especially those on hemodialysis, are needed.

The impact of hemodialysis on retinal and choroidal thickness in patients with chronic renal failure

BACKGROUND

Patients with chronic renal failure are commonly cared using a blood filtration mechanism like hemodialysis. Little information is available regarding ocular changes following hemodialysis for people with chronic renal failure. Accordingly, this study intended to estimate the pre- and post-hemodialysis thickness of retina and choroid and other ocular findings in patients with chronic renal failure.

METHODS

This research is a "before and after" clinical experiment, without control. This prospective study was conducted on patients with chronic renal failure who were in Imam Khomeini Hospital for hemodialysis in 2017. The sample size of this study was estimated to be 67 (134 eyes). In this study, after acquiring consent (by the associated assistant) from all patients, thorough ocular examinations including IOP control, VA and fundus examination, reflection, and macula and choroid OCT were performed 30 min before and after hemodialysis and entered in SPSS V. 16 software by the project manager. Finally, these data were analyzed practicing T-pair tests or their nonparametric equivalent, the Wilcoxon test.

RESULTS

Based on the results of this examination, studying 67 participating patients, 134 eyes were examined, of which 80 eyes (59.8%) belonged to men, and 54 eyes (40.2%) belonged to women. The mean and standard deviation of participants' age in the study was reported to be 57.3 ± 15 years, and the dialysis duration was 3.0 ± 2.11 h. According to the Wilcoxon test, the average rank in terms of weight, patient temperature, pulse, blood sugar, urea, potassium, ocular pressure, 500-micron nasal choroidal thickness, and myopia in diopter vary significantly before and after dialysis (p < 0.05). However, according to the Wilcoxon test, choroidal thickness in the subfoveal area of the eye (p = 0.600), the retinal thickness in the subfoveal area (p = 0.839), the amount of astigmatism in diopter (p = 0.757) and the amount of hypermetropia in diopter (p = 0.068) before and after dialysis do not have a significant difference. Based on the t test, it was reported that the average creatinine score, the best corrected vision, and the 500 and 1000-micron temporal and nasal choroidal thickness had a significant difference (p < 0.05).

CONCLUSION

Based on the results of the current study, it was settled that the corrected vision, ocular pressure, as well as the 500-micron nasal choroidal thickness, and myopia in diopter and the 1000-micron temporal and nasal choroidal thickness of patients before and after hemodialysis vary. This difference shows the impact of hemodialysis on changes in ocular characteristics in patients with renal insufficiency.

Analyzing clinical characteristics of patients with different cumulative hemodialysis durations: a cross-sectional study

Background

The objective of this study was to examine the clinical characteristics of patients with different cumulative hemodialysis (HD) durations, so as to improve their survival rate.

Methods

In this cross-sectional study, we extracted background information and relevant clinical data from 145 patients who were undergoing maintenance HD three times a week at the Affiliated Hospital of Nantong University between January 1998 and January 2019. The study subjects were divided into four groups according to the duration of their HD: <5 years, 5–10 years, 10–15 years, and >15 years of HD. We collected the medical history and relevant clinical parameters for each subject, and measured the urea reduction ratio (URR), hemoglobin (Hb), serum calcium, phosphorus, parathyroid hormone (iPTH), and serum albumin (ALB) levels for each group.

Results

The average patient age was 52.06 ±  11.93 years old. The average patient age in the 10–15 years and >15 years groups was significantly lower than in the <5 years and 5–10 years groups (P = 0.002, P < 0.001, P = 0.012, and P = 0.0025, respectively). The most common cause of end-stage renal disease (ESRD) was chronic glomerulonephritis. We found no significant differences in URR, Hb, serum calcium, serum phosphorus, iPTH, and ALB levels.

Conclusion

A prolonged HD duration was related to a younger mean age at the start of HD treatment. The leading cause of ESRD was chronic glomerulonephritis. We predominantly found diabetic nephropathy in the group with a duration of <5 years cumulative HD. Most of the indexes related to hemodialysis almost satisfied the recommended values in these patients.

Predialysis and Dialysis Therapies Differently Affect Nitric Oxide Synthetic Pathway in Red Blood Cells from Uremic Patients: Focus on Peritoneal Dialysis

Red blood cells (RBCs) have been found to synthesize and release both nitric oxide (NO) and cyclic guanosine monophosphate (cGMP), contributing to systemic NO bioavailability. These RBC functions resulted impaired in chronic kidney disease (CKD). This study aimed to evaluate whether predialysis (conservative therapy, CT) and dialysis (peritoneal dialysis, PD; hemodialysis, HD) therapies used during CKD progression may differently affect NO-synthetic pathway in RBCs. Our data demonstrated that compared to PD, although endothelial-NO-synthase activation was similarly increased, HD and CT were associated to cGMP RBCs accumulation, caused by reduced activity of cGMP membrane transporter (MRP4). In parallel, plasma cGMP levels were increased by both CT and HD and they significantly decreased after hemodialysis, suggesting that this might be caused by reduced cGMP renal clearance. As conceivable, compared to healthy subjects, plasma nitrite levels were significantly reduced by HD and CT but not in patients on PD. Additionally, the increased carotid intima-media thickness (IMT) values did not reach the significance exclusively in patients on PD. Therefore, our results show that PD might better preserve the synthetic NO-pathway in CKD-erythrocytes. Whether this translates into a reduced development of uremic vascular complications requires further investigation.

Comparisons of fatigue between dialysis modalities: A cross-sectional study

Background

Fatigue is one of the most frequent complications in dialyzed patients and is associated with poorer patient outcomes. Multiple factors are reported to be associated with fatigue development. Of them, the impacts of dialysis modalities remain unknown.

Methods

A total of 194 dialysis patients (mean age, 61±11 years; 134 males; modalities included hemodialysis (HD) in 26, online hemodiafiltration (HDF) in 74, peritoneal dialysis (PD) in 68, and combined therapy with PD and HD in 26 cases) were recruited for this cross-sectional study. Fatigue was assessed using the Profile of Mood States (POMS), a Visual Analogue Scale (VAS), and our original scale of fatigue, and depression was assessed by the Beck Depression Inventory-second edition (BDI-II). Our original scale of fatigue was administered both on dialysis and dialysis-free days to patients on HD and online HDF.

Results

The scores of the POMS, VAS, and our original scale were weakly but significantly inter-related (rho = 0.58, P<0.01; rho = 0.47, P<0.01, and rho = 0.42, P<0.01 between POMS and VAS, POMS and our original scale for fatigue, and VAS and our original scale for fatigue, respectively). The scores of these 3 tests showed no significant differences among the 4 modalities. On multivariate analysis, age, body mass index, creatinine, and employment status were associated with the presence or severity of fatigue, whereas dialysis modality was not. A similar result was obtained in 122 patients without depression. The prevalence of fatigue by our original scale was significantly lower on dialysis-free days than on dialysis days in patients on HD and online HDF.

Conclusions

The results suggest that there is no significant association between different dialysis modalities including HD, online HDF, PD and combined therapy with PD and HD and the prevalence or severity of fatigue.

The impact of pain on the quality of life of patients with end-stage renal disease undergoing hemodialysis: a multicenter cross-sectional study from Palestine

BACKGROUND

Chronic kidney disease is considered as a global health problem. Hemodialysis (HD), following renal transplantation, is the most common form of renal replacement therapy. However, HD may impact the quality of life (QOL). Pain is a frequent complaint among this population that also affects their QOL. The purposes of this study were to assess pain and QOL among end-stage renal disease (ESRD) patients on HD and to examine their association.

METHODS

This was a multicenter, cross-sectional study that occurred in Palestine between August and November 2018. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QOL, respectively.

RESULTS

A total of 300 participants were included in the final study. The average age of the subjects was 54 ± 16 years. Their median EQ-5D score was 0.68 [0.54-0.88], whereas their median EQ-VAS score was 60 [40-75]. A statistically significant association of pain severity score with EQ-5D score was found (r = - 0.783, p < 0.001). The association between pain interference score and EQ-5D score was also found to be statistically significant (r = - 0.868, p < 0.001). Similarly, pain severity score was significantly assocsiated with EQ-VAS score (r = - 0.590, p < 0.001), the same as was the pain interference score (r = - 0.647, p < 0.001). Moreover, age, gender, BMI, employment, educational level, income level, dialysis vintage, previous kidney transplantation, and chronic medication use were all significantly correlated with QOL. Regression analysis showed that patients aged < 60 years (p < 0.001), those with lower pain severity scores (p = 0.003), and those with lower pain interference scores (p < 0.001) had significantly higher QOL scores.

CONCLUSIONS

Pain has a significant negative impact on QOL in ESRD patients undergoing HD. The subgroups that were at higher risk included elderly patients, females, those with higher BMI, those without a formal education, those unemployed, those living with low monthly income, smokers, those who have multiple comorbidities, and patients with longer dialysis vintage. Our findings provide reliable data for educators and clinicians working with HD patients.

Encapsulated Peritoneal Sclerosis Masquerading as an Abdominal Catastrophe in Peritoneal Dialysis Therapy

Encapsulated peritoneal sclerosis (EPS) is a rare but known complication of peritoneal dialysis (PD) therapy in patients with end-stage renal disease (ESRD). It commonly manifests insidiously with recurrent intestinal obstruction and malnutrition, worsening over time. We report an ESRD patient on PD therapy for six years presenting with an acute intestinal obstruction, bowel hernia, bowel ischemia, and hemodynamic instability. CT abdomen revealed thickening of walls of colon and ileum in the right lower quadrant, with signs of small bowel obstruction. Patient underwent emergency laparotomy for the repair of hernia and resection of ischemic bowel, and intraoperatively, was found to have dusky, edematous, thickened, inflamed, and distended distal bowels with adhesions in the right lower quadrant. The pathological examination revealed a thin membrane encasing the ileum, colon and the mesenteric tissue diffusely. Microscopic examination of resected bowel showed marked submucosal edema with myxoid and inflammatory changes. Based on these clinical, radiological and pathological findings, a diagnosis of EPS was established. Her postoperative course was complicated by recurrent intraabdominal bleeding with hemoperitoneum, leading to disseminated intravascular coagulation, multiorgan failure, and death, two weeks after the surgery. EPS can present as an acute abdominal catastrophe. Although there are recommendations for ascertainment of EPS diagnosis, there are no clear guidelines for safe and effective surgical strategies and these warrant further research.

Assistência de enfermagem em diálise peritoneal: aplicabilidade da teoria de orem - estudo de método misto

Resumo Objetivo Compreender a aplicabilidade da Teoria Geral de Enfermagem de Orem na assistência prestada aos pacientes em diálise peritoneal domiciliar. Método Estudo de método misto. Na etapa quantitativa realizou-se uma pesquisa transversal, descritiva e exploratória, com 34 pacientes em diálise peritoneal. Aplicou-se um instrumento para caracterização sociodemográfica e clínica e a escala de avaliação da capacidade para o autocuidado - Appraisal of Self Care Agency Scale Revised. Análise dos dados por estatística descritiva. Na abordagem qualitativa, utilizou-se a Teoria Fundamentada nos Dados. Realizaram-se 23 entrevistas domiciliares com 19 participantes. Análise dos dados seguiu as codificações aberta, axial e seletiva. Resultados Dos participantes, 59% tinham capacidade para o autocuidado operacionalizado. Os pacientes em diálise peritoneal atenderam, em diferentes graus, às seis categorias de requisitos de autocuidado de desvio de saúde para a realização da terapia em domicílio. O apoio e a educação destacaram-se como modalidade de sistema de Enfermagem. Conclusão e implicação para a prática A Teoria Geral de Enfermagem de Orem se aplica na assistência de Enfermagem a pessoas em diálise peritoneal. Sugere-se sua utilização como suporte teórico para o Processo de Enfermagem.

Nível de ativação e qualidade de vida relacionada à saúde de pessoas em hemodiálise

Resumo Objetivo associar o nível de ativação com a qualidade de vida relacionada à saúde de pessoas que realizam o tratamento hemodialítico. Método estudo quantitativo, transversal e correlacional com 162 pessoas em tratamento hemodialítico. Os dados foram coletados por meio da aplicação de questionários para a caracterização sociodemográfica, socioeconômica e clínica do Kidney Disease Quality of Life Short Form e da escala Patient Activation Measure. Os dados secundários foram coletados por meio do prontuário médico. Para a análise dos dados, utilizaram-se a estatística descritiva e a regressão logística. Resultados a ativação do paciente em hemodiálise associou-se positivamente com os domínios sintomas, funcionamento físico, saúde geral, bem-estar emocional, energia/fadiga e o componente mental da qualidade de vida relacionada à saúde. Conclusão e implicação para a prática como a ativação apresenta relação com a qualidade de vida relacionada à saúde, na prática assistencial, essa métrica deve ser considerada ao implementar medidas que visem a aumentar a qualidade de vida relacionada à saúde das pessoas em hemodiálise.

Dietary Adherence, Self-Regulatory Fatigue and Trait Self-Control Among Chinese Patients with Peritoneal Dialysis: A Cross-Sectional Study

PURPOSE

Little is known about factors that predict dietary adherence among Chinese patients undergoing peritoneal dialysis. We investigated whether self-regulatory fatigue and trait self-control influence dietary adherence among Chinese patients with peritoneal dialysis.

METHODS

A total of 192 Chinese patients undergoing peritoneal dialysis were recruited at two peritoneal dialysis centers. The dietary adherence, trait self-control and self-regulatory fatigue of these patients were assessed using self-administered questionnaires. Clinical data were extracted from the hospital medical records. The significance of several social demographic factors on dietary adherence was analyzed using One-way ANOVA was used to analyze, whereas the association between dietary adherence and self-regulatory fatigue as well as trait self-control were analyzed using Pearson correlation. The independence association between dietary adherence and other influencing factors was assessed using Multivariable linear regression analyses.

RESULTS

We found that peritoneal dialysis patients only moderately adhere to dietary prescriptions. The top three least adherences were observed for salt intake (1.89±0.36), face of difficulty (2.86±0.26) and fluid restriction adherence intake (2.97±0.30). Multivariable linear regression analysis revealed that education level (β=0.339, P<0.001), residence (β=-0.151, P=0.015), self-regulatory fatigue (β= -0.648, P<0.001), and trait self-control (β=0.118, P=0.022) were independent predictors of dietary adherence.

CONCLUSION

Education level and residence strongly influence dietary adherence among Chinese peritoneal dialysis patients. On the other hand, Self-regulatory fatigue and trait self-control are independent predictors of dietary adherence among peritoneal dialysis patients. These findings can guide the enhancement of dietary adherence of peritoneal dialysis patients.

Impact of health-related quality of life on survival after dialysis initiation: a prospective cohort study in Korea

Background

The effect of each health-related quality of life (HRQOL) component on hemodialysis prognosis has not been well studied. We aimed to investigate the clinical factors associated with HRQOL and the effect of HRQOL after dialysis initiation on long-term survival in an Asian population.

Methods

A total of 568 hemodialysis patients were included from a nationwide prospective cohort study. HRQOL was evaluated using the Kidney Disease Quality of Life (KDQOL) Short FormTM 1.3 at 3 months after dialysis initiation. The effect of each KDQOL item score on mortality was analyzed. Multivariable Cox analysis was performed after adjusting for age, sex, modified Charlson comorbidity index, and causes of primary kidney disease.

Results

Old age, diabetes mellitus, high comorbidities, and low serum albumin levels were associated with poor physical health status. Decreased urine output was associated with both poor physical and mental health status. The scores of 3 indices in the kidney disease domain (effect of kidney disease, social support, and dialysis staff encouragement) showed significant associations with mortality, as did the 3 indices (physical function, physical role limitation, and body pain) in the physical health domain. Neither the 4 indices in the mental health domain nor the mental composite score showed a significant association with mortality. However, a high physical composite score was associated with decreased overall patient mortality (P = 0.003). The effect of physical composite score on survival was prominent among young or middle-aged groups.

Conclusion

Poor physical health status 3 months after hemodialysis start correlates significantly with overall mortality.

Relationship between the comfort level of chronic renal patients and sociodemographic and clinical variables

OBJECTIVE

To assess the association between the comfort level of chronic hemodialysis patients with sociodemographic and clinical variables using the General Comfort Questionnaire.

METHOD

Cross-sectional study, with a quantitative approach, considering 180 chronic hemodialysis renal patients. Two instruments were used: one for sociodemographic and clinical variables; and the General Comfort Questionnaire, Brazilian version. Mann-Whitney's, Kruskal-Wallis's, and Spearman's tests were used for data analysis.

RESULTS

The overall comfort level of patients was 78.16%. The socio-cultural domain presented the lowest level of comfort and the psychospiritual the highest level. Some variables were significantly associated with the domains, such as marital status, education, and considering oneself to be anxious.

CONCLUSION

In the four domains of comfort, it was possible to identify patients' needs, such as the presence and intensity of pain, anxiety, constipation and type of access, making it possible to guide nurses in the systematization of care and improve the comfort of these patients.

Effects of hemodialysis, peritoneal dialysis, and renal transplantation on the quality of life of patients with end-stage renal disease

OBJECTIVE

To evaluate the effects of hemodialysis, peritoneal dialysis, and renal transplantation on the quality of life of patients with end-stage renal disease (ESRD) and analyze the influencing factors.

METHODS

A total of 162 ESRD patients who received maintenance hemodialysis, continuous ambulatory peritoneal dialysis, and renal transplantation from February 2017 to March 2018 in our hospital were divided into a hemodialysis group, a peritoneal dialysis group, and a renal transplantation group. The baseline clinical data, serum indices, as well as environmental factors such as education level, marital status, work, residential pattern, household income, and expenditure were recorded. The quality of life was assessed using the short-form 36-item (SF-36) scale reflecting the Physical Component Summary (PCS) and the Mental Component Summary (MCS). One-way analysis of variance and logistic stepwise multiple regression analysis were performed to analyze the factors influencing the quality of life.

RESULTS

The renal transplantation group had the highest average scores for all dimensions of the SF-36 scale. The PCS and MCS scores of this group were higher than those of the hemodialysis and peritoneal dialysis groups. The peritoneal dialysis group had higher scores for physical functioning, physical role, bodily pain, general health, mental health, PCS, and MCS than those of the hemodialysis group. Age, HGB, GLU, and ALP were the main factors influencing PCS. Age, education level, residential pattern, medication expenditure, and monthly per capita income mainly affected MCS.

CONCLUSION

In terms of quality of life, renal transplantation is superior to peritoneal dialysis and hemodialysis.

Health related quality of life utility weights for economic evaluation through different stages of chronic kidney disease: a systematic literature review

BACKGROUND

A Task Force from the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) provides recommendations on how to systematically identify and appraise health state utility (HSU) weights for cost-effectiveness analyses. We applied these recommendations to conduct a systematic review (SR) to identify HSU weights for different stages of chronic kidney disease (CKD), renal replacement therapy (RRT) and complications.

METHODS

MEDLINE® and Embase were searched for interventional and non-interventional studies reporting HSU weights for patients with CKD stages 1-5 or RRT. As per ISPOR Task Force Guidance, study quality criteria, applicability for Health Technology Assessment (HTA) and generalisability to a broad CKD population were used to grade studies as either 1 (recommended), 2 (to be considered if there are no data from grade 1 studies) or 3 (not recommended).

RESULTS

A total of 17 grade 1 studies were included in this SR with 51 to 1767 participants, conducted in the UK, USA, Canada, China, Spain, and multiple-countries. Health related quality of life (HRQL) instruments used in the studies included were EQ-5D-3L (10 studies), SF-6D (4 studies), HUI2/HUI3 (1 study), and combinations (2 studies). Although absolute values for HSU weights varied among instruments, HSU weights decreased with CKD severity in a consistent manner across all instruments.

CONCLUSIONS

This SR identified HSU weights for a range of CKD states and showed that HRQL decreases with CKD progression. Data were available to inform cost-effectiveness analysis in CKD in a number of geographies using instruments acceptable by HTA agencies.

Impact of pre-transplant dialysis modality on the outcome and health-related quality of life of patients after simultaneous pancreas-kidney transplantation

Background

Simultaneous pancreas-kidney transplantation (SPKT) profoundly improves the health-related quality of life (HRQoL) of recipients. However, the influence of the pre-transplant dialysis modality on the success of the SPKT and post-transplant HRQoL remains unknown.

Methods

We analyzed the surgical outcome, long-term survival, as well as HRQoL of 83 SPKTs that were performed in our hospital between 2000 and 2016. Prior to transplant, 64 patients received hemodialysis (HD) and nineteen patients received peritoneal dialysis (PD). Physical and mental quality of life results from eight basic scales and the physical and mental component summaries (PCS and MCS) were measured using the Short Form 36 (SF-36) survey.

Results

Peri- and postoperative complications, as well as patient and graft survival were similar between the two groups. Both groups showed an improvement of HRQoL in all SF-36 domains after transplantation. Compared with patients who received HD before transplantation, PD patients showed significantly better results in four of the eight SF-36 domains: physical functioning (mean difference HD - PD: − 12.4 ± 4.9, P = < 0.01), bodily pain (− 14.2 ± 6.3, P < 0.01), general health (− 6.3 ± 2.8, P = 0.04), vitality (− 6.8 ± 2.6, P = 0.04), and PCS (− 5.2 ± 1.5, P < 0.01) after SPKT. In the overall study population, graft loss was associated with significant worsening of the HRQoL in all physical components (each P < 0.01).

Conclusions

The results of this analysis show that pre-transplant dialysis modality has no influence on the outcome and survival rate after SPKT. Regarding HRQoL, patients receiving PD prior to SPKT seem to have a slight advantage compared with patients with HD before transplantation.

[Routine collection of perceived health data in the era of payment for quality: Recommendations by the Epidemiology and public health commission of the SFNDT]

In France, the method of financing is mainly based on the quantity of care produced. The fixed-rate financing of patients with chronic kidney disease at stage IV or V introduces the notion of payment to quality. Part of the quality assessment will focus on the patients' feelings about their care. The objective of this paper is to assess these indicators used in nephrology, markers in their own right of the quality of care. The patients reported outcomes measures considering the impact of illness or care and the Patient Reported Experience Measures considering their perception of their experience with the health care system or care pathway, are broader than quality of life. These PROs are measured using standardized and validated questionnaires, generic or specific. The Standardised Outcomes in Nephrology initiative has shown that PROs, too often neglected in favor of biological criteria, are instead favored by patients. In the context of a broad deployment of monitoring the quality of life for the purpose of evaluation of care, outside research protocol, the Commission recommends one of the following 2 tools: EuroQol 5D and 12-Item Short Form Health Survey, a compromise between feasibility and relevance and e-SATIS given its great use in health facilities, with an annual follow-up.

"I Wish Someone Had Told Me That Could Happen": A Thematic Analysis of Patients' Unexpected Experiences With End-Stage Kidney Disease Treatment

BACKGROUND

Preparedness regarding prognosis and treatment options enables patients to cope with uncertainties, make value-based treatment decisions, and set treatment goals. Yet, little is known about the expectedness of end-stage kidney disease (ESKD) patients' treatment experiences beyond their desire for better treatment education.

OBJECTIVE

To describe unexpected adverse treatment experiences among ESKD patients.

METHOD

The authors conducted 7 focus groups with 55 dialysis patients and living-donor kidney transplantation recipients receiving medical care in Baltimore, Maryland. Data were analyzed thematically. Themes present in different treatment groups were highlighted to provide insight into common experiences.

RESULTS

The authors identified 5 themes: (1) psychological reactions, (2) constrained freedom of choice, (3) treatment delivery and logistics, (4) morbidity, and (5) finances.

CONCLUSION

Patients were unprepared for nonclinical, logistical, and clinical aspects of ESKD treatment. The need for providers' use of tailored preparatory techniques and the development of pretreatment interventions to help patients know what to expect from and feel psychologically prepared for treatment, particularly with respect to nonclinical implications, is critical. These efforts have great potential to improve patients' treatment experiences.

Comparisons of quality of life between patients underwent peritoneal dialysis and hemodialysis: a systematic review and meta-analysis

OBJECTIVE

End-stage renal disease (ESRD) leads to renal replacement therapy and certainly has an impact on patients' health-related quality of life (HRQoL). This study aimed to review and compare the HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) patients using the 36-Item Short Form Health Survey (SF-36), EuroQoL-5-dimension (EQ-5D) and the Kidney Disease Quality of Life Instrument (KDQOL).

METHODOLOGY

Systematic review was conducted by identify relevant studies through MEDLINE and SCOPUS up to April 2017. Studies were eligible with following criteria: studied in ESRD patients, compare any pair of renal replacement modalities, and reported HRQoL. The unstandardized mean differences (USMD) of HRQoL among modalities were calculated and pooled using a random-effect models if heterogeneity was present, otherwise a fixed-effect model was applied.

RESULTS

A total of twenty-one studies were included with 29,000 participants. Of them, mean age and percent male were 48.1 years and 45.1, respectively. The pooled USMD (95% CI) of SF-36 between PD and HD (base) were 1.86 (0.47, 3.24) and 0.42 (- 1.99, 2.82) for mental component and physical component summary scores, respectively. For EQ-5D, the pooled USMD of utility and visual analogue scale (VAS) score were 0.02 (- 0.06, 0.10) and 3.56 (1.73, 5.39), respectively. The pooled USMD of KDQOL were 9.67 (5.67, 13.68), 6.71 (- 5.92, 19.32) 6.30 (- 0.41, 12.18), 2.35 (- 4.35, 9.04), 2.10 (0.07, 4.13), and 1.21 (- 2.98, 5.40) for burden of kidney disease, work status, effects of kidney disease, quality of social interaction, symptoms, and cognitive function.

CONCLUSION

Patients with chronic kidney disease (CKD) stage 5 or ESRD treated with PD had better generic HRQoL measured by SF-36 and EQ-5D than HD patients. In addition, PD had higher specific HRQoL by KDQOL than HD patients in subdomain of physical functioning, role limitations due to emotional problems, effects and burden of kidney disease.

Watchful waiting is an appropriate option for peritoneal dialysis candidates with an asymptomatic ventral hernia

PURPOSE

Expert consensus recommends that all ventral hernias be repaired prior to, or concomitantly with, peritoneal dialysis (PD) catheter insertion. We examined the clinical outcomes of patients undergoing initial PD catheter insertion, with asymptomatic ventral hernias that were not repaired and rather managed using a watchful waiting approach.

METHODS

A single-center, retrospective review of patients undergoing PD catheter insertion from 2005-2019 was performed. Patients who did not undergo repair of a pre-existing ventral hernia at the time of their initial PD catheter insertion were included. The primary endpoint was ventral hernia repair following PD catheter insertion.

RESULTS

Forty-one patients were included. Most patients presented with an umbilical hernia (78%). Six patients (15%) underwent ventral hernia repair at a median postoperative interval of 12 months [IQR 8-16], due to abdominal discomfort and hernia enlargement (n = 2) and incarceration (n = 2). Two patients remained asymptomatic, yet underwent ventral hernia repair at the time of renal transplantation. The cumulative incidence of ventral hernia repair within 12 and 24 months of PD catheter insertion was 13% and 21%, respectively.

CONCLUSION

Watchful waiting may be an acceptable option for select patients with asymptomatic ventral hernias at the time of initial PD catheter placement. These findings highlight the need to better identify factors associated with asymptomatic ventral hernias that do not warrant concomitant repair to aid surgeons in the decision-making process.

Quality of Life and Social Support of People on Peritoneal Dialysis: Mixed Methods Research

Although some study has been made into quality of life in patients with peritoneal dialysis, little is known about how this relates to social support. The aim of this paper was to study health-related quality of life, perceived social support and the experiences of people receiving peritoneal dialysis. A cross-sectional study was conducted using quantitative and qualitative methodologies, between June 2015 and March 2017. Fifty-five patients receiving peritoneal dialysis were studied. The most affected quality of life dimensions were the effects of the disease, the burden of the disease, occupational status, sleep and satisfaction. The physical component of the quality of life questionnaire was negatively associated with the number of hospital admissions over the previous year (p = 0.027) and positively associated with social support (p = 0.002). With regard to the mental component, age (p = 0.010) and social support (p = 0.041) were associated with a better quality of life. Peritoneal dialysis, while not a panacea, is experienced as being less aggressive than hemodialysis, allowing greater autonomy and improved perceived health. Greater symptomology corresponded to worse quality of life and to perceiving the disease as a burden. Patients had to adapt to the new situation despite their expectations. Social support was observed to be a key factor in perceived quality of life.

Oral health-related quality of life in adult patients with end-stage kidney diseases undergoing renal replacement therapy - a systematic review

Background

The oral health of patients undergoing renal replacement therapy (RRT) is insufficient. Poor oral health and its components can affect the oral health-related quality of life (OHRQoL) of these patients. The aim of this systematic review was to assess the OHRQoL of adult patients under RRT.

Methods

A systematic literature search was performed using the terms: dialysis OR “renal disease” OR kidney OR “renal failure” OR “kidney transplantation” OR hemodialysis OR “peritoneal dialysis” OR “renal replacement therapy” AND “oral health-related quality of life”, complemented by manual search. Clinical studies including adults (age ≥ 18 years) that were published between 2009 and 2019 were included in qualitative analysis.

Results

Twelve out of 20 studies were included in the qualitative analysis. The majority (11/12 studies) included patients undergoing haemodialysis (HD), with a sample size between 47 and 512 participants. Two studies included patients after kidney transplantation. Only one-quarter of the investigations included a healthy control group. The overall OHRQoL was found to be reduced. The majority of studies found relationships between OHRQoL and different oral health parameters. Furthermore, several relationships between OHRQoL and general quality of life as well as disease related parameters including age, gender, diabetes, blood parameters and dialysis duration were found. OHRQoL subscales psychological/psychosocial impairment and pain were predominantly affected.

Conclusions

Patients under RRT suffer from a reduced OHRQoL, which is potentially influenced by oral health and disease related parameters. Interdisciplinary dental care is needed and should consider both physical and psychosocial issues.

Health-Related Quality of Life in Home Dialysis Patients Compared to In-Center Hemodialysis Patients: A Systematic Review and Meta-analysis

RATIONALE & OBJECTIVE

Dialysis patients judge health-related quality of life (HRQoL) as an essential outcome. Remarkably, little is known about HRQoL differences between home dialysis and in-center hemodialysis (HD) patients worldwide.

STUDY DESIGN

Systematic review and meta-analysis.

SETTING & STUDY POPULATIONS

Search strategies were performed on the Cochrane Library, Pubmed, and EMBASE databases between 2007 and 2019. Home dialysis was defined as both peritoneal dialysis and home HD.

SELECTION CRITERIA FOR STUDIES

Randomized controlled trials and observational studies that compared HRQoL in home dialysis patients versus in-center HD patients.

DATA EXTRACTION

The data extracted by 2 authors included HRQoL scores of different questionnaires, dialysis modality, and subcontinent.

ANALYTICAL APPROACH

Data were pooled using a random-effects model and results were expressed as standardized mean difference (SMD) with 95% CIs. Heterogeneity was explored using subgroup analyses.

RESULTS

Forty-six articles reporting on 41 study populations were identified. Most studies were cross-sectional in design (90%), conducted on peritoneal dialysis patients (95%), and used the 12-item or 36-item Short-Form Health Survey questionnaires (83%). More than half the studies showed moderate or high risk of bias. Pooled analysis of 4,158 home dialysis patients and 7,854 in-center HD patients showed marginally better physical HRQoL scores in home dialysis patients compared with in-center HD patients (SMD, 0.14; 95% CI, 0.04 to 0.24), although heterogeneity was high (I 2>80%). In a subgroup analysis, Western European home dialysis patients had higher physical HRQoL scores (SMD, 0.39; 95% CI, 0.17 to 0.61), while home dialysis patients from Latin America had lower physical scores (SMD, -0.20; 95% CI, -0.28 to -0.12). Mental HRQoL showed no difference in all analyses.

LIMITATIONS

No randomized controlled trials were found and high heterogeneity among studies existed.

CONCLUSIONS

Although pooled data showed marginally better physical HRQoL for home dialysis patients, the quality of design of the included studies was poor. Large prospective studies with adequate adjustments for confounders are necessary to establish whether home dialysis results in better HRQoL.

TRIAL REGISTRATION

PROSPERO 95985.

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

RATIONALE & OBJECTIVE

The efficacy and safety of icodextrin versus glucose-only peritoneal dialysis (PD) regimens is unclear. The aim of this study was to compare once-daily long-dwell icodextrin versus glucose among patients with kidney failure undergoing PD.

STUDY DESIGN

Systematic review of randomized controlled trials (RCTs), enriched with unpublished data from investigator-initiated and industry-sponsored studies.

SETTING & STUDY POPULATIONS

Individuals with kidney failure receiving regular PD treatment enrolled in clinical trials of dialysate composition.

SELECTION CRITERIA FOR STUDIES

Medline, Embase, CENTRAL, Ichushi Web, 10 Chinese databases, clinical trials registries, conference proceedings, and citation lists from inception to November 2018. Further data were obtained from principal investigators and industry clinical study reports.

DATA EXTRACTION

2 independent reviewers selected studies and extracted data using a prespecified extraction instrument.

ANALYTIC APPROACH

Qualitative synthesis of demographics, measurement scales, and outcomes. Quantitative synthesis with Mantel-Haenszel risk ratios (RRs), Peto odds ratios (ORs), or (standardized) mean differences (MDs). Risk of bias of included studies at the outcome level was assessed using the Cochrane risk-of-bias tool for RCTs.

RESULTS

19 RCTs that enrolled 1,693 participants were meta-analyzed. Ultrafiltration was improved with icodextrin (medium-term MD, 208.92 [95% CI, 99.69-318.14] mL/24h; high certainty of evidence), reflected also by fewer episodes of fluid overload (RR, 0.43 [95% CI, 0.24-0.78]; high certainty). Icodextrin-containing PD probably decreased mortality risk compared to glucose-only PD (Peto OR, 0.49 [95% CI, 0.24-1.00]; moderate certainty). Despite evidence of lower peritoneal glucose absorption with icodextrin-containing PD (medium-term MD, -40.84 [95% CI, -48.09 to-33.59] g/long dwell; high certainty), this did not directly translate to changes in fasting plasma glucose (-0.50 [95% CI, -1.19 to 0.18] mmol/L; low certainty) and hemoglobin A_1c levels (-0.14% [95% CI, -0.34% to 0.05%]; high certainty). Safety outcomes and residual kidney function were similar in both groups; health-related quality-of-life and pain scores were inconclusive.

LIMITATIONS

Trial quality was variable. The follow-up period was heterogeneous, with a paucity of assessments over the long term. Mortality results are based on just 32 events and were not corroborated using time-to-event analysis of individual patient data.

CONCLUSIONS

Icodextrin for once-daily long-dwell PD has clinical benefit for some patients, including those not meeting ultrafiltration targets and at risk for fluid overload. Future research into patient-centered outcomes and cost-effectiveness associated with icodextrin is needed.