1
|
Martín-del-Campo F, Vega-Magaña N, Salazar-Félix NA, Cueto-Manzano AM, Peña-Rodríguez M, Cortés-Sanabria L, Romo-Flores ML, Rojas-Campos E. Gut Microbiome Is Related to Cognitive Impairment in Peritoneal Dialysis Patients. Nutrients 2024; 16:2659. [PMID: 39203796 PMCID: PMC11357212 DOI: 10.3390/nu16162659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/30/2024] [Accepted: 07/03/2024] [Indexed: 09/03/2024] Open
Abstract
Gut microbiota disturbances may influence cognitive function, increasing uremic toxins and inflammation in dialysis patients; therefore, we aimed to evaluate the association of the gut microbiota profile with cognitive impairment (CI) in patients on automated peritoneal dialysis (APD). In a cross-sectional study, cognitive function was evaluated using the Montreal Cognitive Assessment in 39 APD patients and classified as normal cognitive function and CI. The gut microbiota was analyzed using the 16S rRNA gene sequencing approach. All patients had clinical, biochemical and urea clearance evaluations. Eighty-two percent of patients were men, with a mean age of 47 ± 24 years and 11 (7-48) months on PD therapy; 64% had mild CI. Patients with CI were older (53 ± 16 vs. 38 ± 14, p = 0.006) and had a higher frequency of diabetes mellitus (56% vs. 21%, p = 0.04) and constipation (7% vs. 48%, p = 0.04) and lower creatinine concentrations (11.3 ± 3.7 vs. 14.9 ± 5.4, p = 0.02) compared to normal cognitive function patients. Patients with CI showed a preponderance of S24_7, Rikenellaceae, Odoribacteraceae, Odoribacter and Anaerotruncus, while patients without CI had a greater abundance of Dorea, Ruminococcus, Sutterella and Fusobacteria (LDA score (Log10) > 2.5; p < 0.05). After glucose and age adjustment, Odoribacter was still associated with CI. In conclusion, patients with CI had a different gut microbiota characterized by the higher abundance of indole-producing and mucin-fermenting bacteria compared to normal cognitive function patients.
Collapse
Affiliation(s)
- Fabiola Martín-del-Campo
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez #1000, Guadalajara 44320, Mexico; (F.M.-d.-C.); (N.A.S.-F.); (L.C.-S.); (E.R.-C.)
| | - Natali Vega-Magaña
- Laboratory of Pathology, Department of Microbiology and Pathology, Health Sciences University Center, University of Guadalajara, Sierra Mojada #950, Guadalajara 44350, Mexico;
| | - Noé A. Salazar-Félix
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez #1000, Guadalajara 44320, Mexico; (F.M.-d.-C.); (N.A.S.-F.); (L.C.-S.); (E.R.-C.)
| | - Alfonso M. Cueto-Manzano
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez #1000, Guadalajara 44320, Mexico; (F.M.-d.-C.); (N.A.S.-F.); (L.C.-S.); (E.R.-C.)
| | - Marcela Peña-Rodríguez
- Research Institute on Chronic and Degenerative Diseases, Department of Molecular Biology and Genomics, Health Sciences University Center, University of Guadalajara, Sierra Mojada #950, Guadalajara 44350, Mexico;
| | - Laura Cortés-Sanabria
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez #1000, Guadalajara 44320, Mexico; (F.M.-d.-C.); (N.A.S.-F.); (L.C.-S.); (E.R.-C.)
| | - María L. Romo-Flores
- Department of Nephrology, Regional General Hospital 46, Mexican Institute of Social Security, Lázaro Cárdenas Av. 1060, Guadalajara 44910, Mexico;
| | - Enrique Rojas-Campos
- Biomedical Research Unit 02, Specialties Hospital, Western National Medical Center, Mexican Institute of Social Security, Belisario Dominguez #1000, Guadalajara 44320, Mexico; (F.M.-d.-C.); (N.A.S.-F.); (L.C.-S.); (E.R.-C.)
| |
Collapse
|
2
|
Altunok M, Çankaya E, Gözübüyük Kaplan H, Çınar E, Uyanık A, Sevinç C. The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients. Int Urol Nephrol 2024; 56:2379-2389. [PMID: 38431535 DOI: 10.1007/s11255-024-03988-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide. Obesity is also increasing in the chronic kidney disease (CKD) population. There are conflicting data on complications such as mortality, peritonitis, and technique proficiency of peritoneal dialysis (PD) in underweight and obese patients according to body mass index (BMI). We aimed to present the data in our region to the literature by comparing the residual renal function (RRF), peritonitis, technique proficiency, and mortality rates of the patients we grouped according to BMI. METHODS The data of 404 patients who were started and followed up in our clinic between March 2005 and November 2021 were evaluated retrospectively. They were grouped as underweight, normal weight, overweight, and obese according to BMI. RRF, mortality, technique proficiency and peritonitis data of the groups were compared. RESULTS Of the 404 patients, 44 were underweight, 199 were normal weight, 110 were overweight, and 55 were obese. No difference was found between the groups in the technique survey and in the time to first peritonitis with Kaplan-Meier analysis (respectively; p = 0.610, p = 0.445). Multivariate Cox regression analysis showed that BMI did not affect mortality (HR 1.196 [95% CI 0.722-1.981] (p = 0.488)). CONCLUSION In conclusion, we report that BMI has no effect on RRF, peritonitis, technique proficiency, and mortality in patients undergoing PD, and that mortality may depend on additional factors such as mean albumin, time to first peritonitis, and loss of RRF.
Collapse
Affiliation(s)
- Murat Altunok
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey.
| | - Erdem Çankaya
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | | | - Enes Çınar
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Abdullah Uyanık
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Can Sevinç
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| |
Collapse
|
3
|
Zhu Q, Huo Z, Zeng F, Gong N, Ye P, Pan J, Kong Y, Dou X, Wang D, Huang S, Yang C, Liu D, Zhang G, Ai J. Apparent Treatment-Resistant Hypertension in the First Year Associated With Cardiovascular Mortality in Peritoneal Dialysis Patients. Am J Hypertens 2024; 37:514-522. [PMID: 38252960 PMCID: PMC11176273 DOI: 10.1093/ajh/hpae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/19/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Few reports have focused on the association between apparent treatment-resistant hypertension (aTRH) and cardiovascular (CV) mortality in peritoneal dialysis (PD) population, thus we conducted this retrospective cohort to explore it. METHODS This was a retrospective cohort study conducted from January 2011 to January 2020 with PD patients in 4 Chinese dialysis centers. aTRH was defined according to the American College of Cardiology and American Heart Association guidelines. aTRH duration was calculated as the total number of months when patients met the diagnostic criteria in the first PD year. The primary outcome was CV mortality, and the secondary outcomes were CV events, all-cause mortality, combined endpoint (all-cause mortality and transferred to hemodialysis [HD]), and PD withdrawal (all-cause mortality, transferred to HD, and kidney transplantation). Cox proportional hazards models were used to assess the association. RESULTS A total of 1,422 patients were finally included in the analysis. During a median follow-up period of 26 months, 83 (5.8%) PD patients incurred CV mortality. The prevalence of aTRH was 24.1%, 19.9%, and 24.6% at 0, 3, and 12 months after PD initiation, respectively. Overall, aTRH duration in the first PD year positively associated with CV mortality (per 3 months increment, adjusted hazards ratio [HR], 1.29; 95% confidence interval 1.10, 1.53; P = 0.002). After categorized, those with aTRH duration more than 6 months presented the highest adjusted HR of 2.92. Similar results were found for secondary outcomes, except for the CV event. CONCLUSIONS Longer aTRH duration in the first PD year is associated with higher CV mortality and worse long-term clinical outcomes. Larger studies are warranted to confirm these findings. CLINICAL TRIALS REGISTRATION There is no clinical trial registration for this retrospective study.
Collapse
Affiliation(s)
- Qingyao Zhu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Zhihao Huo
- Department of Nephrology, Guangdong Clinical Research Academy of Chinese Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fang Zeng
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People’s Hospital), Ganzhou, China
| | - Nirong Gong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Peiyi Ye
- Nephrology Department, The First People’s Hospital of Foshan, Foshan, China
| | - Jianyi Pan
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yaozhong Kong
- Nephrology Department, The First People’s Hospital of Foshan, Foshan, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Di Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Shuting Huang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Cong Yang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Dehui Liu
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People’s Hospital), Ganzhou, China
| | - Guangqing Zhang
- Administrative Office, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Ai
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- National Clinical Research Center for Kidney Disease, Guangzhou, China
- State Key Laboratory of Organ Failure Research, Guangzhou, China
- Guangdong Provincial Institute of Nephrology, Guangzhou, China
- Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| |
Collapse
|
4
|
Yeter HH, Altunok M, Cankaya E, Yildirim S, Akturk S, Bakirdogen S, Akoğlu H, Bulut M, Sahutoglu T, Erdut A, Ozkahya M, Koc Y, Tunca O, Kara E, Erek M, Polat M, Akagun T, Guz G. Effects of incremental peritoneal dialysis with low glucose-degradation product neutral pH solution on clinical outcomes. Int Urol Nephrol 2024:10.1007/s11255-024-04077-7. [PMID: 38740705 DOI: 10.1007/s11255-024-04077-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/06/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Incremental peritoneal dialysis (IPD) could decrease unfavorable glucose exposure results and preserve (RKF). However, there is no standardization of dialysis prescriptions for patients undergoing IPD. We designed a prospective observational multi-center study with a standardized IPD prescription to evaluate the effect of IPD on RKF, metabolic alterations, blood pressure control, and adverse outcomes. METHODS All patients used low GDP product (GDP) neutral pH solutions in both the incremental continuous ambulatory peritoneal dialysis (ICAPD) group and the retrospective standard PD (sPD) group. IPD patients started treatment with three daily exchanges five days a week. Control-group patients performed four changes per day, seven days a week. RESULTS A total of 94 patients (47 IPD and 47 sPD) were included in this study. The small-solute clearance and mean blood pressures were similar between both groups during follow-up. The weekly mean glucose exposure was significantly higher in sPD group than IPD during the follow-up (p < 0.001). The patients with sPD required more phosphate-binding medications compared to the IPD group (p = 0.05). The rates of peritonitis, tunnel infection, and hospitalization frequencies were similar between groups. Patients in the sPD group experienced more episodes of hypervolemia compared to the IPD group (p = 0.007). The slope in RKF in the 6th month was significantly higher in the sPD group compared to the IPD group (65% vs. 95%, p = 0.001). CONCLUSION IPD could be a rational dialysis method and provide non-inferior dialysis adequacy compared to full-dose PD. This regimen may contribute to preserving RKF for a longer period.
Collapse
Affiliation(s)
- Hasan Haci Yeter
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, TR-06560, Ankara, Turkey.
| | - Murat Altunok
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Erdem Cankaya
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Saliha Yildirim
- Department of Nephrology, Sincan State Hospital, Ankara, Turkey
| | - Serkan Akturk
- Department of Nephrology, Ankara Education and Research Hospital, Ankara, Turkey
| | - Serkan Bakirdogen
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, 18 Mart University, Canakkale, Turkey
| | - Hadim Akoğlu
- Department of Nephrology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Mesudiye Bulut
- Department of Nephrology, Gulhane Education and Research Hospital, Ankara, Turkey
| | - Tuncay Sahutoglu
- Department of Nephrology, Mehmet Akif Ersoy Education and Research Hospital, Sanliurfa, Turkey
| | - Arda Erdut
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Hacettepe University, TR-06560, Ankara, Turkey
| | - Mehmet Ozkahya
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Ege University, Izmir, Turkey
| | - Yener Koc
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Onur Tunca
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Afyonkarahisar Health Science University, Afyon, Turkey
| | - Ekrem Kara
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Müge Erek
- Department of Nephrology, Harakani State Hospital, Kars, Turkey
| | - Mehmet Polat
- Department of Nephrology, Nevsehir State Hospital, Nevsehir, Turkey
| | - Tulin Akagun
- Department of Nephrology, Giresun Education and Research Hospital, Giresun, Turkey
| | - Galip Guz
- Department of Nephrology Dialysis and Transplantation, Faculty of Medicine, Gazi University, Ankara, Turkey
| |
Collapse
|
5
|
Harvey E. Bioimpedance analysis in children on peritoneal dialysis: to fill or not to fill? Pediatr Nephrol 2024; 39:1319-1321. [PMID: 38206433 DOI: 10.1007/s00467-023-06274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Affiliation(s)
- Elizabeth Harvey
- Hospital for Sick Children, Toronto, Canada.
- University of Toronto, Toronto, Canada.
| |
Collapse
|
6
|
Munshi R, Swartz SJ. Incremental dialysis: review of the literature with pediatric perspective. Pediatr Nephrol 2024; 39:49-55. [PMID: 37306719 DOI: 10.1007/s00467-023-06030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/24/2023] [Accepted: 05/12/2023] [Indexed: 06/13/2023]
Abstract
Drivers towards initiation of kidney replacement therapy in advanced chronic kidney disease include metabolic and fluid derangements, growth, and nutritional status with focus on health optimization. Once initiated, prescription of dialysis is often uniform despite variability in patient characteristics and etiology of kidney failure. Preservation of residual kidney function has been associated with improved outcomes in patients with advanced chronic kidney disease on dialysis. Incremental dialysis is the approach of reducing the dialysis dose by reduction in treatment time, days, or efficiency of clearance. Incremental dialysis has been described in adults at initiation of kidney replacement therapy, to better preserve residual kidney function and meet the individual needs of the patient. Consideration of incremental dialysis in pediatrics may be reasonable in a subset of children with continued emphasis on promotion of growth and development.
Collapse
Affiliation(s)
- Raj Munshi
- Division of Pediatric Nephrology, Department of Pediatrics, Seattle Children's, University of Washington, Seattle, WA, USA.
| | - Sarah J Swartz
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| |
Collapse
|
7
|
Meyer TW, Bargman JM. The Removal of Uremic Solutes by Peritoneal Dialysis. J Am Soc Nephrol 2023; 34:1919-1927. [PMID: 37553867 PMCID: PMC10703087 DOI: 10.1681/asn.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
ABSTRACT Peritoneal dialysis (PD) is now commonly prescribed to achieve target clearances for urea or creatinine. The International Society for Peritoneal Dialysis has proposed however that such targets should no longer be imposed. The Society's new guidelines suggest rather that the PD prescription should be adjusted to achieve well-being in individual patients. The relaxation of treatment targets could allow increased use of PD. Measurement of solute levels in patients receiving dialysis individualized to relieve uremic symptoms could also help us identify the solutes responsible for those symptoms and then devise new means to limit their accumulation. This possibility has prompted us to review the extent to which different uremic solutes are removed by PD.
Collapse
Affiliation(s)
- Timothy W. Meyer
- Departments of Medicine, Stanford University and VA Palo Alto HCS, Palo Alto, California
| | - Joanne M. Bargman
- Division of Nephrology and Department of Medicine, University Health Network and the University of Toronto, Canada
| |
Collapse
|
8
|
Maliha G, Weinhandl ED, Reddy YNV. Deprescribing the Kt/V Target for Peritoneal Dialysis in the United States: The Path Toward Adopting International Standards for Dialysis Adequacy. J Am Soc Nephrol 2023; 34:751-754. [PMID: 36787755 PMCID: PMC10125636 DOI: 10.1681/asn.0000000000000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/31/2023] [Indexed: 02/16/2023] Open
Affiliation(s)
- George Maliha
- Department of Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric D. Weinhandl
- Satellite Healthcare, San Jose, California
- Department of Pharmaceutical Care and Health Systems, University of Minnesota, Minneapolis, Minnesota
| | - Yuvaram N. V. Reddy
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
- Renal-Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania
- ASN Quality Committee, American Society of Nephrology, Washington, District of Columbia
- ASN Home Dialysis Steering Committee, American Society of Nephrology, Washington, District of Columbia
| |
Collapse
|
9
|
Huo Z, Zhuo Q, Zhong S, Wang F, Xie C, Gong N, Zhong X, Yi Z, Kong Y, Liu D, Dou X, Wang G, Ai J. Hypokalemia Duration in the First Year Associated with Subsequent Peritoneal Dialysis-Associated Peritonitis: A Multicenter Retrospective Cohort Study. J Clin Med 2022; 11:jcm11247518. [PMID: 36556134 PMCID: PMC9783936 DOI: 10.3390/jcm11247518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The association of hypokalemia (LK) with peritoneal dialysis-associated peritonitis (PDAP) risk remains uncertain. Here, we calculated LK duration in the first PD year and evaluated its association with PDAP. METHODS A multicenter, retrospective, incident cohort study of 1633 participants was conducted from January 2008 to October 2020 in China. The duration of LK and severe hypokalemia (SLK) was calculated as the total number of months that a patient's serum potassium (SK) level was less than 3.5 or 3.0 mEq/L during the first PD year. The study outcome was the risk of subsequent PDAP started in the second year and later. Cox proportional hazards models and competing risk models were used to assess the association. RESULTS The subsequent PDAP occurred in 420 (25.7%) participants during a median of 28 months of follow-up. Overall, LK duration in the first year was positively associated with a subsequent PDAP risk (per 3-month increments, adjusted HR, 1.13; 95%CI: 1.05-1.23). After categorization, patients with LK duration longer than 6 months had the highest adjusted HR of 1.53 (p = 0.005 vs. those without LK) for subsequent PDAP risk. A similar trend was also found for SLK duration. In a competing risk model, a similar trend was also observed. None of the variables, including demographic and PD characteristics, diabetes history, and several clinical measurements, significantly modified this association. The causative organisms of PDAP were similar to those previously reported. CONCLUSIONS PD patients with longer LK duration in the first year had a higher subsequent PDAP risk.
Collapse
Affiliation(s)
- Zhihao Huo
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Qianqian Zhuo
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Shaoxin Zhong
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan 528308, China
| | - Fang Wang
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People’s Hospital), Ganzhou 341000, China
| | - Chao Xie
- Nephrology Department, The First People’s Hospital of Foshan, Foshan 528000, China
| | - Nirong Gong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Xiaohong Zhong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Zhixiu Yi
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
| | - Yaozhong Kong
- Nephrology Department, The First People’s Hospital of Foshan, Foshan 528000, China
| | - Dehui Liu
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People’s Hospital), Ganzhou 341000, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan 528308, China
| | - Guobao Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
- Correspondence: (G.W.); (J.A.); Tel.: +86-20-62787120 (G.W.); +86-20-62787120 (J.A.)
| | - Jun Ai
- Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
- National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou 510515, China
- Correspondence: (G.W.); (J.A.); Tel.: +86-20-62787120 (G.W.); +86-20-62787120 (J.A.)
| |
Collapse
|
10
|
Tillquist K, Floyd S, Shah AD. Peritoneal Dialysis Adequacy: Too Much of a Good Thing? KIDNEY360 2022; 3:1777-1779. [PMID: 36514734 PMCID: PMC9717664 DOI: 10.34067/kid.0000922022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/08/2022] [Indexed: 05/23/2023]
Affiliation(s)
- Kristen Tillquist
- Kent Hospital/Brown University Internal Medicine Residency, Warwick, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Stephanie Floyd
- Kent Hospital/Brown University Internal Medicine Residency, Warwick, Rhode Island
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ankur D Shah
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Kidney Disease and Hypertension, Department of Medicine, Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
11
|
Chen CH, Teitelbaum I. Peritoneal dialysis adequacy: a paradigm shift. Kidney Res Clin Pract 2022; 41:150-155. [PMID: 35286794 PMCID: PMC8995486 DOI: 10.23876/j.krcp.21.208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 11/21/2022] Open
Abstract
For the past 30 years, nephrologists have focused on a single minimal threshold of Kt/Vurea to determine the adequacy of peritoneal dialysis (PD). To date, there is no evidence that shows Kt/Vurea to be a good surrogate measure of uremic symptom control or nutritional state in patients on PD. Volume of distribution (Vurea) generally is considered equivalent to total body water (TBW). Yet, accurate determination of TBW is difficult. The most recent International Society for Peritoneal Dialysis practice recommendations on prescribing high-quality PD emphasized incorporation of multiple measures rather than the single value of Kt/Vurea. These measures include shared decision-making between the patient and the care team and assessment of health-related quality of life, burden of uremic symptoms, presence of residual kidney function, volume status, and biochemical measures including serum potassium and bicarbonate levels. In some cases, PD prescriptions can be tailored to the patient priorities and goals of care, such as in frail and pediatric patients. Overall, there has been a paradigm shift in providing high-quality care to PD patients. Instead of focusing on small solute clearance in the form of Kt/Vurea, nephrologists are encouraged to use a more comprehensive assessment of the patient as a whole.
Collapse
Affiliation(s)
- Chang Huei Chen
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Isaac Teitelbaum
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
12
|
Li D, Huo Z, Liu D, Gong N, Zhang F, Kong Y, Zhang Y, Su X, Xu Q, Feng J, Luo F, Wang C, Dou X, Sun G, Zhang D, Qin X, Zhang G, Lu F, Ai J. Current apparent treatment-resistant hypertension in patients undergoing peritoneal dialysis: A multi-center cross-sectional study. J Clin Hypertens (Greenwich) 2022; 24:493-501. [PMID: 35235248 PMCID: PMC8989747 DOI: 10.1111/jch.14455] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 01/09/2023]
Abstract
Apparent treatment‐resistant hypertension (aTRH) is the most commonly used term to report resistant hypertension (RH) and is considered as a common problem in dialysis population. However, few reports have focused on peritoneal dialysis (PD) hypertensive patients. The authors conducted a multi‐center cross‐sectional study involving 1789 PD patients from nine centers in Guangdong, China. The prevalence of aTRH was estimated by home blood pressure (BP) monitoring. Evaluating drug adherence through Eight‐item Morisky Medication Adherence Scale (MMAS‐8) and pill counting was performed to assess RH in one PD center. Related factors of aTRH were analyzed using logistic regression analysis. The prevalence of aTRH in PD patients was estimated at 42.2% (755 out of 1789 hypertensive patients) based on home BP. Of those, 91.4% patients were classified as uncontrolled RH, 2.0% as controlled RH, and 6.6% as refractory hypertension. The prevalence of RH was 40.6% and 41.9% among those with medium/high adherence based on the MMAS‐8 scores and the pill counting rate, respectively. PD patients who were younger, with higher body mass index, with lower serum albumin and poorer dialysis adequacy were significantly associated with higher aTRH incident. In conclusion, the present study demonstrates a high prevalence of aTRH in PD population, which occurs in about two in five treated hypertensive patients. Nutritional status and dialysis adequacy might tightly associate with aTRH.
Collapse
Affiliation(s)
- Dan Li
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China.,School of Nursing, Southern Medical University, Guangzhou, PR, China
| | - Zhihao Huo
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Danyang Liu
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Nirong Gong
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Fen Zhang
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Yaozhong Kong
- Nephrology Department, The First People's Hospital of Foshan, Foshan, PR, China
| | - Yunfang Zhang
- Department of Nephrology, Affiliated Huadu Hospital, Southern Medical University, Guangzhou, PR, China
| | - Xiaoyan Su
- Department of Nephrology, Tungwah Hospital, Sun Yat-sen University, Dongguan, PR, China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, PR, China
| | - Jiexia Feng
- Department of Nephrology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-sen University, Jiangmen, PR, China
| | - Fuzhang Luo
- Division of Nephrology, Nanhai District People's Hospital of Foshan, Foshan, PR, China
| | - Cheng Wang
- Division of Nephrology, Department of Medicine, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, PR, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, PR, China
| | - Guohui Sun
- Department of Nephrology, Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Difei Zhang
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR, China
| | - Xianhui Qin
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Guangqing Zhang
- Administrative Office, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| | - Fuhua Lu
- Department of Nephrology, Guangdong Provincial Hospital of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, PR, China
| | - Jun Ai
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, PR, China
| |
Collapse
|
13
|
Crabtree JH, Hathaway PB. Patient Selection and Planning for Image-Guided Peritoneal Dialysis Catheter Placement. Semin Intervent Radiol 2022; 39:32-39. [PMID: 35210730 PMCID: PMC8856782 DOI: 10.1055/s-0041-1741078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Image-guided percutaneous peritoneal dialysis (PD) catheter insertion has become increasingly relied upon to provide urgent access for late presenting kidney failure patients, to overcome surgical backlogs and limited operating room access, to avoid general anesthesia in high-risk patients, and, by itself, as an alternative approach to surgical PD access. Advanced planning for the procedure is essential to assure the best possible outcome. Appropriate selection of patients for percutaneous PD catheter placement, choosing the most suitable catheter type, determining insertion and exit site locations, and final patient preparations facilitate the performance of the procedure, minimizes the risk of complications, and improves the likelihood of providing a successful long-term peritoneal access.
Collapse
Affiliation(s)
- John H. Crabtree
- Division of Nephrology and Hypertension, Harbor-University of California Los Angeles Medical Center, Torrance, California,Address for correspondence John H. Crabtree, MD 340 South Lemon Avenue, Suite 2404, Walnut, CA
| | - Peter B. Hathaway
- Utah Imaging Associates, Inc., St. Marks Hospital Interventional Radiology, Salt Lake City, Utah
| |
Collapse
|
14
|
Huang LL, Mah JY, Howard J, Roberts MA, McMahon LP. Incremental peritoneal dialysis is a safe and feasible prescription in incident patients with preserved residual kidney function. Nephrology (Carlton) 2021; 27:74-81. [PMID: 34392587 DOI: 10.1111/nep.13962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/08/2021] [Accepted: 08/09/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Incremental peritoneal dialysis (PD) is recommended as a component of high-quality care by the international society for PD; however, its feasibility and clinical outcomes have not been widely reported. The aim of this study is to describe our experience with incremental PD. METHODS This was a retrospective cohort study of incident PD patients at Eastern Health between 2015 and 2019. Patients who stopped PD within 30 days were excluded. Incremental PD was defined in CAPD as using <8 L/day of exchange volume and in automated PD as dialysing without a last fill. Dialysis modality accorded with patient and physician preferences. RESULTS The 96 patients were included in this study; 54 with incremental PD. Compared to full-dose PD, incremental PD patients were more likely to be female, had less comorbid diabetes (28% vs. 52%) and higher residual kidney function (RKF) (Kt/V 2.0 ± 0.7 vs. 1.4 ± 0.7). Age, BMI and starting eGFR did not differ between groups. Incremental PD exposed patients to lower exchange volumes (4.4 ± 2.1 vs. 8.5 ± 1.1 L/day), glucose load (46 ± 41 g/day vs. 119 ± 46) and was associated with a longer peritonitis-free survival. PD technique survival, rates of peritonitis or hospitalization were comparable between groups. Predictors for longer incremental PD use included older age and higher starting eGFR. CONCLUSIONS Incremental PD is a feasible, goal-directed initial prescription in patients with RKF with comparable peritonitis rates and technique survival. Validation of this prescription in prospective studies is warranted.
Collapse
Affiliation(s)
- Louis L Huang
- Eastern Health Integrated Renal Service, Box Hill Hospital, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Jia Y Mah
- Eastern Health Integrated Renal Service, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Jennifer Howard
- Eastern Health Integrated Renal Service, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Matthew A Roberts
- Eastern Health Integrated Renal Service, Box Hill Hospital, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Lawrence P McMahon
- Eastern Health Integrated Renal Service, Box Hill Hospital, Box Hill, Victoria, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| |
Collapse
|
15
|
Sharma S, Bera S, Goyal VD, Gupta V, Bisht N. Ulnar-Basilic Arteriovenous Fistula for Hemodialysis Access: Utility as the "Second Procedure" after Radio Cephalic Fistula. Ann Vasc Dis 2021; 14:132-138. [PMID: 34239638 PMCID: PMC8241561 DOI: 10.3400/avd.oa.20-00124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/29/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: As per standard guidelines, the recommended order of arteriovenous fistula (AVF) creation for hemodialysis (HD) access is radiocephalic (RC), followed by proximal elbow fistulas and arteriovenous graft. Although ulnar-basilic (UB) fistula has been an alternative to RC-AVF, still this procedure searches clear recommendations. We present here our experience on UB-AVF as the preferred “second procedure” instead of proximal fistula after the RC-AVF. Methods: Forty-two UB-AVF were created in nonfeasible and failed RC-AVF cases between 2016 and 2018. They were reviewed retrospectively and outcomes were compared with 480 RC-AVF constructed within the same period. Results: The primary patency at 18 months was 73.8%, 69.6% and mean maturation time was 33.7±6.6 days, 32.1±4.7 days for UB-AVF and RC-AVF respectively (p>0.05). Conclusion: Our altered order of preference enabled us to create all the first-time fistula in the distal forearm, providing all the advantages of distal fistula like RC-AVF and avoiding proximal fistula, improved patient convenience and short-term benefit. In an inference that may be used for references and needs support from a larger sample and longer duration study from other centers, UB-AVF may be considered as the second option after RC-AVF depending on the clinical scenario.
Collapse
Affiliation(s)
- Shobhit Sharma
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly (UP)-243202, India
| | - Sudipta Bera
- Department of Plastic and Reconstructive Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi (UP), India
| | - Vikas Deep Goyal
- Department of Surgery, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly (UP)-243202, India
| | - Vivek Gupta
- Department of Plastic and Reconstructive Surgery, Sir Gangaram Hospital, New Delhi, India
| | - Navneeta Bisht
- Department of Anesthesia, Shri Ram Murti Samarak Institute of Medical Sciences, Bareilly (UP), India
| |
Collapse
|
16
|
Chanliau J, Durand PY. Lowering dialysis sessions duration may be dangerous. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i1.60263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysis session in less duration - either to give a better quality of life for the patient or to optimize the organization the dialysis institution - may have bad repercussions on the quality of the treatment and therefore the quality of life of the patient.
According to the result of the publications listed in this work, we conclude that it is necessary to perform either longer sessions or more frequent treatments to limit the interval time between two sessions.
As this is difficult to perform by the providers, we recommend to develop home dialysis to obtain the best result.
Collapse
|
17
|
Hsu CY, Parikh RV, Pravoverov LN, Zheng S, Glidden DV, Tan TC, Go AS. Implication of Trends in Timing of Dialysis Initiation for Incidence of End-stage Kidney Disease. JAMA Intern Med 2020; 180:1647-1654. [PMID: 33044519 PMCID: PMC7551228 DOI: 10.1001/jamainternmed.2020.5009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE In the last 2 decades, there have been notable changes in the level of estimated glomerular filtration rate (eGFR) at which patients initiate long-term dialysis in the US and around the world. How changes over time in the likelihood of dialysis initiation at any given eGFR level in at-risk patients are associated with the population burden of end-stage kidney disease (ESKD) has not been not well defined. OBJECTIVE To examine temporal trends in long-term dialysis initiation by level of eGFR and to quantify how these patterns are associated with the number of patients with ESKD. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study analyzing data obtained from a large, integrated health care delivery system in Northern California from 2001 to 2018 in successive 3-year intervals. Included individuals, ranging in number from as few as 983 122 (2001-2003) to as many as 1 844 317 (2016-2018), were adult members with 1 or more outpatient serum creatinine levels determined in the prior year. MAIN OUTCOMES AND MEASURES One-year risk of initiating long-term dialysis stratified by eGFR levels. Multivariable logistic regression was performed to assess temporal trends in each 3-year cohort with adjustment for age, sex, race, and diabetes status. The potential change in dialysis initiation in the final cohort (2016-2018) was estimated using the relative difference between the standardized risks in the initial cohort (2001-2003) and the final cohort. RESULTS In the initial 3-year cohort, the mean (SD) age was 55.4 (16.3) years, 55.0% were women, and the prevalence of diabetes was 14.9%. These characteristics, as well as the distribution of index eGFR, were stable across the study period. The likelihood of receiving dialysis at eGFR levels of 10 to 24 mL/min/1.73 m2 generally increased over time. For example, the 1-year odds of initiating dialysis increased for every 3-year interval by 5.2% (adjusted odds ratio, 1.052; 95% CI, 1.004-1.102) among adults with an index eGFR of 20 to 24 mL/min/1.73 m2, by 6.6% (adjusted odds ratio, 1.066; 95% CI, 1.007-1.130) among adults with an eGFR of 16 to 17 mL/min/1.73 m2, and by 5.3% (adjusted odds ratio, 1.053; 95% CI, 1.008-1.100) among adults with an eGFR of 10 to 13 mL/min/1.73 m2, adjusting for age, sex, race, and diabetes. The incidence of new cases of ESKD was estimated to have potentially been 16% (95% CI, 13%-18%) lower if there were no changes in system-level practice patterns or other factors besides timing of initiating long-term dialysis from the initial 3-year interval (2001-2003) to the final interval (2016-2018) assessed in this study. CONCLUSIONS AND RELEVANCE The present results underscore the importance the timing of initiating long-term dialysis has on the size of the population of individuals with ESKD.
Collapse
Affiliation(s)
- Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco.,Division of Research, Kaiser Permanente Northern California, Oakland
| | - Rishi V Parikh
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Leonid N Pravoverov
- Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California
| | - Sijie Zheng
- Division of Research, Kaiser Permanente Northern California, Oakland.,Department of Nephrology, Kaiser Permanente Oakland Medical Center, Oakland, California.,Division of Medical Education, Department of Medicine, University of California, San Francisco, San Francisco
| | - David V Glidden
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco
| | - Thida C Tan
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Alan S Go
- Division of Nephrology, Department of Medicine, University of California, San Francisco, San Francisco.,Division of Research, Kaiser Permanente Northern California, Oakland.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco.,Department of Medicine, Stanford University, Stanford, California.,Department of Health Research and Policy, Stanford University, Stanford, California
| |
Collapse
|
18
|
Gong N, Xiao Z, Zhang F, Zhong X, He Y, Yi Z, Tang D, Yang C, Lin Y, Nie J, Ai J. Duration of Serum Phosphorus Control Associated with Overall Mortality in Patients Undergoing Peritoneal Dialysis. KIDNEY DISEASES (BASEL, SWITZERLAND) 2020; 6:434-443. [PMID: 33313064 PMCID: PMC7706521 DOI: 10.1159/000507785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Serum phosphorus (SP) level is closely associated with overall mortality and cardiovascular events, while the role of SP controlled duration is not fully recognized. Here, we conducted a retrospective cohort study in our department to identify the relationship of SP controlled duration with clinical outcomes in patients undergoing peritoneal dialysis (PD). METHODS PD patients in our center from January 1, 2009, to June 30, 2019, were followed up at 2-month (the first year) or 5-month (the next follow-up period) intervals, and until death, until PD withdrawal, or until June 30, 2019. Data at each follow-up point were collected from their medical records. SP levels, changed degree of SP over baseline, and SP controlled duration were analyzed with overall mortality, PD withdrawal (including death, transferred to hemodialysis, and received renal transplantation), and combined endpoint (including death, acute heart failure, cardiovascular event, and stroke). RESULTS A total of 530 patients entered the analysis. Of them, 456 (86.0%) had hyperphosphatemia before dialysis, and the SP levels decreased soon after dialysis. The degree of SP change over baseline was the maximum at the 3rd month after dialysis (-31.0%), and lower degree was associated with higher overall mortality (hazard ratio [HR], 1.012; 95% CI, 1.004-1.020; p = 0.003). The median SP controlled duration was 13 (5-28) months, and longer duration was significantly associated with lower overall mortality (HR, 0.968; 95% CI, 0.956-0.981; p < 0.001). After categorization, duration more than 12 months greatly improved overall mortality with a HR of 0.197 (0.082-0.458; p < 0.001 vs. SP never controlled group) and 0.329 (0.150-0.724; p = 0.006 vs. duration <12 months group). Longer SP controlled duration also improved PD withdrawal and combined endpoint. CONCLUSIONS In summary, both degree and duration of SP control were tightly associated with overall mortality. We should control SP levels as early, as possible, and as long as we could.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jun Ai
- State Key Laboratory of Organ Failure Research, National Clinical Research Center of Kidney Disease, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
19
|
Wan ZM, Hu B, Lai QQ, Gao XJ, Tu B, Zhou Y, Zhao WB. Radial artery diameterand and age related functional maturation of the radio-cephalic arteriovenous fistula. BMC Nephrol 2020; 21:234. [PMID: 32571240 PMCID: PMC7310035 DOI: 10.1186/s12882-020-01883-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Previous studies have not described the relationship between reducing radial artery diameter as well as increasing age and functional maturation of the radio-cephalic arteriovenous fistula (RCAVF) and no data identify these as linear relationship. The objective of this study was to perform trend analysis to assess these aspects. Methods Our retrospective cohort study enrolled and analyzed 353 follow-up cases that underwent first AVF creation. The artery and vein sizes were measured by ultrasound. We performed follow-up, a minimum of 3 months after surgery. Multivariable logistic regression analysis was used to identify independent risk factors inmaturation. Participant age was categorized into four groups (age ≤ 29, 30–49, 50–69, and 70–90 years). Radial artery diameter was categorized into four groups (≤ 1.9, >1.9 and ≤ 2.1, >2.1 and ≤ 2.4, >2.4 mm) according to median and interquartile ranges. We adjusted for confounders in four logistic models, and primary analyses were based on building ordered category models and tested P values for trends to estimate the relationship of radial artery diameter and each 20-year increase in age with risk of maturation. Results The mature RCAVF group included 301 cases, and the immature group included 52 cases. Radial artery diameter, age, and diabetes were independent risk factors of maturation. Odds ratios (ORs) associated with maturation reduced with increasing age, while ORs increased with increasing radial artery diameter. P values for trends(<0.05) were observed in all four models. A reduction in radial artery diameter and higher age were significantly associated with a higher incidence of immaturity after adjusting the multivariate models. The risks of immaturation were increased by more than 1.54 fold for each 20-year increase and increased by more than 1.34 fold for the smaller radial artery diameter group. Conclusion Our findings suggest that a significantly higher immaturity risk of RCAVF was associated with increasing age and a reduction in radial artery diameter. Our study identified a linear exposure-response relationship of age and radial artery diameter with immaturity incident. A careful selection of patients will be helpful in improving AVF functional maturation.
Collapse
Affiliation(s)
- Zi-Ming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Bo Hu
- Department of Nephrology, The First Affiliated Hospital of Jinan University , Guangzhou, China
| | - Qi-Quan Lai
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Xue-Jing Gao
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China
| | - Bo Tu
- Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhou
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Youyi Road 1, Chongqing, 400042, China.
| | - Wen-Bo Zhao
- Department of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Tianhe Road NO.600, Guangzhou, 510632, China.
| |
Collapse
|
20
|
Bonnal H, Bechade C, Boyer A, Lobbedez T, Guillouët S, Verger C, Ficheux M, Lanot A. Effects of educational practices on the peritonitis risk in peritoneal dialysis: a retrospective cohort study with data from the French peritoneal Dialysis registry (RDPLF). BMC Nephrol 2020; 21:205. [PMID: 32471380 PMCID: PMC7260816 DOI: 10.1186/s12882-020-01867-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/25/2020] [Indexed: 12/02/2022] Open
Abstract
Background Peritoneal dialysis (PD) is a home-based therapy performed by patients or their relatives in numerous cases, and the role of patients’ educational practices in the risk of peritonitis is not well assessed. Our aim was to evaluate the effect of PD learning methods on the risk of peritonitis. Methods This was a retrospective multicentric study based on data from a French registry. All incident adults assisted by family or autonomous for PD exchanges in France between 2012 and 2015 were included. The event of interest was the occurrence of peritonitis. Cox and hurdle regression models were used for statistical analysis to asses for the survival free of peritonitis, and the risk of first and subsequent peritonitis. Results 1035 patients were included. 967 (93%) received education from a specialized nurse. Written support was used for the PD learning in 907 (87%) patients, audio support in 221 (21%) patients, and an evaluation grid was used to assess the comprehension in 625 (60%) patients. In the “zero” part of the hurdle model, the use of a written support and starting PD learning with hands-on training alone were associated with a lower survival free of peritonitis (respectively HR 1.59, 95%CI 1.01–2.5 and HR 1.94, 95%CI 1.08–3.49), whereas in the “count” part, the use of an audio support and starting of PD learning with hands-on training in combination with theory were associated with a lower risk of presenting further episodes of peritonitis after a first episode (respectively HR 0.55, 95%CI 0.31–0.98 and HR 0.57, 95%CI 0.33–0.96). Conclusions The various PD education modalities were associated with differences in the risk of peritonitis. Prospective randomized trials are necessary to confirm causal effect. Caregivers should assess the patient’s preferred learning style and their literacy level and adjust the PD learning method to each individual.
Collapse
Affiliation(s)
- Hélène Bonnal
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Clémence Bechade
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Annabel Boyer
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Thierry Lobbedez
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France.,RDPLF, 30 Rue Sere Depoin, 95 300, Pontoise, France
| | - Sonia Guillouët
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France
| | | | - Maxence Ficheux
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France
| | - Antoine Lanot
- Normandie Univ, UNICAEN, CUMR, CHU de Caen Normandie, Néphrologie, Avenue de la cote de nacre, 14033, Caen-Cedex, France. .,U1086 INSERM - ANTICIPE - Centre Régional de Lutte Contre le Cancer François Baclesse, Caen, France.
| |
Collapse
|
21
|
Jaques DA, Davenport A. Characterization of sodium removal to ultrafiltration volume in a peritoneal dialysis outpatient cohort. Clin Kidney J 2020; 14:917-924. [PMID: 33777375 PMCID: PMC7986363 DOI: 10.1093/ckj/sfaa035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 02/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background Failure to control volume is the second most common cause of peritoneal dialysis (PD) technique failure. Sodium is primarily removed by convection, but according to the three-pore model, water and sodium movements are not necessarily concordant. We wished to determine factors increasing sodium to water clearance in clinical practice. Methods We reviewed 24-h peritoneal dialytic sodium removal (DSR) and ultrafiltration (UF) volume in consecutive PD patients attending for routine assessment of peritoneal membrane function and adequacy testing. We used a regression model with the DSR/UF ratio as the dependent variable. A second model with DSR as the dependent variable and interaction testing for UF was used as sensitivity analysis. Results We included 718 adult PD patients. Mean values were 51.8 ± 64.6 mmol/day and 512 ± 517 mL/day for DSR and UF, respectively. In multivariable analysis, DSR/UF ratio was positively associated with transport type (fast versus slow, P < 0.001), serum sodium (P < 0.001) and diabetes (P = 0.026), and negatively associated with PD mode [automated PD versus continuous ambulatory PD (CAPD), P < 0.001] and the use of 2.27% glucose dialysate (P < 0.001). Sensitivity analysis showed positive interaction with UF for transport type (P < 0.001) and serum sodium (P = 0.032) and negative interaction for PD mode (P < 0.001) and cycles number (P < 0.001). Conclusions CAPD, fast transport and high serum sodium allow relatively more sodium to be removed compared with water. Icodextrin has no effect on sodium removal once confounders have been accounted for. Although widely used in the assessment of PD patients, UF should not be considered as a surrogate for DSR in clinical practice.
Collapse
Affiliation(s)
- David A Jaques
- Division of Nephrology, Geneva University Hospitals, Geneva, Switzerland.,UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
| |
Collapse
|
22
|
Navaratnarajah A, Clemenger M, McGrory J, Hisole N, Chelapurath T, Corbett RW, Brown EA. Flexibility in peritoneal dialysis prescription: Impact on technique survival. Perit Dial Int 2020; 41:49-56. [DOI: 10.1177/0896860820911521] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Patient burnout is a major cause of technique failure on peritoneal dialysis (PD). Reducing the PD prescription on an individual basis, dependent upon residual kidney function (RKF), may have a role in prolonging time on PD by reducing dialysis burden. This retrospective study aimed to determine the safety and impact of flexible PD prescribing on technique and patient survival. Methods: All patients (186) from our centre starting PD from 1st January 2012 to 31st December 2016 were included. Data on dialysis prescription were collected for each patient from the time they had started PD, and dialysis adequacy measured regularly (3–6 monthly) using PD Adequest. Results: Median age at start of dialysis was 61 years. Only 49% started on PD 7 days a week and this dropped to 27% at 3 months following the first clearance test. Over 90% achieved creatinine clearance > 50 L/week/1.73 m2 up to 2 years of follow-up, with 87% achieving this standard at 3 years. Patient and technique survival at 1, 2 and 3 years were 91%, 81%, and 72%, and 89%, 87% and 78% respectively. Factors on univariate analysis affecting technique survival included increasing age (HR 0.98, p = 0.04, 95% CI (0.96–0.999)), two or more episodes of PD-associated peritonitis (HR 4.52, p = 0.00, 95% CI (1.87–10.91)) and increasing PD intensity (HR 3.30, p = 0.02, 95% CI (1.22–8.93)). After multivariate adjustment which included baseline kidney function, low PD intensity continued to be associated with better technique survival (HR 0.17, p = 0.03, 95% CI (0.03–0.85)). Conclusion: Tailoring the PD prescription to RKF enables days off dialysis while still maintaining recommended levels of small solute clearance. This approach reduces dialysis burden and is associated with higher technique survival.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Edwina A Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| |
Collapse
|
23
|
Haraldsson B. Optimization of Peritoneal Dialysis Prescription Using Computer Models of Peritoneal Transport. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Computer models are valuable clinical tools in the effort to improve quality of life for dialysis patients. At present, two software programs have been validated clinically in adult and pediatric populations. They are the Personal Dialysis Capacity (PDC: Gambro Lundia AB, Lund, Sweden) and PD Adequest (Baxter Healthcare Corporation, Deerfield, IL, U.S.A.). Both programs seem to give accurate predictions of small-solute clearance, but the PDC seems to be superior in predicting ultrafiltration volumes. Indeed, the software programs have several important differences that affect their accuracy and, hence, their clinical value. The PDC software introduces the concepts of capillary physiology to the field of peritoneal dialysis. It gives a functional description of the peritoneal membrane of the individual patient. Recently, its “new” area parameter (A0/Δx) was shown to be superior to the peritoneal equilibration test (PET) in predicting transperitoneal exchange.
Collapse
Affiliation(s)
- Börje Haraldsson
- Department of Nephrology, Sahlgrenska University Hospital, Göteborg, Sweden
| |
Collapse
|
24
|
Affiliation(s)
- Tao Wang
- Institute of Nephrology First Hospital, Peking University Beijing, P.R. China
- Divisions of Baxter Novum and Renal Medicine Karolinska Institutet Huddinge University Hospital Stockholm, Sweden
| | - Bengt Lindholm
- Divisions of Baxter Novum and Renal Medicine Karolinska Institutet Huddinge University Hospital Stockholm, Sweden
| |
Collapse
|
25
|
Noh H, Song HY, Kang SW, Choi KH, Lee HY, Han DS. Impact of Total Solute Clearance on Clinical Outcomes in Korean CAPD Patients. Perit Dial Int 2020. [DOI: 10.1177/089686080002000315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hyunjin Noh
- Division of Nephrology Department of Internal Medicine Institute of Kidney Disease Yonsei University College of Medicine Seoul, Korea
| | - Hyun Yong Song
- Division of Nephrology Department of Internal Medicine Institute of Kidney Disease Yonsei University College of Medicine Seoul, Korea
| | - Shin Wook Kang
- Division of Nephrology Department of Internal Medicine Institute of Kidney Disease Yonsei University College of Medicine Seoul, Korea
| | - Kyu Hun Choi
- Division of Nephrology Department of Internal Medicine Institute of Kidney Disease Yonsei University College of Medicine Seoul, Korea
| | - Ho Yung Lee
- Division of Nephrology Department of Internal Medicine Institute of Kidney Disease Yonsei University College of Medicine Seoul, Korea
| | - Dae Suk Han
- Division of Nephrology Department of Internal Medicine Institute of Kidney Disease Yonsei University College of Medicine Seoul, Korea
| |
Collapse
|
26
|
Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Dempster J, Fraenkel MB, Harris A, Harris DC, Johnson DW, Kesselhut J, Luxton G, Pilmore A, Pollock CA, Tiller DJ. The Initiating Dialysis Early and Late (Ideal) Study: Study Rationale and Design. Perit Dial Int 2020. [DOI: 10.1177/089686080402400209] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives The primary objective of the IDEAL study is to determine whether the timing of dialysis initiation has an effect on survival in subjects with end-stage renal disease (ESRD). The secondary objectives are to determine the impact of “early start” versus “late start” dialysis on nutritional and cardiac morbidity, quality of life, and economic cost. Design Prospective multicenter randomized controlled trial. Patients are randomized to commence dialysis at a glomerular filtration rate (by Cockcroft–Gault) of either 10 – 14 mL/minute/1.73 m2 (“early start”) or 5 – 7 mL/min/1.73 m2 (“late start”), with stratification for dialysis modality (hemodialysis vs peritoneal dialysis), study center, and the presence or not of diabetes mellitus. Setting Dialysis units throughout Australia and New Zealand. Patients Patients with ESRD commencing chronic dialysis therapy. Outcome Measures Three years from randomization, all-cause mortality, morbidity, and economic impact; structural and functional cardiac status, nutritional state, and quality of life will be assessed. Results To date, 388 patients of a minimum 800 patients have been entered and randomized into the study. Current recruitment rates suggest sufficient patients will be enrolled by December 2004 and follow-up completed by December 2007. Conclusions The IDEAL study will provide evidence for the optimal time to commence dialysis.
Collapse
Affiliation(s)
| | - Bruce A. Cooper
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Pauline Branley
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Liliana Bulfone
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - John F. Collins
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Jonathan C. Craig
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Jenny Dempster
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Margaret B. Fraenkel
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Anthony Harris
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - David C. Harris
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - David W. Johnson
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Joan Kesselhut
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Grant Luxton
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Andrew Pilmore
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - Carol A. Pollock
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| | - David J. Tiller
- Department of Renal Medicine, Kolling Institute of Medical Research, Royal North Shore Hospital, University of Sydney, New South Wales, Australia
| |
Collapse
|
27
|
Edefonti A, Picca M, Paglialonga F, Loi S, Grassi MR, Ardissino G, Marra G, Ghio L, Fossali E. A Novel Objective Nutritional Score for Children on Chronic Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080202200511] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives To establish a novel nutritional score based on a series of objective parameters capable of detecting protein-calorie malnutrition in children being treated with chronic peritoneal dialysis (CPD), to test the score in a healthy pediatric population, and to apply it to children on CPD to evaluate their nutritional status. Study Population 264 healthy school children (mean age 8.69 ± 3.26 years, range 3.05 – 14.98 years) and 29 patients treated with CPD for 1.75 ± 1.02 years (mean age 10.54 ± 6.28 years, range 2.8 – 15.24 years). Methods Nutritional status was evaluated by means of three sets of measurements: anthropometric (A1 and A2) and bioimpedance analysis (BIA) measurements. Anthropometry included two sets of measures: set A1 consisted of height (H), weight (W), and body mass index (BMI); set A2 consisted of midarm muscle circumference (MAMC), arm muscle area (AMA), and arm fat area (AFA). The BIA measurements included reactance, phase angle, and distance. All parameters are expressed as standard deviation scores (SDS). Tanner's, Rolland–Cachera's, and Frisancho's data were used as references for H, W, BMI, MAMC, AMA, and AFA; personal data obtained from 551 healthy boys and girls were used for the BIA indices. The nine anthropometry and BIA parameters were given scores of 1 to 5: 5 = > 0 SDS, 4 = ≤ 0 and > –1 SDS, 3 = ≤ –1 and > –2 SDS, 2 = ≤ –2 and > –3 SDS, and 1 = ≤ –3 SDS. Average scores were established for each of A1, A2, and BIA, and then summed to obtain the anthropometry–BIA nutrition (ABN) score. To establish the cutoff value between normal nutritional status and malnutrition, the method was first applied to the 264 healthy children; distribution percentiles were calculated for each area score and the ABN score. The ABN score corresponding to the 3rd percentile was considered the limit of normality and then applied three times to the 29 children on CPD, for a total of 87 nutritional assessments. Results The score corresponding to the 3rd percentile in the population of healthy children was 10.33. Among the CPD-treated children, 41.4% of the ABN scores were higher than 10.33 (indicating a state of normal nutrition) and 58.6% were lower (indicating various degrees of malnutrition). Severe malnutrition was found in only 1.1% of the cases. The values of all nine A1, A2, and BIA parameters, as well as serum albumin levels, were significantly higher in patients with an ABN score > 10.33 than in those with a score < 10.33. Conclusion The ABN score is a simple and objective method of assessing, in clinical practice, the nutritional status of children on CPD.
Collapse
Affiliation(s)
- Alberto Edefonti
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Marina Picca
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Fabio Paglialonga
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Silvana Loi
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Maria Rosa Grassi
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Gianluigi Ardissino
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Giuseppina Marra
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Luciana Ghio
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| | - Emilio Fossali
- Pediatric Renal Unit, First Department of Pediatrics, University of Milan Medical School, Milan, Italy
| |
Collapse
|
28
|
Ekim M, Ikinciogullari A, Ulukol B, Bakkaloglu SA, Ozkaya N, Kendirli T, Adiyaman P, Babacan E, Ocal G. Evaluation of Nutritional Status and Factors Related to Malnutrition in Children on CAPD. Perit Dial Int 2020. [DOI: 10.1177/089686080302300607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveThe aim of this study was to investigate the nutritional status of children on continuous ambulatory peritoneal dialysis (CAPD) and to relate it to the dose of dialysis and serum levels of inflammatory cytokines and insulin-like growth factor-1 (IGF-1).Patients17 CAPD patients (8 girls, 9 boys; mean age 13.1 ± 3.5 years, median 15 years) were included in the study. Anthropometric measurements and serum albumin levels were used in the evaluation of nutritional status. Serum interleukin (IL)-1β, IL-6, tumor necrosis factor α, and IGF-1 levels were determined in all CAPD patients and in a healthy control group. Weekly Kt/V and creatinine clearance (CCr) were measured to determine adequacy of dialysis.ResultsThe mean dialysis period was 23.7 ± 15.2 months (median 23 months). Anthropometric measurements and serum albumin level were as follows: height 130.2 ± 15.6 cm, height standard deviation score (HtSDS) -4.2 ± 2.4, body mass index (BMI) 16.3 ± 1.6 kg/m2, body mass index standard deviation score (BMISDS) -0.8 ± 0.9, triceps skinfold thickness (TST) 4.2 ± 1.4 mm, midarm circumference (MAC) 16.21 ± 2.3 cm, upper arm muscle area (AMA) 1799.1 ± 535.7 mm2, upper arm fat area (AFA) 334.5 ± 143 mm2, and serum albumin 3.1 ± 0.7 g/dL. The BMI was above the fifth percentile in all patients; TST and MAC were below the fifth percentile in 14 patients (82.4%) and 10 patients (58.8%) respectively. The AMA was below the fifth percentile in 8 patients; however, the AFA was below the fifth percentile in all patients. Mean serum albumin level was under 3.5 g/dL in 70.5% of the children. We found significant positive correlations between BMI and Kt/V ( r = 0.69, p < 0.01), CCr ( r = 0.64, p < 0.05), and IL-6 ( r = 0.61, p < 0.01). There was an inverse correlation between BMISDS and dialysis period ( r = -0.58, p < 0.05); and between IL-6 and serum albumin ( r = -0.49, p < 0.05). A significant positive correlation between BMISDS and serum IGF-1 level ( r = 0.62, p < 0.01) was noted. We also found a significant positive correlation between serum IGF-1 level and both HtSDS ( r = 0.57, p < 0.05) and TST ( r = 0.52, p < 0.05). Significant positive correlations between AFA and CCr and IGF-1 were also noted (both r = 0.56, p < 0.05).ConclusionAlthough many factors may be responsible for malnutrition and growth retardation, we found that prolonged period of dialysis, inadequate dialysis, and low IGF-1 levels are the most important risk factors in CAPD patients.
Collapse
Affiliation(s)
- Mesiha Ekim
- Departments of Pediatric Nephrology, School of Medicine, Ankara University, Ankara, Turkey
| | - Aydan Ikinciogullari
- Pediatric Immunology and Allergy, School of Medicine, Ankara University, Ankara, Turkey
| | - Betul Ulukol
- Pediatrics, School of Medicine, Ankara University, Ankara, Turkey
| | - Sevcan A. Bakkaloglu
- Departments of Pediatric Nephrology, School of Medicine, Ankara University, Ankara, Turkey
| | - Nuray Ozkaya
- Departments of Pediatric Nephrology, School of Medicine, Ankara University, Ankara, Turkey
| | - Tanil Kendirli
- Pediatrics, School of Medicine, Ankara University, Ankara, Turkey
| | - Pelin Adiyaman
- Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| | - Emel Babacan
- Pediatric Immunology and Allergy, School of Medicine, Ankara University, Ankara, Turkey
| | - Gonul Ocal
- Pediatric Endocrinology, School of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
29
|
Jung B, Blake PG, Mehta RL, Mendelssohn DC. Attitudes of Canadian Nephrologists toward Dialysis Modality Selection. Perit Dial Int 2020. [DOI: 10.1177/089686089901900313] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To determine the opinions and attitudes of Canadian nephrologists about dialysis modality decisions and optimal dialysis system design. Participants Members of the Canadian Society of Nephrology. Intervention A mailed survey questionnaire. Results A 66% response rate was obtained. Decisions about modality are reported to be based most strongly on patient preference (4.4 on a scale from 1 to 5), followed by quality of life (4.06), morbidity (3.97), mortality (3.85), and rehabilitation (3.69), while neither facility (1.78) nor physician (1.62) reimbursement are important. When asked about the current relative utilization of each modality, nephrologists felt that hospital-based hemodialysis (HD) is slightly overutilized (2.53), continuous ambulatory peritoneal dialysis (CAPD) is about right (3.00), while cycler peritoneal dialysis (PD) (3.53), community-based full (3.83) and self-care HD (3.91), and home HD (4.02) are underutilized. A hypothetical question about optimal distribution to maximize survival revealed that a type of HD should constitute 62.8% of the mix, with more emphasis on cycler PD (14.9%), community-based full care HD (13.8%), self-care HD (14.5%), and home HD (9.0%) than is current practice. However, when the goal was to maximize cost effectiveness, HD fell slightly to 57.8%. Conclusions These survey results suggest that the current national average 66%/34% HD/PD ratio is reasonable. However, there appears to be a consensus that Canada could evolve to a more cost-effective, community-based dialysis system without compromising patient outcomes.
Collapse
Affiliation(s)
- Beverly Jung
- Division of Nephrology, University of Toronto, Toronto
| | | | - Ravindra L. Mehta
- Division of Nephrology, University of California at San Diego, San Diego, California, U.S.A
| | | |
Collapse
|
30
|
Brown EA, Davies SJ, Heimbürger O, Meeus F, Mellotte G, Rosman J, Rutherford P, Van Bree M, Borras M, Brown E, Caillette–Beaudoin A, Clutterbuck E, Davies S, D'Auzac C, Ekstrand A, Frandsen N, Freida P, Heimbürger O, Kuypers+ D, Gasthuisberg+ A, Mactier R, MacNamara E, Malmsten G, Mastrangelo F, Meeus F, Melotte G, Perez–Contreras J, Riegel W, Rodrigues A, Rodriguez–Carmona A, Rosman J, Rutherford P, Scanziani R, Vega Diaz N, Vychytil A, Weinreich T. Adequacy Targets Can be Met in Anuric Patients by Automated Peritoneal Dialysis: Baseline Data from Eapos. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s19] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
♦ Objective Conventional continuous ambulatory peritoneal dialysis (CAPD) in patients without residual renal function and with high solute transport is associated with worse clinical outcomes. Automated peritoneal dialysis (APD) has the potential to improve both solute clearance and ultrafiltration in these circumstances, but its efficacy as a treatment modality is unknown. The European Automated Peritoneal Dialysis Outcomes Study (EAPOS) is a 2-year, prospective, European multi-center study designed to determine APD feasibility and clinical outcomes in anuric patients. The present article describes the baseline data for patients recruited into the study. ♦ Design All PD patients treated in the participating centers were screened for inclusion criteria [urinary output < 100 mL/24 h, or residual renal function (RRF) < 1 mL/min, or both]. After enrollment, changes were made to the dialysis prescription to achieve a weekly creatinine clearance above 60 L per 1.73 m2 and an ultrafiltration rate above 750 mL in 24 hours. ♦ Setting The study is being conducted in 26 dialysis centers in 13 European countries. ♦ Baseline Data Collection The information collected includes patient demographics, dialysis prescription, achieved weekly creatinine clearance, and 24-hour ultra-filtration (UF). ♦ Results The study enrolled 177 anuric patients. Median dialysis duration before enrollment was 22.5 months (range: 0 – 285 months). Mean solute transport measured as the dialysate-to-plasma ratio of creatinine (D/PCr) was 0.74 ± 0.12. Patients received APD for a median of 9.0 hours overnight (range: 7 – 12 hours) using a median of 11.0 L of fluid (range: 6 – 28.75 L). Median daytime volume was 4.0 L (range: 0.0 – 9.0 L). Tidal dialysis was used in 26 patients, and icodextrin in 86 patients. At baseline, before treatment optimization, the weekly mean total creatinine clearance was 65.2 ± 14.4 L/1.73 m2, with 105 patients (60%) achieving the target of more than 60 L/1.73 m2. At baseline, 81% of patients with high transport, 69% with high-average transport, and 40% with low-average transport met the target. At baseline, 70% of patients with a body surface area (BSA) below 1.7 m2, 60% with a BSA of 1.7 – 2.0 m2, and 56% with a BSA above 2.0 m2 achieved 60 L/1.73 m2 weekly. Median UF was 1090 mL/24 h, and 75% of patients achieved the UF target of more than 750 mL/24 h. ♦ Conclusion This baseline analysis of anuric patients recruited into the EAPOS study demonstrates that a high proportion of anuric patients on APD can achieve dialysis and ultrafiltration targets using a variety of regimes. This 2-year follow-up study aims to optimize APD prescription to reach predefined clearance and ultrafiltration targets, and to observe the resulting clinical outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - M. Borras
- Hospital Amau de Vilanova, Lerida, Spain
| | - E. Brown
- Charing Cross Hospital, London, U.K
| | | | | | - S. Davies
- North Staffordshire Hospital, Stoke-on-Trent, U.K
| | - C. D'Auzac
- Hôpital Européen Georges Pompidou, Paris, France
| | - A. Ekstrand
- Helsinki University Hospital, Helsinki, Finland
| | | | - P. Freida
- Centre Hospitalier Louis Pasteur, Cherbourg, France
| | | | | | | | - R. Mactier
- Stobhill Hospital NHS Trust, Glasgow, Scotland, U.K
| | - E. MacNamara
- Centre Hospitalier Germon et Gauthier, Bethune, France
| | - G. Malmsten
- Orebro Medical Center Hospital, Orebro, Sweden
| | | | - F. Meeus
- Centre Hospitalier Louise Michel Evry, Evry, France
| | | | | | - W. Riegel
- Klinikum Darmstadt, Darmstadt, Germany
| | | | | | - J. Rosman
- Westeinde Hospital, The Hague, Netherlands
| | | | | | - N. Vega Diaz
- Hospital Nuestra Senora del Pino, Las Palmas, Spain
| | - A. Vychytil
- Universitat Klinik für Innere Medezin III, Vienna, Austria
| | - T. Weinreich
- Dialyse Institüt Villingen– Schwenningen, Schwenningen, Germany
| | | |
Collapse
|
31
|
Davies SJ, Brown EA. What have we Learned about PD from Recent Major Clinical Trials? Perit Dial Int 2020. [DOI: 10.1177/089686080702700205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Simon J. Davies
- Department of Nephrology, University Hospital of North Staffordshire, Stoke-on-Trent West London
| | - Edwina A. Brown
- Renal and Transplant Centre, Hammersmith Hospital, London, United Kingdom
| |
Collapse
|
32
|
Affiliation(s)
- Salim Mujais
- Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| | - Edward Vonesh
- Baxter Healthcare Corporation, McGaw Park, Illinois, USA
| |
Collapse
|
33
|
Johnson DW, Mudge DW, Blizzard S, Arndt M, O'Shea A, Watt R, Hamilton J, Cottingham S, Isbel NM, Hawley CM. A Comparison of Peritoneal Equilibration Tests Performed 1 and 4 Weeks after PD Commencement. Perit Dial Int 2020. [DOI: 10.1177/089686080402400511] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
ObjectiveThe aim of this study was to prospectively evaluate the ability of a peritoneal equilibration test (PET) performed in the first week of peritoneal dialysis (PD) to predict subsequent transport status, as determined by a PET at 4 weeks and >1 year after PD commencement.DesignProspective observational study of an incident PD cohort at a single center.SettingTertiary-care institutional dialysis center.ParticipantsThe study included 50 consecutive patients commencing PD at the Princess Alexandra Hospital between 25/2/2001 and 14/5/2003 (mean age 60.9 ± 12.2 years, 54% male, 92% Caucasian, 38% diabetic). All patients were initially prescribed continuous ambulatory PD.Main MeasurementsMeasurements performed during paired PETs included dialysate-to-plasma ratios of urea (D/P urea) and creatinine (D/P creatinine) at 4 hours, the ratio of dialysate glucose concentrations at 0 and 4 hours (D/D0glucose), and drain volumes at 4 hours.ResultsWhen paired 1-week and 1-month PET data were analyzed, significant changes were observed in measured D/P urea (0.91 ± 0.07 vs 0.94 ± 0.07 respectively; p < 0.05), D/P creatinine (0.55 ± 0.12 vs 0.66 ± 0.11, p < 0.001), and D/D0glucose (0.38 ± 0.08 vs 0.36 ± 0.10, p < 0.05). Using Bland–Altman analysis, the repeatability coefficients were 0.17, 0.20, and 0.13, respectively. Agreement between 1-week and 1-month PET measurements with respect to peritoneal transport category was moderate for D/D0glucose (weighted κ 0.52), but poor for D/P urea (0.30), D/P creatinine (0.35), and drain volumes (0.20). The PET measurements performed more than 1 year following PD commencement ( n = 28) generally agreed closely with 1-month measurements, and poorly with 1-week measurements.ConclusionsPeritoneal transport characteristics change significantly within the first month of PD. PETs carried out during this time should be considered preliminary and should be confirmed by a PET 4 weeks later. Nevertheless, performing an early D/D0glucose measurement at 1 week predicted ultimate transport status sufficiently well to facilitate early clinical decision-making about optimal PD modality while patients were still receiving PD training. On the other hand, the widespread practice of using measured drain volumes in the first week to predict ultimate transport category is highly inaccurate and not recommended.
Collapse
Affiliation(s)
- David W. Johnson
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - David W. Mudge
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Sophie Blizzard
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Mary Arndt
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Amanda O'Shea
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Rhonda Watt
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Jan Hamilton
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Sharon Cottingham
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Nicole M. Isbel
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| | - Carmel M. Hawley
- Department of Renal Medicine, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
| |
Collapse
|
34
|
Wang AYM, Dong J, Xu X, Davies S. Volume management as a key dimension of a high-quality PD prescription. Perit Dial Int 2020; 40:282-292. [PMID: 32063208 DOI: 10.1177/0896860819895365] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for "High-quality PD prescription" necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. METHODS A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. RESULTS There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only "practice points" were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. CONCLUSIONS High-quality goal-directed PD prescription should include volume management as one of the key dimensions.
Collapse
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong SAR, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China
| | - Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University and University Hospitals of North Midlands, Stoke-on-Trent, UK
| |
Collapse
|
35
|
Wang AYM, Zhao J, Bieber B, Kanjanabuch T, Wilkie M, Marshall MR, Kawanishi H, Perl J, Davies S. International comparison of peritoneal dialysis prescriptions from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). Perit Dial Int 2020; 40:310-319. [DOI: 10.1177/0896860819895356] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: We describe peritoneal dialysis (PD) prescription variations among Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) participants on continuous ambulatory PD (CAPD) and automated PD (APD; n = 4657) from Australia/New Zealand (A/NZ), Canada, Japan, Thailand, United Kingdom (UK), and United States (US). Results: CAPD was more commonly used in Thailand and Japan, while APD predominated over CAPD in A/NZ, Canada, the US, and the UK. Total prescribed PD volume normalized to the surface area was the highest in Thailand and the lowest in Japan (for both APD and CAPD) and the UK (for CAPD). PD patients from Thailand had the lowest residual urine volume and residual renal urea clearance, yet achieved the highest dialysis urea clearance. Japanese patients had the lowest dialysis urea clearances for both APD and CAPD. Despite having similar urine volumes to patients in A/NZ, Canada, Japan, and the UK, US CAPD and APD patients used 2.5% and 3.86% glucose PD solutions more frequently, whereas fewer than 25% of these patients used icodextrin. Over half of the patients in A/NZ, Canada, the UK, and Japan used icodextrin, whereas it was hardly used in Thailand. Japan and Thailand were more likely to use 1.5% glucose solutions for their PD prescription. Conclusions: There are considerable international variations in PD modality use and prescription patterns that translate into important differences in achieved dialysis clearances. Ongoing recruitment of additional PDOPPS participants and accrual of follow-up time will allow us to test the associations between specific PD prescription regimens and clinical and patient-reported outcomes.
Collapse
Affiliation(s)
- Angela Yee-Moon Wang
- Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | | | | | - Jeffrey Perl
- St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University and University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | |
Collapse
|
36
|
Karaboyas A, Morgenstern H, Li Y, Bieber BA, Hakim R, Hasegawa T, Jadoul M, Schaeffner E, Vanholder R, Pisoni RL, Port FK, Robinson BM. Estimating the Fraction of First-Year Hemodialysis Deaths Attributable to Potentially Modifiable Risk Factors: Results from the DOPPS. Clin Epidemiol 2020; 12:51-60. [PMID: 32021471 PMCID: PMC6974411 DOI: 10.2147/clep.s233197] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Mortality among first-year hemodialysis (HD) patients remains unacceptably high. To address this problem, we estimate the proportions of early HD deaths that are potentially preventable by modifying known risk factors. METHODS We included 15,891 HD patients (within 60 days of starting HD) from 21 countries in the Dialysis Outcomes and Practice Patterns Study (1996-2015), a prospective cohort study. Using Cox regression adjusted for potential confounders, we estimated the fraction of first-year deaths attributable to one or more of twelve modifiable risk factors (the population attributable fraction, AF) identified from the published literature by comparing predicted survival based on risk factors observed vs counterfactually set to reference levels. RESULTS The highest AFs were for catheter use (22%), albumin <3.5 g/dL (19%), and creatinine <6 mg/dL (12%). AFs were 5%-9% for no pre-HD nephrology care, no residual urine volume, systolic blood pressure <130 or ≥160 mm Hg, phosphorus <3.5 or ≥5.5 mg/dL, hemoglobin <10 or ≥12 g/dL, and white blood cell count >10,000/μL. AFs for ferritin, calcium, and PTH were <3%. Overall, 65% (95% CI: 59%-71%) of deaths were attributable to these 12 risk factors. Additionally, the AF for C-reactive protein >10 mg/L was 21% in facilities where it was routinely measured. CONCLUSION A substantial proportion of first-year HD deaths could be prevented by successfully modifying a few risk factors. Highest priorities should be decreasing catheter use and limiting malnutrition/inflammation whenever possible.
Collapse
Affiliation(s)
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Yun Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Brian A Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Raymond Hakim
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Takeshi Hasegawa
- Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan, and Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan
| | - Michel Jadoul
- Cliniques universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Elke Schaeffner
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Friedrich K Port
- Department of Epidemiology, University of Michigan School of Public Health, and Department of Internal Medicine-Nephrology, University of Michigan Medical School, Ann Arbor, MI, USA
| | | |
Collapse
|
37
|
Yousuf M, Gouda Wahdan M, Assem Mohamed H, Elwan S. Percutaneous transluminal angioplasty for failing native hemodialysis arteriovenous fistulas. AL-AZHAR ASSIUT MEDICAL JOURNAL 2020. [DOI: 10.4103/azmj.azmj_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
38
|
Winnicki E, Johansen KL, Cabana MD, Warady BA, McCulloch CE, Grimes B, Ku E. Higher eGFR at Dialysis Initiation Is Not Associated with a Survival Benefit in Children. J Am Soc Nephrol 2019; 30:1505-1513. [PMID: 31320460 DOI: 10.1681/asn.2018111130] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Study findings suggest that initiating dialysis at a higher eGFR level in adults with ESRD does not improve survival. It is less clear whether starting dialysis at a higher eGFR is associated with a survival benefit in children with CKD. METHODS To investigate this issue, we performed a retrospective cohort study of pediatric patients aged 1-18 years who, according to the US Renal Data System, started dialysis between 1995 and 2015. The primary predictor was eGFR at the time of dialysis initiation, categorized as higher (eGFR>10 ml/min per 1.73 m2) versus lower eGFR (eGFR≤10 ml/min per 1.73 m2). RESULTS Of 15,170 children, 4327 (29%) had a higher eGFR (median eGFR, 12.8 ml/min per 1.73 m2) at dialysis initiation. Compared with children with a lower eGFR (median eGFR, 6.5 ml/min per 1.73 m2), those with a higher eGFR at dialysis initiation were more often white, girls, underweight or obese, and more likely to have GN as the cause of ESRD. The risk of death was 1.36 times higher (95% confidence interval, 1.24 to 1.50) among children with a higher (versus lower) eGFR at dialysis initiation. The association between timing of dialysis and survival differed by treatment modality-hemodialysis versus peritoneal dialysis (P<0.001 for interaction)-and was stronger among children initially treated with hemodialysis (hazard ratio, 1.56, 95% confidence interval, 1.39 to 1.75; versus hazard ratio, 1.07, 95% confidence interval, 0.91 to 1.25; respectively). CONCLUSIONS In children with ESRD, a higher eGFR at dialysis initiation is associated with lower survival, particularly among children whose initial treatment modality is hemodialysis.
Collapse
Affiliation(s)
| | - Kirsten L Johansen
- Division of Nephrology, Department of Medicine, Hennepin Healthcare Medical Center, Minneapolis, Minnesota.,Division of Nephrology, University of Minnesota, Minneapolis, Minnesota; and
| | | | - Bradley A Warady
- Division of Nephrology, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | | | | | - Elaine Ku
- Division of Nephrology.,Departments of Pediatrics.,Epidemiology and Biostatistics, and.,Department of Medicine, University of California, San Francisco, California
| |
Collapse
|
39
|
Lee Y, Chung SW, Park S, Ryu H, Lee H, Kim DK, Joo KW, Ahn C, Lee J, Oh KH. Incremental Peritoneal Dialysis May be Beneficial for Preserving Residual Renal Function Compared to Full-dose Peritoneal Dialysis. Sci Rep 2019; 9:10105. [PMID: 31300708 PMCID: PMC6626037 DOI: 10.1038/s41598-019-46654-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 06/28/2019] [Indexed: 11/09/2022] Open
Abstract
Maintaining residual renal function (RRF) is a crucial issue in peritoneal dialysis (PD). Incremental dialysis is the practice of initiating PD exchanges less than four times a day in consideration of RRF, and increasing dialysis dose in a step-wise manner as the RRF decreases. We aimed to compare the outcomes of incremental PD and full-dose PD in terms of RRF preservation and other outcomes. This was a single-center, observational study. Data were extracted retrospectively from a cohort of incident PD patients over 16 years old who started PD between 2007 and 2015 in the PD Unit of Seoul National University Hospital. We used inverse probability weighting (IPW) adjustment based on propensity scores to balance covariates between the incremental and full-dose PD groups. Multivariate, time-dependent Cox analyses were performed. Among 347 incident PD patients, 176 underwent incremental PD and 171 underwent conventional full-dose PD. After IPW adjustment, the incremental PD group exhibited a lower risk of developing anuria (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.43–0.88). Patient survival, technique survival, and peritonitis-free survival were all similar between these groups (P > 0.05 by log-rank test). Incremental PD was beneficial for preserving RRF and showed similar patient survival when compared to conventional full-dose PD.
Collapse
Affiliation(s)
- Yeonhee Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Won Chung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Seokwoo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunjin Ryu
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kwon Wook Joo
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Joongyub Lee
- Prevention and Management Center, Inha University Hospital, Incheon, Korea.
| | - Kook-Hwan Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| |
Collapse
|
40
|
Deira J, Suárez MA, López F, García-Cabrera E, Gascón A, Torregrosa E, García GE, Huertas J, de la Flor JC, Puello S, Gómez-Raja J, Grande J, Lerma JL, Corradino C, Musso C, Ramos M, Martín J, Basile C, Casino FG. IHDIP: a controlled randomized trial to assess the security and effectiveness of the incremental hemodialysis in incident patients. BMC Nephrol 2019; 20:8. [PMID: 30626347 PMCID: PMC6325813 DOI: 10.1186/s12882-018-1189-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 12/17/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Most people who make the transition to renal replacement therapy (RRT) are treated with a fixed dose thrice-weekly hemodialysis réegimen, without considering their residual kidney function (RKF). Recent papers inform us that incremental hemodialysis is associated with preservation of RKF, whenever compared with conventional hemodialysis. The objective of the present controlled randomized trial (RCT) is to determine if start HD with one sessions per week (1-Wk/HD), it is associated with better patient survival and other safety parameters. METHODS/DESIGN IHDIP is a multicenter RCT experimental open trial. It is randomized in a 1:1 ratio and controlled through usual clinical practice, with a low intervention level and non-commercial. It includes 152 incident patients older than 18 years, with a RRF of ≥4 ml/min/1.73 m2, measured by renal clearance of urea (KrU). The intervention group includes 76 patients who will start with incremental HD (1-Wk/HD). The control group includes 76 patients who will start with thrice-weekly hemodialysis régimen. The primary outcome is assessing the survival rate, while the secondary outcomes are the morbidity rate, the clinical parameters, the quality of life and the efficiency. DISCUSSION This study will enable to know the number of sessions a patient should receive when starting HD, depending on his RRF. The potentially important clinical and financial implications of incremental hemodialysis warrant this RCT. TRIAL REGISTRATION U.S. National Institutes of Health, ClinicalTrials.gov . Number: NCT03239808 , completed 13/04/2017. SPONSOR Foundation for Training and Research of Health Professionals of Extremadura.
Collapse
Affiliation(s)
- Javier Deira
- Hospital San Pedro de Alcantara, Cáceres, Spain.
| | | | | | | | | | | | | | - Jorge Huertas
- Hospital de Especialidades de las Fuerzas Armadas, Quito, Ecuador
| | | | - Suleya Puello
- Hospital Clínico Universitario, Santiago de Compostela, Spain
| | | | | | - José L Lerma
- Complejo Asistencial Universitario, Salamanca, Spain
| | | | - Carlos Musso
- Hospital Durand de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Carlo Basile
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy
| | - Francesco G Casino
- Clinical Research Branch, Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Bari, Italy.,Dialysis Centre SM2, Potenza, Italy
| |
Collapse
|
41
|
Peng Y, Yang X, Chen W, Yu XQ. Association between timing of peritoneal dialysis initiation and mortality in end-stage renal disease. Chronic Dis Transl Med 2018; 5:37-43. [PMID: 30993262 PMCID: PMC6449773 DOI: 10.1016/j.cdtm.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/23/2022] Open
Abstract
Despite the widespread use of chronic dialysis for end-stage renal disease (ESRD), there is no consensus on the optimal timing of initiating renal replacement therapy. Over the past decade, a worldwide trend toward increasing glomerular filtration rate at the initiation of dialysis has been noted. However, available data indicate that early dialysis has no survival benefit or is harmful. Peritoneal dialysis (PD) is one alternative for ESRD and has potential survival factors different from those of hemodialysis. The association between the timing of PD initiation and survival is unclear. This review examines the effect of the timing of dialysis on clinical outcomes in PD patients.
Collapse
Affiliation(s)
- Yuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong 510080, China
| | - Xue-Qing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510080, China.,Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangzhou, Guangdong 510080, China
| |
Collapse
|
42
|
Park H, Liu X, Henry L, Harman J, Ross EA. Trends in anemia care in non-dialysis-dependent chronic kidney disease (CKD) patients in the United States (2006-2015). BMC Nephrol 2018; 19:318. [PMID: 30413150 PMCID: PMC6230235 DOI: 10.1186/s12882-018-1119-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 10/25/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The objective of the study was to examine overall anemia management trends in non-dialysis patients with chronic kidney disease (CKD) from 2006 to 2015, and to evaluate the impact of Trial to Reduced Cardiovascular Events with Ananesp Therapy (TREAT)'s study results (October 2009) and the US Food and Drug Administration (FDA)'s (June 2011) safety warnings and guidelines on the use of ESA therapy in the current treatment of anemia. METHODS A retrospective cohort analysis of anemia management in CKD patients using Truven MarketScan Commercial and Medicare Supplemental databases was conducted. Monthly rates and types of anemia treatment for post-TREAT and post-FDA safety warning periods were compared to pre-TREAT period. Anemia management included ESA, intravenous iron, and blood transfusion. A time-series analysis using Autoregressive Integrated Moving Average (ARIMA) model and a Generalized Estimating Equation (GEE) model were used. RESULTS Between 2006 and 2015, CKD patients were increasingly less likely to be treated with ESAs, more likely to receive intravenous iron supplementation, and blood transfusions. The adjusted probabilities of prescribing ESAs were 31% (odds ratio (OR) = 0.69, 95% confidence interval (CI): 0.67-0.71) and 59% (OR = 0.41, 95% CI: 0.40, 0.42) lower in the post-TREAT and post-FDA warning periods compared to pre-TREAT period. The probability of prescribing intravenous iron was increased in the post-FDA warning period (OR = 1.11, 95% CI: 1.03-1.19) although the increase was not statistically significant in the post-TREAT period (OR = 1.03, 95% CI: 0.94-1.12). The probabilities of prescribing blood transfusion during the post-TREAT and post-FDA warning periods increased by 14% (OR = 1.14, 95% CI: 1.06-1.23) and 31% (OR = 1.31, 95% CI: 1.22-1.39), respectively. Similar trends of prescribing ESAs and iron supplementations were observed in commercially insured CKD patients but the use of blood transfusions did not increase. CONCLUSIONS After the 2011 FDA safety warnings, the use of ESA continued to decrease while the use of iron supplementation continued to increase. The use of blood transfusions increased significantly in Medicare patients while it remained stable in commercially insured patients. Results suggest the TREAT publication had effected treatment of anemia prior to the FDA warning but the FDA warning solidified TREAT's recommendations for anemia treatment for non- dialysis dependent CKD patients.
Collapse
Affiliation(s)
- Haesuk Park
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP Building Room 3325, 1225 Center Drive, Gainesville, FL, 32610, USA.
| | - Xinyue Liu
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP Building Room 3325, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Linda Henry
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, HPNP Building Room 3325, 1225 Center Drive, Gainesville, FL, 32610, USA
| | - Jeffrey Harman
- Department of Behavioral Sciences and Social Medicine, Florida State University, College of Medicine, Tallahassee, FL, 32306, USA
| | - Edward A Ross
- Department of Internal Medicine, University of Central Florida, College of Medicine, Orlando, FL, 32827, USA
| |
Collapse
|
43
|
Gebregeorgis W, Bhat ZY, Pradhan N, Migdal SD, Nandagopal L, Singasani R, Mushtaq T, Thomas R, Osman Malik YM. Correlation between Dt/V derived from ionic dialysance and blood-driven Kt/V of urea in African-American hemodialysis patients, based on body weight and ultrafiltration volume. Clin Kidney J 2018; 11:734-741. [PMID: 30288271 PMCID: PMC6165765 DOI: 10.1093/ckj/sfx155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Background The Dt/V obtained by using ionic dialysance (D) as a surrogate for urea clearance (K) is a well-validated adjunct measure of hemodialysis adequacy, with a variable level of correlation with urea-based Kt/V. However, this correlation has not been examined based on patients’ body size and ultrafiltration (UF) volume during the dialysis session. Methods Simultaneous evaluations of online Dt/V and single-pool variable-volume urea Kt/V were made. Patients were categorized into three subgroups based on their weight (<60, 60–80 and ≥80 kg), body mass index (<25, 25–30 and >30 kg/m2) and UF volume (<1.5, 1.5–3 and >3 L). The correlation between Dt/V and Kt/V was evaluated for the entire cohort per dialysis session in each subgroup. Results Mean Kt/V was greater than the mean Dt/V (1.72 versus 1.50, P < 0.001), with an overall correlation r value of 0.602. This correlation was stronger in the medium weight group versus lower and higher weights. The correlation between Dt/V and Kt/V was inversely related to the UF volume (r = 0.698, 0.621 and 0.558 for those with UF volume of <1.5, 1.5–3.0 and >3 L, respectively). A total of 99.3% of patients with Dt/V of >1.2 also had Kt/V >1.2 and 9.5% of those with Dt/V <1.2 had their Kt/V <1.2. Conclusions There is a moderate degree of correlation between Dt/V and Kt/V in African-American hemodialysis patients, which is impacted by body size and UF volume. A Dt/V of >1.2 strongly predicts adequate dialysis as defined by Kt/V of >1.2.
Collapse
Affiliation(s)
- Wihib Gebregeorgis
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Zeenat Yousuf Bhat
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nishigandha Pradhan
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Stephen D Migdal
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Lakshminarayanan Nandagopal
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Tehmina Mushtaq
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ronald Thomas
- Children's Research Center of Michigan, Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, USA
| | - Yahya M Osman Malik
- Division of Nephrology and Hypertension, Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
44
|
Kim KT, Ryu JW, Seo PW, Ryu KM. Clinical Results of Arteriovenous Fistulas Constructed Using Autologous Vessels in End-Stage Renal Disease Patients on Hemodialysis. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:122-129. [PMID: 29662810 PMCID: PMC5894576 DOI: 10.5090/kjtcs.2018.51.2.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/10/2017] [Accepted: 10/11/2017] [Indexed: 11/22/2022]
Abstract
Background For hemodialysis patients with end-stage renal disease (ESRD), it is important to construct an efficient vascular access with a superior patency rate. This study investigated the factors influencing the efficiency of arteriovenous fistulas (AVFs) constructed using an autologous vessel and evaluated the necessity of ultrasonography as a preoperative tool for AVF construction. Methods A retrospective analysis was performed of 250 patients in whom an AVF was constructed using an autologous vessel due to ESRD at our institution from January 2009 to April 2016. Results The 1-, 3-, and 5-year patency rates for all subjects were 87.6%, 85.6%, and 84.4%, respectively. The patients who underwent a preoperative evaluation of their vessels via ultrasonography had better patency rates than those who did not. Superior patency rates were found in patients under 65 years of age or with an anastomotic vein diameter of 3 mm or more. The 1-year patency rate and the diameter of the anastomotic vein showed a positive relationship. Conclusion Ultrasonography is strongly recommended for AVF construction, and efforts should be made to increase the patency rate in patients over 65. Superior clinical results can be expected when an AVF is made using an autologous vessel with an anastomotic vein diameter of at least 3 mm.
Collapse
Affiliation(s)
- Ki Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Dankook University College of Medicine
| | - Jae Wook Ryu
- Department of Thoracic and Cardiovascular Surgery, Dankook University College of Medicine
| | - Pil Won Seo
- Department of Thoracic and Cardiovascular Surgery, Dankook University College of Medicine
| | - Kyoung Min Ryu
- Department of Thoracic and Cardiovascular Surgery, Dankook University College of Medicine
| |
Collapse
|
45
|
A Review of Percutaneous Transluminal Angioplasty in Hemodialysis Fistula. Int J Vasc Med 2018; 2018:1420136. [PMID: 29785307 PMCID: PMC5892221 DOI: 10.1155/2018/1420136] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/26/2018] [Indexed: 12/31/2022] Open
Abstract
The number of patients in dialysis increases every year. In this review, we will evaluate the role of percutaneous transluminal angioplasty (PTA) according to patency of arteriovenous fistula and grafts. The main indication of PΤΑ is stenosis > 50% or obstruction of the vascular lumen of an arteriovenous fistula and graft. It is usually performed under local anesthesia. The infection rate is as low as the number of complications. Fistula can be used in dialysis in the same day without the need for a central venous catheter. Primary patency is >50% in the first year while primary assisted patency is 80-90% in the same time period. Repeated PTA is as durable as the primary PTA. An early PTA carries a risk of new interventions. Cutting balloon can be used as a second-line method. Stents and covered stents are kept for the management of complications and central outflow venous stenosis. PTA is the treatment of choice for stenosis or obstruction of dialysis fistulas. Repeated PTA may be needed for better patency. Drug eluting balloon may become the future in PTA of dialysis fistula, but more trials are needed.
Collapse
|
46
|
Ting CY, Wu WS, Tang KT, Wang HE, Lin CC. Evaluation of radiation dose during the percutaneous angioplasty for arteriovenous shunt assembling. Radiat Phys Chem Oxf Engl 1993 2017. [DOI: 10.1016/j.radphyschem.2017.03.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
47
|
Peritoneal dialysis catheter function and survival are not adversely affected by obesity regardless of the operative technique used. Surg Endosc 2017; 32:1714-1723. [DOI: 10.1007/s00464-017-5852-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
|
48
|
Incremental start to PD as experienced in Italy: results of censuses carried out from 2005 to 2014. J Nephrol 2017; 30:593-599. [PMID: 28500518 DOI: 10.1007/s40620-017-0403-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND It is not known how widely used in Italy an incremental start to in peritoneal dialysis (Incr-PD) is. METHODS By analyzing the peritoneal dialysis (PD) censuses conducted by the PD Study Group (GSDP-SIN) for the years 2005, 2008, 2010, 2012 and 2014 in all the Centers performing PD in Italy, the use of Incr-PD, i.e. continuous ambulatory peritoneal dialysis (CAPD) with 1 or 2 exchanges/day or automated peritoneal dialysis (APD) with 3-4 sessions/week, was examined among incident PD patients. RESULTS In 2014 PD was started in Italy by 1,652 patients, 455 (27.5%) of whom incrementally (Incr-CAPD 82.2% vs. Incr-APD 17.8%). Incr-PD was used in 53.5% of the 225 Centers. The number of patients and of Centers using Incr-DP increased constantly over the years up to 2012 (in 2005 Incr-PD was used in 33.4% of Centers, and in 11.9% of patients). The use of Incr-PD was greater in Centers with a more extensive PD program and greater use of PD in general. The most widely-used modality in Incr-PD was CAPD. CONCLUSIONS Incr-PD is used in Italy in a large number of incident PD patients. The reasons for this increase need to be clarified, as current adequacy targets are based on full-dose studies with a very low glomerular filtration rate (GFR).
Collapse
|
49
|
Li Y, Jin Y, Kapke A, Pearson J, Saran R, Port FK, Robinson BM. Explaining trends and variation in timing of dialysis initiation in the United States. Medicine (Baltimore) 2017; 96:e6911. [PMID: 28514305 PMCID: PMC5440142 DOI: 10.1097/md.0000000000006911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The United States Renal Data System (USRDS) registry of end-stage renal disease has often been used to study the timing of dialysis initiation, measured by estimated glomerular filtration rate (eGFR) at dialysis initiation. We conducted an observational study and examined how well variables in the USRDS database explain the trends and variation in eGFR at dialysis initiation.We identified 971,481 patients who initiated dialysis between 1995 and 2012 in the USRDS registry.The mean eGFR at dialysis initiation monotonically rose from 7.7 in 1995 to 11.1 in 2009, and then leveled off to 10.9 mL/min/1.73 m in 2012. The trend of rising, then leveling off was similar across all subgroups studied. Substantial variation in eGFR at dialysis initiation was observed, with standard deviation of 4.38 (95% CI: 2.0-18.4). A total of 11.4% of the total variation occurred across physicians and 88.6% within physicians. Adjustment for measured factors only modestly decreased the total variation. Of the total variance, 10.7% was explained by measured patient-level variables and 1.2% by measured physician and other factors, while 9.2% of physician-level variation and 78.9% of patient-level variation remained unexplained. The extent of variation explained by measured variables was similar over the entire study period.The finding that the majority of variation in eGFR at dialysis initiation is unexplained by measured variables casts doubt on how well eGFR serves as a measure for "timing" of dialysis initiation, and it indicates the need to collect more focused data to gain understanding of factors that affect timing of dialysis initiation in the US.
Collapse
Affiliation(s)
- Yun Li
- Arbor Research Collaborative for Health
- University of Michigan, Ann Arbor, MI, USA
| | - Yan Jin
- Arbor Research Collaborative for Health
| | | | | | | | | | - Bruce M. Robinson
- Arbor Research Collaborative for Health
- University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
50
|
Ankawi GA, Woodcock NI, Jain AK, Garg AX, Blake PG. The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program. Can J Kidney Health Dis 2016; 3:2054358116679131. [PMID: 28781885 PMCID: PMC5518964 DOI: 10.1177/2054358116679131] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/23/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The use of an incremental peritoneal dialysis (PD) strategy in a large contemporary patient population has not been described. OBJECTIVE We report the use of this strategy in clinical practice, the prescriptions required, and the clearances achieved in a large center which has routinely used this approach for more than 10 years. DESIGN This is a cross-sectional observational study. SETTING A single large Canadian academic center. PATIENTS This study collected data on 124 prevalent PD patients at a single Canadian academic center. METHODS AND MEASUREMENTS The proportion of patients who achieve the clearance target on a low clearance or incremental PD prescription; the actual PD prescriptions and consequent total, peritoneal, and renal urea clearances [Kt/V] achieved; and patient and technique survival and peritonitis rate in comparison with national and international reports. RESULTS Of the 124 prevalent PD patients in this PD unit, 106 (86%) were achieving the Kt/V target, and of these, 54 (44% of all patients) were doing so using incremental PD prescriptions. Fifty of these incremental PD patients were using automated PD (APD) with either no day dwell (68%) or less than 7 days a week treatment (12%) or both (20%). Patient survival in our PD unit was not different from that reported in Canada as a whole. Peritonitis rates were better than internationally recommended standards. LIMITATIONS This is an observational study with no randomized control group. CONCLUSIONS Incremental PD is feasible in a contemporary PD population treated mainly with APD. Almost half of the patients were able to achieve clearance targets while receiving less onerous and less costly low clearance prescriptions. We suggest that incremental PD should be widely used as a cost-effective strategy in PD.
Collapse
|