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Zhang Y, Feng S, Lu Y, Zhan Z, Shen H. Efficacy of APD in perioperative period of non-abdominal operation for peritoneal dialysis patients. Int J Gen Med 2019; 12:207-212. [PMID: 31213879 PMCID: PMC6538830 DOI: 10.2147/ijgm.s203158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: Whether automated peritoneal dialysis (APD) is a feasible strategy in perioperative period of uremic patients undergoing nonabdominal surgery remains unclear. This study was conducted to research the perioperative management and the best choice of dialysis modalities for peritoneal dialysis patients. Materials and methods: A retrospective analysis was made on the clinical data of 58 ESRD patients who had received peritoneal dialysis for more than three months were treated with APD during perioperative period from July 2015 to March 2018 in the Second Affiliated Hospital of Soochow University. The differences of clinical parameters, such as urine volume, ultrafiltration volume, hemoglobin, renal function and electrolytes were collected and analyzed before and after APD. Results: The vital signs of 58 patients were stable after APD treatment, and there were no significant differences in 24-hour urine volume, hemoglobin and electrolytes (calcium, phosphorus, potassium, sodium) before and after surgery (P>0.05). Compared with those before treatment, the amount of ultrafiltration increased significantly (P<0.05), creatinine, urea nitrogen and parathyroid hormone decreased significantly (P<0.05), while albumin decreased (P<0.05). Conclusion: Application of APD for peritoneal dialysis patients undergoing nonabdominal surgery during the perioperative period is safe and effective.
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Affiliation(s)
- Yi Zhang
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Sheng Feng
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Ying Lu
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Zhoubing Zhan
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
| | - Huaying Shen
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People's Republic of China
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Cao XY, He YN, Zhou JH, Sun SR, Miao LN, Chen W, Fang JA, Wang M, Wang NS, Lin HL, Liu J, Ni ZH, Liu WH, Na Y, Zhao JY, Guo ZY, Zheng HG, Shi W, Jiang GR, Cai GY, Chen XM. Safety, Effectiveness, and Manipulability of Peritoneal Dialysis Machines Made in China: A Randomized, Crossover, Multicenter Clinical Study. Chin Med J (Engl) 2018; 131:2785-2791. [PMID: 30511680 PMCID: PMC6278200 DOI: 10.4103/0366-6999.246079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Automated peritoneal dialysis (APD) can cater to individual needs, provide treatment while asleep, take into account the adequacy of dialysis, and improve the quality of life. Currently, independent research and development of APD machines made in China are more conducive to patients. A randomized, multicenter, crossover study was conducted by comparing an APD machine made in China with an imported machine. The safety, effectiveness, and manipulability of the two machines were compared. Methods: Two hundred and sixty patients who underwent peritoneal dialysis (PD) on a regular basis in 18 centers between August 2015 and February 2016 were included. The inclusion criteria include age ≥18 years and PD ≥30 days. The exclusion criteria were as follows: hemodialysis; exit site or tunnel infection; and peritonitis ≤30 days. The patients were randomly divided into Group A, who were first treated with a FM machine made in China, then changed to an imported machine; and Group B, who were treated using the reverse sequence. APD treatment was performed with 10 L/10 h and 5 cycles of exchange. After 72 h, the daily peritoneal Kt/V, the accuracy of the injection rate, accuracy of the injection temperature, safety, and manipulability of the machine were assessed. Noninferiority test was conducted between the two groups. Results: The daily peritoneal Kt/V in the APD machine made in China and the imported APD machine were 0.17 (0.14, 0.25) and 0.16 (0.13, 0.23), respectively. There was no significant difference between the groups (Z = 0.15, P = 0.703). The lower limit of the daily Kt/V difference between the two groups was 0.0069, which was greater than the noninferiority value of −0.07 in this study. The accuracy of the injection rate and injection temperature was 89.7% and 91.5%, respectively, in the domestic APD machine, which were both slightly better than the accuracy rates of 84.0% and 86.8% in the imported APD machine (89.7% vs. 84.0%, P = 0.2466; 91.5% vs. 86.8%, P = 0.0954). Therefore, the APD machine made in China was not inferior to the imported APD machine. The fuselage of the imported APD machine was space-saving, while the APD machine made in China was superior with respect to body mobility, man-machine dialog operation, alarm control, and patient information recognition. Conclusions: The FM machine made in China was not inferior to the imported APD machine. In addition, the FM machine made in China had better operability. Trial Registration: Clinicaltrials.gov, NCT02525497; https://clinicaltrials.gov/ct2/results?cond=&term=NCT02525497&cntry=& state=&city=&dist=.
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Affiliation(s)
- Xue-Ying Cao
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Ya-Ni He
- Department of Nephrology, Daping Hospital, Army Military Medical University, Chongqing 400042, China
| | - Jian-Hui Zhou
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Shi-Ren Sun
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi 710032, China
| | - Li-Ning Miao
- Department of Nephrology, Second Hospital of Jilin University, Changchun, Jilin 130041, China
| | - Wen Chen
- Department of Nephrology, Hainan Provincial Agricultural Reclamation General Hospital, Haikou, Hainan 570311, China
| | - Jing-Ai Fang
- Department of Nephrology, First Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Ming Wang
- Department of Nephrology, Hangzhou First People's Hospital, Hangzhou, Zhejiang 310006, China
| | - Nian-Song Wang
- Department of Nephrology and Rheumatology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai 200233, China
| | - Hong-Li Lin
- Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
| | - Jian Liu
- Department of Nephrology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China
| | - Zhao-Hui Ni
- Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Wen-Hu Liu
- Department of Nephrology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yu Na
- Department of Nephrology, The 306th Hospital of People's Liberation Army, Beijing 100101, China
| | - Jiu-Yang Zhao
- Department of Nephrology, The Second Affiliated Hospital of Dalian Medical University, Dalian Medical University, Dalian, Liaoning 116023, China
| | - Zhi-Yong Guo
- Department of Nephrology, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Hong-Guang Zheng
- Department of Nephrology, People's Liberation Army General Hospital of Shenyang Military Region, Shenyang, Liaoning 110016, China
| | - Wei Shi
- Department of Nephrology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong 510080, China
| | - Geng-Ru Jiang
- Department of Nephrology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Guang-Yan Cai
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China
| | - Xiang-Mei Chen
- Department of Nephrology, Chinese People's Liberation Army General Hospital, Chinese People's Liberation Army Institute of Nephrology, State Key Laboratory of Kidney Diseases (2011DAV00088), National Clinical Research Center for Kidney Diseases, Beijing 100853, China
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Vega-Diaz N, Gonzalez-Cabrera F, Marrero-Robayna S, Santana-Estupiñan R, Gallego-Samper R, Henriquez-Palop F, Perez-Borges P, Rodriguez-Perez JC. Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients. J Clin Med 2015; 4:1518-35. [PMID: 26239689 PMCID: PMC4519803 DOI: 10.3390/jcm4071518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD), a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF) in patients on peritoneal dialysis (PD) is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD) patients, with end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in comparison to non-diabetic nephropathy (NDN), using different PD solutions in combination. DESIGN Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. RESULTS The fraction of renal urea clearance (Kt) relative to distribution volume (V) (or total body water) (Kt/V), or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl) decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively), and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively). Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0.22, 12 months 1.63 ± 0.39, 24 months 1.73 ± 0.47; NDN: baseline 1.59 ± 0.40, 12 months 1.76 ± 0.47, 24 months 1.80 ± 0.46), in order to maintain the net water balance. The daytime dwell contribution, the fraction of day and the renal fraction of studies parameters provide sustained benefit in the follow-up time, above 30%. CONCLUSIONS The wet day and residual renal function are determinants in the achievement of the objective dose of dialysis, as well as in the water and sodium balance. The cause of chronic kidney disease (CKD) does not seem to influence the cleansing effectiveness of the technique.
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Affiliation(s)
- Nicanor Vega-Diaz
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Fayna Gonzalez-Cabrera
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Silvia Marrero-Robayna
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Raquel Santana-Estupiñan
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Roberto Gallego-Samper
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Fernando Henriquez-Palop
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Patricia Perez-Borges
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - José Carlos Rodriguez-Perez
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
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