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Fernàndez Labadía E, Masot O, Tejero Vidal LL, Botigué T, Bielsa-Gracia S. Educational interventions and identification of risk factors to prevent and reduce peritonitis in peritoneal dialysis: A scoping review. J Ren Care 2024; 50:307-318. [PMID: 38378190 DOI: 10.1111/jorc.12490] [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: 10/02/2023] [Revised: 01/02/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Peritonitis is a common and serious complication of peritoneal dialysis and is one of the main causes of peritoneal dialysis technique failure and long-term hemodialysis conversion. OBJECTIVES The aim of the review was to identify and clarify peritonitis risk factors and learn about strategies employed at international level to prevent and reduce the occurrence of peritoneal dialysis associated infections and their complications. DESIGN A scoping review. PARTICIPANTS Adults in pertitoneal dialysis. MEASUREMENTS The methodology framework of Arksey and O'Malley and PRISMA for Scoping Reviews guidelines were applied. A search was conducted of PubMed, Scopus and CINAHL using terms to identify peritoneal dialysis -associated risk factors and interventions carried out for the prevention and reduction of peritonitis in adult persons living at home. RESULTS The 17 studies selected were based on work carried out in nine different countries. Eleven articles analysed modifiable risk factors (low educational level, being a foreigner and low adherence to aseptic technique) and non-modifiable risk factors (age and comorbidities) that predispose to peritonitis in peritoneal dialysis. The other six studies applied an intervention to improve the prevalence of peritonitis considering educational practices adapted to patient characteristics and the application of retraining. CONCLUSIONS Personalised patient training and the identification of risk factors for peritonitis are key to reducing complications and enhancing the survival of peritoneal dialysis patients and the effectiveness of the technique.
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Affiliation(s)
- Elena Fernàndez Labadía
- Dyvision of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Olga Masot
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group, University of Lleida, Lleida, Spain
| | | | - Teresa Botigué
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, Lleida, Spain
- Health Education, Nursing, Sustainability and Innovation Research Group, University of Lleida, Lleida, Spain
| | - Sara Bielsa-Gracia
- Dyvision of Nephrology, Arnau de Vilanova University Hospital, Lleida, Spain
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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.
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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
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Dong X, Xie C, Yi C, Ye P, Ye H, Guo Q, Huang F, Kong YZ, Yang X. Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by Pseudomonas species: a review of 15 years' experience from southern China. Microbiol Spectr 2024; 12:e0009624. [PMID: 38695572 PMCID: PMC11237785 DOI: 10.1128/spectrum.00096-24] [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: 01/11/2024] [Accepted: 03/25/2024] [Indexed: 06/06/2024] Open
Abstract
Pseudomonas can lead to peritoneal dialysis-associated peritonitis, which is characterized by a poor prognosis, such as a substantial failure rate and a high death rate. This study aimed to provide an overview of Pseudomonas peritonitis's clinical features, the regimens of antibiotic, antibiotic resistance, and outcomes in peritoneal dialysis (PD) patients. This study observed patients with Pseudomonas peritonitis in two large PD centers in South China from January 2008 to December 2022. The demographics, symptomatology, antibiotics regimens, resistance to common antibiotics, and clinical outcomes of all included patients were reviewed. A total of 3,459 PD patients were included, among them 57 cases of peritonitis caused by Pseudomonas, including 48 cases (84.2%) of Pseudomonas aeruginosa. The incidence rate of Pseudomonas peritonitis was 0.0041 episode per patient-year. Of them, 28.1% (16 cases) of the patients were accompanied by exit site infection (ESI), and all had abdominal pain and turbid ascites at the time of onset. The most commonly used antibiotic combination was ceftazidime combined with amikacin. Approximately 89% of Pseudomonas species were sensitive to ceftazidime, and 88% were sensitive to amikacin. The overall primary response rate was 28.1% (16 patients), and the complete cure rate was 40.4% (23 patients). There was no significant difference in the complete cure rate of peritonitis using three and other antibiotic treatment regimens (44.8% vs 46.4%; P = 0.9). The successful treatment group had higher baseline albumin level (35.9 ± 6.2; P = 0.008) and residual urine volume (650.7 ± 375.5; P = 0.04). Although the incidence of peritonitis caused by Pseudomonas was low, the symptoms were serious, and prognosis was very poor. Pseudomonas was still highly susceptible to first-line antibiotics currently in use against Gram-negative bacteria. Patients with successful treatment had higher albumin levels and higher urine output. IMPORTANCE Although the incidence of peritoneal dialysis-associated peritonitis caused by Pseudomonas is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on Pseudomonas peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of Pseudomonas peritonitis.
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Affiliation(s)
- Xiao Dong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Chao Xie
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Peiyi Ye
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
| | - Yao-Zhong Kong
- Department of Nephrology, The First People's Hospital of Foshan, Foshan, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, National Health Commission and Guangdong Province, Guangdong, Guangdong, China
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Osaki Y, Maeoka Y, Sami M, Takahashi A, Ishiuchi N, Sasaki K, Masaki T. Peritoneal dialysis-associated peritonitis, caused by superior mesenteric artery thrombosis with intestinal necrosis: a case report. CEN Case Rep 2024:10.1007/s13730-024-00894-y. [PMID: 38825653 DOI: 10.1007/s13730-024-00894-y] [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: 11/26/2023] [Accepted: 05/14/2024] [Indexed: 06/04/2024] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is a common complication of PD. Enteric peritonitis is defined as peritonitis arising from an intestinal or intra-abdominal organ source. The delay in the diagnosis or treatment of enteric peritonitis has been reported to increase mortality. Therefore, the early consideration of enteric peritonitis, particularly in cases of culture-negative peritonitis, is imperative. A 67-year-old Japanese man who had been undergoing PD for 3 years, was admitted to our hospital with a diagnosis of PD-associated peritonitis. A month previously, he experienced a bleeding gastric ulcer, which led to severe anemia (hemoglobin 6.3 mg/dL), followed by thrombocytosis. On admission, peritoneal fluid analysis showed a high white blood cell count (WBC: 8,570 /µL), with neutrophils predominating (74.5%). Cultures of both his dialysis effluent and blood were negative. After admission, the WBC count of the dialysis effluent gradually decreased alongside antibiotic therapy, but the patient's abdominal pain did not improve. After 4 days, enhanced computed tomography showed superior mesenteric artery (SMA) thrombosis and intestinal necrosis. Therefore, emergency intestinal resection and PD catheter removal were performed, and then antithrombosis therapy was initiated. Because the patient's abdominal pain was improved and platelet count and D-dimer concentration were reduced by these treatments, he was discharged from the hospital after 47 days. Thus, we report a rare case of culture-negative PD-associated peritonitis, which was caused by SMA thrombosis and intestinal necrosis. It is likely that combination of severe calcification of SMA and prolonged thrombocytosis secondary to the severe anemia contributed to the thrombosis.
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Affiliation(s)
- Yosuke Osaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Yujiro Maeoka
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Mai Sami
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Akira Takahashi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Naoki Ishiuchi
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Kensuke Sasaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
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Raguž F, Tomić M, Stojčić A, Tipurić M, Volarić M, Bevanda S. Peritoneal dialysis in Herzegovina, Federation of Bosnia and Herzegovina: 18 years of experience from our center. Ther Apher Dial 2024; 28:409-416. [PMID: 38115783 DOI: 10.1111/1744-9987.14097] [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: 09/13/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Due to treatment of end-stage-renal-disease (ESRD), continuous peritoneal dialysis (CAPD) is used in 11% of cases and is associated with several PD-associated infections. METHODS Clinical data on 71 patients with CAPD were evaluated in addition to exit site infections and episodes of acute peritonitis (AP). RESULTS There were 39 men and 32 women. Average age was 61 years when we began CAPD and average time spent on CAPD program was 3.35 years. Illness that dominantly caused ESRD was diabetes (23 patients). Exit site infection was mostly caused by S epidermidis-MRSE and AP was most commonly caused by Staphylococcus sp. group. Most common cause of death was cardiovascular disease. At the end of this study, 9 patients were alive and still on CAPD, 10 were transplanted, 15 switched to HD and 36 died. CONCLUSION Optimal prevention measures and treatment of infectious complications in CAPD is necessary for better treatment possibilities.
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Affiliation(s)
- Fila Raguž
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Monika Tomić
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Andrea Stojčić
- Department of Nephrology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Manuel Tipurić
- Department of Urology, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Mile Volarić
- Department of Gastroenterology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
| | - Sanja Bevanda
- Department of Endocrinology, Division of Internal Medicine with Centre for Dialysis, University Hospital Mostar, Bijeli brijeg bb, Mostar, Bosnia and Herzegovina
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Mekraksakit P, Suppadungsuk S, Thongprayoon C, Miao J, Leelaviwat N, Thongpiya J, Qureshi F, Craici IM, Cheungpasitporn W. Outcomes of peritoneal dialysis in cirrhosis: A systematic review and meta-analysis. Perit Dial Int 2024:8968608241237401. [PMID: 38757682 DOI: 10.1177/08968608241237401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Cirrhosis and end-stage kidney disease (ESKD) are significant global health concerns, contributing to high mortality and morbidity. Haemodialysis (HD) is frequently used to treat ESKD in patients with cirrhosis. However, it often presents challenges such as haemodynamic instability during dialysis sessions, leading to less than optimal outcomes. Peritoneal dialysis (PD), while less commonly used in cirrhotic patients, raises concerns about the risks of peritonitis and mortality. Our systematic review and meta-analysis aimed to assess outcomes in PD patients with cirrhosis. METHODS We executed a comprehensive search in Ovid MEDLINE, EMBASE and Cochrane databases up to 25 September 2023. The search focused on identifying studies examining mortality and other clinical outcomes in ESKD patients with cirrhosis receiving PD or HD. In addition, we sought studies comparing PD outcomes in cirrhosis patients to those without cirrhosis. Data from each study were aggregated using a random-effects model and the inverse-variance method. RESULTS Our meta-analysis included a total of 13 studies with 15,089 patients. Seven studies compared ESKD patients on PD with liver cirrhosis (2753 patients) against non-cirrhosis patients (9579 patients). The other six studies provided data on PD (824 patients) versus HD (1943 patients) in patients with cirrhosis and ESKD. The analysis revealed no significant difference in mortality between PD and HD in ESKD patients with cirrhosis (pooled odds ratio (OR) of 0.77; 95% confidence interval (CI), 0.53-1.14). In PD patients with cirrhosis, the pooled OR for peritonitis compared to non-cirrhosis patients was 1.10 (95% CI: 1.03-1.18). The pooled ORs for hernia and chronic hypotension in cirrhosis patients compared to non-cirrhosis controls were 2.48 (95% CI: 0.08-73.04) and 17.50 (95% CI: 1.90-161.11), respectively. The pooled OR for transitioning from PD to HD among cirrhotic patients was 1.71 (95% CI: 0.76-3.85). Mortality in cirrhosis patients on PD was comparable to non-cirrhosis controls, with a pooled OR of 1.05 (95% CI: 0.53-2.10). CONCLUSIONS Our meta-analysis demonstrates that PD provides comparable mortality outcomes to HD in ESKD patients with cirrhosis. In addition, the presence of cirrhosis does not significantly elevate the risk of mortality among patients undergoing PD. While there is a higher incidence of chronic hypotension and a slightly increased risk of peritonitis in cirrhosis patients on PD compared to those without cirrhosis, the risks of hernia and the need to transition from PD to HD are comparable between both groups. These findings suggest PD as a viable and effective treatment option for ESKD patients with cirrhosis.
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Affiliation(s)
- Poemlarp Mekraksakit
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Faculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol University, Samut Prakan, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jing Miao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Natnicha Leelaviwat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Jerapas Thongpiya
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Iasmina M Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Cho Y, Chow KM, Kam-Tao Li P, Runnegar N, Johnson DW. Peritoneal Dialysis-Related Infections. Clin J Am Soc Nephrol 2024; 19:641-649. [PMID: 37574658 PMCID: PMC11108252 DOI: 10.2215/cjn.0000000000000280] [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: 02/02/2023] [Accepted: 08/01/2023] [Indexed: 08/15/2023]
Abstract
Peritoneal dialysis (PD) represents an important treatment choice for patients with kidney failure. It allows them to dialyze outside the hospital setting, facilitating enhanced opportunities to participate in life-related activities, flexibility in schedules, time and cost savings from reduced travel to dialysis centers, and improved quality of life. Despite its numerous advantages, PD utilization has been static or diminishing in parts of the world. PD-related infection, such as peritonitis, exit-site infection, or tunnel infection, is a major concern for patients, caregivers, and health professionals-which may result in hesitation to consider this as treatment or to cease therapy when these complications take place. In this review, the definition, epidemiology, risk factors, prevention, and treatment of PD-related infection on the basis of the contemporary evidence will be described.
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Affiliation(s)
- Yeoungjee Cho
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
- Carol and Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Naomi Runnegar
- Infectious Management Services, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - David W. Johnson
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Australia
- Department of Kidney and Transplant Services, Princess Alexandra Hospital, Brisbane, Australia
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Hsu CM, Li NC, Lacson EK, Weiner DE, Paine S, Majchrzak K, Argyropoulos C, Roumelioti ME, Pankratz VS, Miskulin D, Manley HJ, Salenger P, Johnson D, Johnson HK, Harford A. Peritoneal Dialysis Technique Survival: A Cohort Study. Am J Kidney Dis 2024:S0272-6386(24)00718-2. [PMID: 38640994 DOI: 10.1053/j.ajkd.2024.03.012] [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: 09/29/2023] [Revised: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
RATIONALE & OBJECTIVE Reasons for transfer from peritoneal dialysis (PD) to hemodialysis (HD) remain incompletely understood. Among incident and prevalent patients receiving PD, we evaluated the association of clinical factors, including prior treatment with HD, with PD technique survival. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Adults who initiated PD at a Dialysis Clinic, Inc (DCI) outpatient facility between January 1, 2010, and September 30, 2019. EXPOSURE The primary exposure of interest was timing of PD start, categorized as PD-first, PD-early, or PD-late. Other covariates included demographics, clinical characteristics, and routine laboratory results. OUTCOME Modality switch from PD to HD sustained for more than 90 days. ANALYTICAL APPROACH Multivariable Fine-Gray models with competing risks and time-varying covariates, stratified at 9 months to account for lack of proportionality. RESULTS Among 5,224 patients who initiated PD at a DCI facility, 3,174 initiated dialysis with PD ("PD-first"), 942 transitioned from HD to PD within 90 days ("PD-early"), and 1,108 transitioned beyond 90 days ("PD-late"); 1,472 (28%) subsequently transferred from PD to HD. The PD-early and PD-late patients had a higher risk of transfer to HD as compared with PD-first patients (in the first 9 months: adjusted hazard ratio [AHR], 1.51 [95% CI, 1.17-1.96] and 2.41 [95% CI, 1.94-3.00], respectively; and after 9 months: AHR, 1.16 [95% CI, 0.99-1.35] and AHR, 1.43 [95% CI, 1.24-1.65], respectively). More peritonitis episodes, fewer home visits, lower serum albumin levels, lower residual kidney function, and lower peritoneal clearance calculated with weekly Kt/V were additional risk factors for PD-to-HD transfer. LIMITATIONS Missing data on dialysis adequacy and residual kidney function, confounded by short PD technique survival. CONCLUSIONS Initiating dialysis with PD is associated with greater PD technique survival, though many of those who initiate PD-late in their dialysis course still experience substantial time on PD. Peritonitis, lower serum albumin, and lower Kt/V are risk factors for PD-to-HD transfer that may be amenable to intervention. PLAIN-LANGUAGE SUMMARY Peritoneal dialysis (PD) is an important kidney replacement modality with several potential advantages compared with in-center hemodialysis (HD). However, a substantial number of patients transfer to in-center HD early on, without having experienced the quality-of-life and other benefits that come with sustained maintenance of PD. Using retrospective data from a midsize national dialysis provider, we found that initiating dialysis with PD is associated with longer maintenance of PD, compared with initiating dialysis with HD and a later switch to PD. However, many of those who initiate PD-late in their dialysis course still experience substantial time on PD. Peritonitis, lower serum albumin, and lower small protein removal are other risk factors for PD-to-HD transfer that may be amenable to intervention.
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Affiliation(s)
| | | | - Eduardo K Lacson
- Tufts Medical Center, Boston, Massachusetts; Dialysis Clinic Inc., Nashville, Tennessee
| | | | | | | | | | | | | | | | | | | | | | | | - Antonia Harford
- Dialysis Clinic Inc., Nashville, Tennessee; University of New Mexico, Albuquerque, New Mexico
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Virzì GM, Morisi N, Marturano D, Milan Manani S, Tantillo I, Ronco C, Zanella M. Peritoneal Inflammation in PD-Related Peritonitis Induces Systemic Eryptosis: In Vitro and In Vivo Assessments. Int J Mol Sci 2024; 25:4284. [PMID: 38673869 PMCID: PMC11049828 DOI: 10.3390/ijms25084284] [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: 02/24/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Erythrocytes (RBCs) have a highly specialized and organized membrane structure and undergo programmed cell death, known as eryptosis. Our preliminary data show a significant increase in the eryptosis during peritoneal dialysis (PD)-associated peritonitis. The objectives of the present study were assessment of the incrementation of eryptosis in PD patients with peritonitis, evaluation of the relationship between systemic eryptosis in peritonitis and specific peritonitis biomarkers in PD effluent (PDE), and confirmation of the induction of eryptosis by peritonitis in a vitro setting. We enrolled 22 PD patients with peritonitis and 17 healthy subjects (control group, CTR). For the in vivo study, eryptosis was measured in freshly isolated RBCs. For the in vitro study, healthy RBCs were exposed to the plasma of 22 PD patients with peritonitis and the plasma of the CTR group for 2, 4, and 24 h. Eryptosis was evaluated by flow cytometric analyses in vivo and in vitro. PDE samples were collected for biomarkers analysis.The percentage of eryptotic RBCs was significantly higher in PD patients with peritonitis than in CTR (PD patients with peritonitis: 7.7; IQR 4.3-14.2, versus CTR: 0.8; IQR 0.7-1.3; p < 0.001). We confirmed these in vivo results by in vitro experiments: healthy RBCs incubated with plasma from PD patients with peritonitis demonstrated a significant increase in eryptosis compared to healthy RBCs exposed to plasma from the control group at all times. Furthermore, significant positive correlations were observed between eryptosis level and all analyzed peritoneal biomarkers of peritonitis. We investigated a potential connection between systemic eryptosis and peritoneal biomarkers of peritonitis. Up-regulation of inflammatory markers could explain the increased rate of systemic eryptosis during PD-related peritonitis.
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Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Niccolò Morisi
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
- Nephrology Dialysis and Renal Transplantation Unit, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Davide Marturano
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Claudio Ronco
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
| | - Monica Zanella
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, 36100 Vicenza, Italy; (D.M.); (S.M.M.); (I.T.); (M.Z.)
- IRRIV—International Renal Research Institute, 36100 Vicenza, Italy; (N.M.); (C.R.)
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10
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Dogan I, Ucar E, Odabas M, Kaya NU, Sadioglu RE, Celik G, Acikgoz E, Sayarlioglu H, Turkmen E, Delibalta B, Aktas N, Cakir SK, Kaya EA, Alsancak S, Ayar Y, Ustunel N, Inan Z, Yildirim T, Sen F, Oruc A, Korkmaz R, Kayadibi H, Ates K. The effect of hand fine motor skills on peritoneal dialysis-related peritonitis. Ther Apher Dial 2024; 28:284-296. [PMID: 37932586 DOI: 10.1111/1744-9987.14079] [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: 06/16/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION We aimed to evaluate the relationship between the hand fine motor skills of peritoneal dialysis (PD) practitioners and PD-related peritonitis. METHODS This multicenter prospective observational study was conducted with 120 incident PD patients. Patients were divided into two groups who had PD-related peritonitis within the first year as Group 1, and those who did not as Group 2. Hand fine motor skills were evaluated by Nine-Hole Peg Test (NHPT) and Nut Screwing Test (NST). RESULTS Initial NHPT (28.5 ± 6.0 s vs. 25.8 ± 5.0 s, p = 0.011) and NST (82.3 (61.5-102.8) s versus 65.3 (52.3-88.5) s p = 0.023) scores were significantly higher in Group 1 than Group 2. In multivariate logistic regression analysis, NHPT, Body Mass Index, Mini-Mental Test, self PD practitioner, and catheter complications were found to be independent variables in predicting PD-related peritonitis. CONCLUSION Decreased hand fine motor skills of PD patients is a risk factor for peritonitis.
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Affiliation(s)
- Ibrahim Dogan
- Department of Nephrology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Emel Ucar
- Department of Peritonael Dialysis, Baxter, Baxter International Inc, Ankara, Turkey
| | - Mehtap Odabas
- Department of Nephrology, Hitit University, Faculty of Medicine, Corum, Turkey
| | - Nur Unal Kaya
- Department of Nephrology, Hitit University, Faculty of Medicine, Corum, Turkey
| | | | - Gulden Celik
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elif Acikgoz
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Hayriye Sayarlioglu
- Department of Nephrology, 19 Mayis University Faculty of Medicine, Samsun, Turkey
| | - Ercan Turkmen
- Department of Nephrology, 19 Mayis University Faculty of Medicine, Samsun, Turkey
| | - Bulbul Delibalta
- Department of Nephrology, 19 Mayis University Faculty of Medicine, Samsun, Turkey
| | - Nimet Aktas
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Selma Kuran Cakir
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Emel Acar Kaya
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Serap Alsancak
- Department of Nephrology, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Narin Ustunel
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Zuhal Inan
- Department of Nephrology, Bursa City Hospital, Bursa, Turkey
| | - Tolga Yildirim
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Sen
- Department of Nephrology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aysegul Oruc
- Department of Nephrology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Rahime Korkmaz
- Department of Nephrology, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Huseyin Kayadibi
- Department of Medical Biochemistry, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Kenan Ates
- Department of Nephrology, Ankara University Faculty of Medicine, Ankara, Turkey
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11
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Song Q, Wang P, Wang H, Pan M, Li X, Yao Z, Wang W, Tang G, Zhou S. Integrative analysis of chromatin accessibility and transcriptome landscapes in the induction of peritoneal fibrosis by high glucose. J Transl Med 2024; 22:243. [PMID: 38443979 PMCID: PMC10916192 DOI: 10.1186/s12967-024-05037-6] [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: 09/12/2023] [Accepted: 02/24/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Peritoneal fibrosis is the prevailing complication induced by prolonged exposure to high glucose in patients undergoing peritoneal dialysis. METHODS To elucidate the molecular mechanisms underlying this process, we conducted an integrated analysis of the transcriptome and chromatin accessibility profiles of human peritoneal mesothelial cells (HMrSV5) during high-glucose treatment. RESULTS Our study identified 2775 differentially expressed genes (DEGs) related to high glucose-triggered pathological changes, including 1164 upregulated and 1611 downregulated genes. Genome-wide DEGs and network analysis revealed enrichment in the epithelial-mesenchymal transition (EMT), inflammatory response, hypoxia, and TGF-beta pathways. The enriched genes included VEGFA, HIF-1α, TGF-β1, EGF, TWIST2, and SNAI2. Using ATAC-seq, we identified 942 hyper (higher ATAC-seq signal in high glucose-treated HMrSV5 cells than in control cells) and 714 hypo (lower ATAC-seq signal in high glucose-treated HMrSV5 cells versus control cells) peaks with differential accessibility in high glucose-treated HMrSV5 cells versus controls. These differentially accessible regions were positively correlated (R = 0.934) with the nearest DEGs. These genes were associated with 566 up- and 398 downregulated genes, including SNAI2, TGF-β1, HIF-1α, FGF2, VEGFA, and VEGFC, which are involved in critical pathways identified by transcriptome analysis. Integrated ATAC-seq and RNA-seq analysis also revealed key transcription factors (TFs), such as HIF-1α, ARNTL, ELF1, SMAD3 and XBP1. Importantly, we demonstrated that HIF-1α is involved in the regulation of several key genes associated with EMT and the TGF-beta pathway. Notably, we predicted and experimentally validated that HIF-1α can exacerbate the expression of TGF-β1 in a high glucose-dependent manner, revealing a novel role of HIF-1α in high glucose-induced pathological changes in human peritoneal mesothelial cells (HPMCs). CONCLUSIONS In summary, our study provides a comprehensive view of the role of transcriptome deregulation and chromosome accessibility alterations in high glucose-induced pathological fibrotic changes in HPMCs. This analysis identified hub genes, signaling pathways, and key transcription factors involved in peritoneal fibrosis and highlighted the novel glucose-dependent regulation of TGF-β1 by HIF-1α. This integrated approach has offered a deeper understanding of the pathogenesis of peritoneal fibrosis and has indicated potential therapeutic targets for intervention.
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Affiliation(s)
- Qiong Song
- Department of Nephrology, Shaanxi Second People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Pengbo Wang
- Department of Nephrology, Shaanxi Second People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Huan Wang
- Department of Emergency, Xijing Hospital, The Fourth Military Medical University of People's Liberation Army, Xi'an, Shaanxi, People's Republic of China
| | - Meijing Pan
- Department of Clinical Medicine, Xi'an Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Xiujuan Li
- School of Automation Science and Engineering, Faculty of Electronic and Information Engineering, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Zhuan'e Yao
- Department of Nephrology, Shaanxi Second People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Wei Wang
- Department of Nephrology, Shaanxi Second People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Guangbo Tang
- Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China.
| | - Sen Zhou
- Department of Nephrology, The First Hospital of Lanzhou University, Lanzhou, Gansu, People's Republic of China.
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12
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Chula DC, Riella MC, Portiolli Franco R, de Alcântara MT, Campos RP, Gordon GM, Rokukawa PE, do Nascimento MM. Minimally invasive peritoneal access: A new approach of catheter placement for peritoneal dialysis. J Vasc Access 2024; 25:557-565. [PMID: 36203380 DOI: 10.1177/11297298221127756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheter implantation techniques for peritoneal dialysis (PD) have advanced significantly in recent years. We aimed to analyze the survival and associated complications of catheters inserted using a new technique that is guided by ultrasound and fluoroscopy and requires minimal tissue dissection. The procedure was performed by nephrologists in the outpatient basis, we compared these results of the minimally invasive insertion with traditional implantation using trocars. METHODS A total of 152 PD catheters were placed in 152 patients with stage 5 chronic kidney disease; 62.5% of the patients were men, with a mean age of 56.6 ± 18.5 years. The following two methods were used: minimally invasive insertion (MI group, n = 73) and trocar insertion (T group, n = 79). Patients in both the groups were followed prospectively for 26 months from the date of the first implantation. RESULTS Gender, age, and prevalence of diabetes mellitus were not significantly different between the groups, while the body mass index, presence of obesity, and abdominal scars from previous surgeries were higher in the MI group (p = 0.021). The incidence of catheter dysfunction was lower in the MI group compared to group T (6.8% vs 20.3%; p = 0.019). Exit site infection was also lower with the new technique (4.1% vs. 18.9%; p = 0.005). Further, the cumulative incidence of peritonitis also reduced with MI (p = 0.034). Finally, the overall catheter survival at 1 year was 89%, which has been shown as higher in group MI (95% vs 82% in group T; p = 0.025). CONCLUSION The MI technique for catheter insertion showed low complication rates and excellent catheter survival as compared to traditional implantation methods; thus, it may be an alternative method for PD catheter placement.
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Affiliation(s)
- Domingos Candiota Chula
- Pro Renal Foundation Brazil, Curitiba, Paraná, Brazil
- Hospital de Clínicas Complex-Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Internal Medicine and Health Sciences of the Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | - Márcia Tokunaga de Alcântara
- Pro Renal Foundation Brazil, Curitiba, Paraná, Brazil
- Hospital de Clínicas Complex-Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | | | | | - Marcelo Mazza do Nascimento
- Pro Renal Foundation Brazil, Curitiba, Paraná, Brazil
- Hospital de Clínicas Complex-Federal University of Paraná, Curitiba, Paraná, Brazil
- Postgraduate Program in Internal Medicine and Health Sciences of the Federal University of Paraná, Curitiba, Paraná, Brazil
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13
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Zang Z, Xu Q, Zhou X, Ma N, Pu L, Tang Y, Li Z. Random forest can accurately predict the technique failure of peritoneal dialysis associated peritonitis patients. Front Med (Lausanne) 2024; 10:1335232. [PMID: 38298506 PMCID: PMC10829598 DOI: 10.3389/fmed.2023.1335232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Instructions Peritoneal dialysis associated peritonitis (PDAP) is a major cause of technique failure in peritoneal dialysis (PD) patients. The purpose of this study is to construct risk prediction models by multiple machine learning (ML) algorithms and select the best one to predict technique failure in PDAP patients accurately. Methods This retrospective cohort study included maintenance PD patients in our center from January 1, 2010 to December 31, 2021. The risk prediction models for technique failure were constructed based on five ML algorithms: random forest (RF), the least absolute shrinkage and selection operator (LASSO), decision tree, k nearest neighbor (KNN), and logistic regression (LR). The internal validation was conducted in the test cohort. Results Five hundred and eight episodes of peritonitis were included in this study. The technique failure accounted for 26.38%, and the mortality rate was 4.53%. There were resignificant statistical differences between technique failure group and technique survival group in multiple baseline characteristics. The RF prediction model is the best able to predict the technique failure in PDAP patients, with the accuracy of 93.70% and area under curve (AUC) of 0.916. The sensitivity and specificity of this model was 96.67 and 86.49%, respectively. Conclusion RF prediction model could accurately predict the technique failure of PDAP patients, which demonstrated excellent predictive performance and may assist in clinical decision making.
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Affiliation(s)
- Zhiyun Zang
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Qijiang Xu
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Yibin Second People's Hospital, Yibin, China
| | - Xueli Zhou
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Niya Ma
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Pu
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Tang
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Zi Li
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
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14
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Yang J, Wan J, Feng L, Hou S, Yv K, Xu L, Chen K. Machine learning algorithms for the prediction of adverse prognosis in patients undergoing peritoneal dialysis. BMC Med Inform Decis Mak 2024; 24:8. [PMID: 38166909 PMCID: PMC10763100 DOI: 10.1186/s12911-023-02412-z] [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: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND An appropriate prediction model for adverse prognosis before peritoneal dialysis (PD) is lacking. Thus, we retrospectively analysed patients who underwent PD to construct a predictive model for adverse prognoses using machine learning (ML). METHODS A retrospective analysis was conducted on 873 patients who underwent PD from August 2007 to December 2020. A total of 824 patients who met the inclusion criteria were included in the analysis. Five commonly used ML algorithms were used for the initial model training. By using the area under the curve (AUC) and accuracy (ACC), we ranked the indicators with the highest impact and displayed them using the values of Shapley additive explanation (SHAP) version 0.41.0. The top 20 indicators were selected to build a compact model that is conducive to clinical application. All model-building steps were implemented in Python 3.8.3. RESULTS At the end of follow-up, 353 patients withdrew from PD (converted to haemodialysis or died), and 471 patients continued receiving PD. In the complete model, the categorical boosting classifier (CatBoost) model exhibited the strongest performance (AUC = 0.80, 95% confidence interval [CI] = 0.76-0.83; ACC: 0.78, 95% CI = 0.72-0.83) and was selected for subsequent analysis. We reconstructed a compression model by extracting 20 key features ranked by the SHAP values, and the CatBoost model still showed the strongest performance (AUC = 0.79, ACC = 0.74). CONCLUSIONS The CatBoost model, which was built using the intelligent analysis technology of ML, demonstrated the best predictive performance. Therefore, our developed prediction model has potential value in patient screening before PD and hierarchical management after PD.
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Affiliation(s)
- Jie Yang
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jingfang Wan
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lei Feng
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
- Teaching Office, Medical Research Department, Army Special Medical Center, Chongqing, China
| | - Shihui Hou
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Kaizhen Yv
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Liang Xu
- Department of Medical Engineering, The Second Affiliated Hospital of the Army Medical University, Chongqing, 400037, China.
| | - Kehong Chen
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
- State Key Laboratory of Trauma, Burns and Combined Injury, Wound Trauma Medical Center, Army Medical University, Chongqing, China.
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15
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Kayes M, Potter D, Wong J, Spicer T. Peritoneal dialysis-associated peritonitis with Elizabethkingia miricola. BMJ Case Rep 2023; 16:e255491. [PMID: 38081734 PMCID: PMC10729244 DOI: 10.1136/bcr-2023-255491] [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] [Indexed: 12/18/2023] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is linked to increased mortality rates and transfer to haemodialysis or PD discontinuation. Rare and emerging pathogens can pose challenges in management. We present the first case of PD peritonitis caused by Elizabethkingia miricola through direct contamination, which was successfully treated with intraperitoneal and oral antibiotics.
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Affiliation(s)
- Masnun Kayes
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Daniela Potter
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Jeffrey Wong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Tim Spicer
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
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16
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Çankaya E, Altunok M, Yağanoğlu AM. The effect of rural and urban life on peritonitis rates in chronic peritoneal patients. Ren Fail 2023; 45:2163504. [PMID: 36645062 PMCID: PMC9848302 DOI: 10.1080/0886022x.2022.2163504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND It has been reported that living far from the peritoneal dialysis (PD) unit is a risk factor for peritonitis. Considering that PD units are urban located; the question of whether living in a rural area compared to an urban area is a risk factor for peritonitis has arisen. METHODS From March 2010 to August 2020, 335 episodes of peritonitis in 202 PD patients followed in a single center were evaluated retrospectively. People living in areas with a population <1000 were defined as living in rural areas regardless of their distance from the PD center. Cox regression analysis was used to identify independent factors associated with peritonitis. RESULTS A total of 202 PD patients were followed during 791 patient-years (mean follow-up of 3.9 years per patient). Total patients had 335 episodes of peritonitis and the rate of peritonitis was 0.42 episodes per year (episodes/patient-year). Cox regression analysis revealed that living environment (urban vs. rural) was not a risk factor for peritonitis (p = 0.57). CONCLUSIONS In Turkey, we report that living in a rural area in our region is not a risk factor for peritonitis. It is not the right approach for both the physician and the patient to be reluctant in the choice of PD due to the concern of peritonitis in rural areas.
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Affiliation(s)
- Erdem Çankaya
- Department of Nephrology, Medical Faculty, Atatürk University, Erzurum, Turkey,CONTACT Erdem Çankaya Department of Nephrology, Medical Faculty, Atatürk University, Erzurum25240, Turkey
| | - Murat Altunok
- Department of Nephrology, Medical Faculty, Atatürk University, Erzurum, Turkey
| | - Aycan Mutlu Yağanoğlu
- Department of Animal Science, Faculty of Agrıculture, Atatürk University, Erzurum, Turkey
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17
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Peng Y, Zeng Y, Zheng T, Xie X, Wu J, Fu L, Lu F, Zhang L, Chen Y, Liu X, Wang L. Effects of Tiaopi Xiezhuo decoction on constipation and gut dysbiosis in patients with peritoneal dialysis. PHARMACEUTICAL BIOLOGY 2023; 61:531-540. [PMID: 36994999 PMCID: PMC10064829 DOI: 10.1080/13880209.2023.2193595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 01/24/2023] [Accepted: 03/12/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT A Chinese herbal formula, Tiaopi Xiezhuo decoction (TXD), is developed from a classical Chinese prescription Sanhuang Xiexin decoction. OBJECTIVE To investigate the regulatory effect of TXD on gut dysbiosis, as a treatment of constipation in patients with peritoneal dialysis (PD). MATERIALS AND METHODS The chemical content of TXD was assessed by high-performance liquid chromatography. A total of 29 PD patients were enrolled and treated with TXD orally (3 g crude drug/each/twice/day) for 3 months. Blood and faecal samples were collected at the beginning and end, to determine the changes in biochemical characteristics and gut microbial composition. The stool conditions were asked to be scored. Additional 30 healthy individuals were recruited as a control for the analysis of gut microbiota. RESULTS Although having no significant effects on serum biochemical characteristics, 3-month TXD intervention improved constipation in PD patients: decreased 80% abdominal distention (p < 0.01), increased 2.6-fold sloppy stools (p < 0.05) and eliminated hard stool completely (p < 0.01). The analysis of gut microbiota showed that, compared to the healthy group, the microbial richness was reduced in PD patients. After a 3-month TXD treatment, this reduced richness was raised, and Paraprevotella clara, Lachnospiraceae bacterium 2-146FA, Phascolarctobaterium succinatutens, Lachnospiraceae bacterium 2-1-58FAA, Fusobacterium mortiferum, and Prevotella copri were accumulated in the intestinal flora. Furthermore, the bacterial species enriched by TXD correlated with the improvement of constipation. DISCUSSION AND CONCLUSIONS TXD treatment may improve constipation by modulating gut dysbiosis in PD patients. These findings provide data to support the further application of TXD in the adjuvant treatment of PD.
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Affiliation(s)
- Yu Peng
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Yuting Zeng
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Tingting Zheng
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Xiaoning Xie
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Jianfeng Wu
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Lizhe Fu
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Fuhua Lu
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - La Zhang
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Yang Chen
- Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Xusheng Liu
- Department of Nephrology, Second Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
| | - Lei Wang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, P.R. China
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18
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Leung WY, Ng MSN, Hau AKC, So WKW. Retraining programme for older patients undergoing peritoneal dialysis: A randomised controlled trial. J Ren Care 2023; 49:253-263. [PMID: 36463502 DOI: 10.1111/jorc.12450] [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: 04/08/2022] [Revised: 10/14/2022] [Accepted: 11/05/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Peritonitis is a common cause of hospitalisation and death among patients undergoing peritoneal dialysis. Periodic retraining is recommended to prevent peritonitis, especially in older adults. OBJECTIVES We evaluated the effectiveness of a retraining programme for reducing peritonitis and exit site infection rates in older adults on peritoneal dialysis. The cost-benefit ratio was also calculated. DESIGN A two-arm prospective randomised controlled trial. PARTICIPANTS One hundred and thirty patients aged 55 years or older were recruited. Participants were randomly assigned to the intervention or control group. While both groups received usual care, the intervention group received a retraining programme (a knowledge and practical assessment and a one-on-one retraining session) 90 days after starting home-based continuous ambulatory peritoneal dialysis therapy. MEASUREMENTS The outcomes included peritonitis rate, exit site infection rate and direct medical costs at 180, 270, and 360 days after starting home-based continuous ambulatory peritoneal dialysis therapy. RESULTS No significant differences were found in the baseline characteristics between groups. The peritonitis rates were 0.11 episodes per patient-year in the intervention group versus 0.13 in the control group. The incidence of exit site infection was 20.0% in the intervention group and 12.3% in the control group. The cost-benefit ratio of retraining was 1:9.6. None of the results were statistically significant. CONCLUSIONS The absence of statistical significance may be partly explained by the premature termination of the study. Large-scale multi-centre trials are warranted to examine the effectiveness of retraining. The timing and long-term effects of retraining also need to be examined.
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Affiliation(s)
- Wai Yin Leung
- The Mount Sinai Hospital, New York City, New York, USA
| | | | | | - Winnie K W So
- The Chinese University of Hong Kong, Hong Kong, China
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He Y, Zhu J, Xiao F, Luo Q, Wang P, Wang X, He Y, Xiong Z. Association of Different Total Bilirubin Levels with Prognosis of Peritoneal Dialysis-Associated Peritonitis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1837. [PMID: 37893555 PMCID: PMC10607946 DOI: 10.3390/medicina59101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/24/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Peritoneal dialysis-associated peritonitis (PDAP) poses significant challenges in peritoneal dialysis (PD) patient management and outcomes. Total bilirubin has gained attention due to its antioxidant and immunomodulatory properties. However, its relationship with PDAP prognosis remains underexplored. Materials and Methods: We conducted a retrospective single-center study involving 243 PDAP patients stratified into tertile-based groups according to total bilirubin levels. The association between total bilirubin levels and treatment failure risk was investigated through statistical analyses and restricted cubic spline curve analysis. Results: Our analysis revealed a non-linear correlation between total bilirubin levels and PDAP treatment failure risk. At total bilirubin levels below 8.24 µmol/L, a protective effect was observed, while levels exceeding this threshold heightened the risk of treatment failure. Conclusions: This study unveils a dual role of total bilirubin in PDAP prognosis. Below a certain threshold, it confers protection, while higher levels exacerbate the risk of treatment failure. These findings emphasize the need for further investigation in larger, multicenter prospective studies to validate and elucidate the mechanisms behind bilirubin's impact on PDAP, potentially guiding the development of targeted therapeutic strategies.
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Affiliation(s)
- Yujian He
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shantou University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Jingjing Zhu
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Fei Xiao
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shantou University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Qingyun Luo
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Pengpeng Wang
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Xu Wang
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
- PKU-Shenzhen Clinical Institute of Shenzhen University Medical College, Lianhua Road 1120, Shenzhen 518036, China
| | - Yan He
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
| | - Zibo Xiong
- Renal Division, Peking University Shenzhen Hospital, Lianhua Road 1120, Shenzhen 518036, China; (Y.H.); (J.Z.); (F.X.); (Q.L.); (P.W.); (X.W.); (Y.H.)
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Huang W, Xia D, Bi W, Lai X, Yu B, Chen W. Advances in stem cell therapy for peritoneal fibrosis: from mechanisms to therapeutics. Stem Cell Res Ther 2023; 14:293. [PMID: 37817212 PMCID: PMC10566108 DOI: 10.1186/s13287-023-03520-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 09/26/2023] [Indexed: 10/12/2023] Open
Abstract
Peritoneal fibrosis (PF) is a pathophysiological condition caused by a variety of pathogenic factors. The most important features of PF are mesothelial-mesenchymal transition and accumulation of activated (myo-)fibroblasts, which hinder effective treatment; thus, it is critical to identify other practical approaches. Recently, stem cell (SC) therapy has been indicated to be a potential strategy for this disease. Increasing evidence suggests that many kinds of SCs alleviate PF mainly by differentiating into mesothelial cells; secreting cytokines and extracellular vesicles; or modulating immune cells, particularly macrophages. However, there are relatively few articles summarizing research in this direction. In this review, we summarize the risk factors for PF and discuss the therapeutic roles of SCs from different sources. In addition, we outline effective approaches and potential mechanisms of SC therapy for PF. We hope that our review of articles in this area will provide further inspiration for research on the use of SCs in PF treatment.
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Affiliation(s)
- Weiyan Huang
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Demeng Xia
- Department of Pharmacy, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wendi Bi
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xueli Lai
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China
| | - Bing Yu
- Department of Cell Biology, Center for Stem Cell and Medicine, Naval Medical University (Second Military Medical University), Shanghai, China.
| | - Wei Chen
- Department of Nephrology, Shanghai Changhai Hospital, Naval Medical University, Shanghai, China.
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Yang N, Yang K, Pan S, He Q, Jin J. Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications. Ren Fail 2023; 45:2259996. [PMID: 37791567 PMCID: PMC10552595 DOI: 10.1080/0886022x.2023.2259996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is a novel predictive biomarker that reflects systemic inflammatory status and is routinely measured in blood tests. Owing to its ease of use and affordability, it is being increasing used as a prognostic indicator of cardiovascular disease, tumors, autoimmune disorders, and kidney disease. In recent years, a number of studies have demonstrated the clinical utility of the NLR in identifying and predicting complications associated with hemodialysis and peritoneal dialysis, including cardiovascular disease and infection. This review aimed to provide a new perspective on the application of the NLR as a valuable tool enabling clinicians to better assess the occurrence and prognosis of complications in patients undergoing dialysis.
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Affiliation(s)
- Nan Yang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Kaibi Yang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Shujun Pan
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Qiang He
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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Huang YJ, Xiong LP, Zhang X, Zhou JF, Zhang R. Higher D-dimer and activated partial thromboplastin time are poor prognostic factors in patients with peritoneal dialysis-related peritonitis. Ther Apher Dial 2023; 27:918-925. [PMID: 37357362 DOI: 10.1111/1744-9987.14027] [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: 03/20/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/27/2023]
Abstract
INTRODUCTION Coagulation system dysfunction is associated with adverse outcomes of peritoneal dialysis (PD) and bacterial infection. We investigated the association between coagulation system and treatment failure of peritoneal dialysis-related peritonitis (PDRP). METHODS We collected records of patients aged ≥18 years with PDRP. PDRP episodes were divided into: shortened activated partial thromboplastin time (APTT) group and prolonged APTT group, low D-dimer (DD) group and high DD group. The baseline characteristics of the groups were collected and compared. The association between APTT, DD and treatment failure of PDRP was analyzed using logistic regression analysis. RESULTS Thirty episodes of treatment failure were observed in 110 episodes of PDRP in our study. After adjusting for variables, prolonged APTT (OR = 1.166 [1.049-1.296], p = 0.004) or high level of DD (OR = 1.374 [1.057-1.787], p = 0.017) was associated with treatment failure of PDRP. CONCLUSION Prolonged baseline APTT or high level of DD increased the risk of treatment failure of PDRP.
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Affiliation(s)
- Ya-Juan Huang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li-Ping Xiong
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Zhang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia-Fan Zhou
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rui Zhang
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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23
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Peng YK, Tai TS, Wu CY, Tsai CY, Lee CC, Chen JJ, Hsiao CC, Chen YC, Yang HY, Yen CL. Clinical outcomes between elderly ESKD patients under peritoneal dialysis and hemodialysis: a national cohort study. Sci Rep 2023; 13:16199. [PMID: 37758848 PMCID: PMC10533893 DOI: 10.1038/s41598-023-43476-1] [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: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 09/29/2023] Open
Abstract
With ageing populations, new elderly end-stage kidney disease (ESKD) cases rise. Unlike younger patients, elderly ESKD patients are less likely to undergo kidney transplant, and therefore the decision of receiving peritoneal dialysis (PD) and hemodialysis (HD) is more crucial. A total of 36,852 patients, aged more than 65, who were newly diagnosed with ESKD and initiated renal replacement therapy between 2013 and 2019 were identified. These patients were categorized into two groups: the PD group and the HD group according to their long-term renal replacement treatment. After propensity score matching, the PD group (n = 1628) displayed a lower incidence of major adverse cardiac and cerebrovascular events (MACCE) (10.09% vs. 13.03%, hazard ratio (HR): 0.74, 95% confidence interval (CI): 0.66-0.83), malignancy (1.23% vs. 2.14%, HR: 0.55, 95% CI: 0.40-0.76), and MACCE-associated mortality (1.35% vs. 2.25%, HR: 0.62, 95% CI: 0.46-0.84) compared to the HD group (n = 6512). However, the PD group demonstrated a higher rate of infection (34.09% vs. 24.14%, HR: 1.28, 95% CI: 1.20-1.37). The risks of all-cause mortality and infection-associated mortality were not different. This study may provide valuable clinical information to assist elderly ESKD patients to choose HD or PD as their renal replacement therapy.
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Affiliation(s)
- Yu-Kai Peng
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tzong-Shyuan Tai
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
| | - Chao-Yi Wu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
- Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chung-Ying Tsai
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
| | - Cheng-Chia Lee
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-Jin Chen
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chung Hsiao
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Huang-Yu Yang
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chieh-Li Yen
- Division of Nephrology, Nephrology Department, Kidney Research Center, Linkou Medical Center, Kidney Research Institute, Chang Gung Memorial Hospital, No.5, Fuxing Street, Guishan District, Taoyuan City, 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Dai R, Peng C, Sang T, Cheng M, Wang Y, Zhang L. Construction and validation of a predictive model for the risk of peritoneal dialysis-associated peritonitis after peritoneal dialysis catheterization. Front Med (Lausanne) 2023; 10:1193754. [PMID: 37790129 PMCID: PMC10543278 DOI: 10.3389/fmed.2023.1193754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Aim To construct and validate a risk prediction model for the development of peritoneal dialysis-associated peritonitis (PDAP) in patients undergoing peritoneal dialysis (PD). Methods This retrospective analysis included patients undergoing PD at the Department of Nephrology, the First Affiliated Hospital of Anhui University of Chinese Medicine, between January 2016 and January 2021. Baseline data were collected. The primary study endpoint was PDAP occurrence. Patients were divided into a training cohort (n = 264) and a validation cohort (n = 112) for model building and validation. Least Absolute Shrinkage and Selection Operator (LASSO) regression was applied to optimize the screening variables. Predictive models were developed using multifactorial logistic regression analysis with column line plots. Receiver operating characteristic (ROC) curves, calibration curves, and Hosmer-Lemeshow goodness-of-fit tests were used to verify and evaluate the discrimination and calibration of the prediction models. Decision curve analysis (DCA) was used to assess the clinical validity of the prediction models. Results Five potential predictors of PDAP after PD catheterization were screened using LASSO regression analysis, including neutrophil-to-lymphocyte ratio (NLR), serum ALBumin (ALB), uric acid (UA), high sensitivity C-reactive protein (hsCRP), and diabetes mellitus (DM). Predictive models were developed by multi-factor logistic regression analysis and plotted in columns. The area under the ROC curve (AUC) values were 0.891 (95% confidence interval [CI]: 0.829-0.844) and 0.882 (95% CI: 0.722-0.957) for the training and validation cohorts, respectively. The Hosmer-Lemeshow test showed a good fit (p = 0.829 for the training cohort; p = 0.602 for the validation cohort). The DCA curves indicated that the threshold probabilities for the training and validation cohorts were 4-64% and 3-90%, respectively, predicting a good net gain for the clinical model. Conclusion NLR, ALB, UA, hsCRP, and DM are independent predictors of PDAP after PD catheterization. The column line graph model constructed based on the abovementioned factors has good discriminatory and calibrating ability and helps to predict the risk of PDAP after PD catheterization.
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Affiliation(s)
- Rong Dai
- Department of Chinese Medicine, Anhui University of Chinese Medicine, Hefei, China
| | - Chuyi Peng
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
| | - Tian Sang
- Graduate School, Anhui University of Chinese Medicine, Hefei, China
| | - Meng Cheng
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Yiping Wang
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
| | - Lei Zhang
- Department of Nephrology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, China
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Jaelani TR, Ibrahim K, Jonny J, Pratiwi SH, Haroen H, Nursiswati N, Ramadhani BP. Peritoneal Dialysis Patient Training Program to Enhance independence and Prevent Complications: A Scoping Review. Int J Nephrol Renovasc Dis 2023; 16:207-222. [PMID: 37720493 PMCID: PMC10505035 DOI: 10.2147/ijnrd.s414447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 08/04/2023] [Indexed: 09/19/2023] Open
Abstract
Background Peritoneal dialysis (PD) training is essential to ensure patient independence and prevent life-threatening complications, such as peritonitis. The International Society for Peritoneal Dialysis (ISPD) recommends that every PD unit worldwide implement local PD training programs with the goal of improving self-care capabilities. This scoping review aims to give an overview of recent literature and recommendations on PD training programs aiming to improve the quality of care and outcomes for PD patients. Methods The literature search was conducted using the PC (Population, Concept) approach. The population of interest in this study is PD patients, and the study concept is the PD training program. Several databases were used to conduct the literature search, including PubMed, Science Direct, and CINAHL. The search process began from July 2022 until January 2023. The inclusion criteria for the search included research articles and recommendations. Results The search yielded 22 articles recommending training programs lasting from 5-8 days, with 1-3-hour sessions and a nurse-to-patient ratio of 1:1. A cumulative training time of 15 hours or more is recommended to enhance patient independence and reduce peritonitis rates. Home-based or in-unit PD training, conducted by experienced nurses using adult learning strategies, has shown significant value in improving self-care and preventing peritonitis. Evaluating training outcomes should encompass knowledge, skills, and attitudes, and the impact on peritonitis rates. Training programs should be flexible and consider physiological and psychosocial barriers to achieving the best results. Conclusion There are a variety of strategies for dialysis training concerning duration, session length, patient-to-trainer ratio, timing, methods, location, compliance, and the need for retraining. More evidence is needed to assess the impact of PD patient training programs on self-care capabilities and peritonitis incidence. Future studies should investigate the effects of training programs on compliance, self-efficacy, and patient and nurse perspectives.
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Affiliation(s)
| | - Kusman Ibrahim
- Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia
| | - Jonny Jonny
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
| | | | - Hartiah Haroen
- Faculty of Nursing, Padjadjaran University, Bandung, West Java, Indonesia
| | | | - Bunga Pinandhita Ramadhani
- Nephrology Division, Department of Internal Medicine, Gatot Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia
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Xiao A, Dilmaghani S, Bhuiyan MN. 62-Year-Old Man With Abdominal Pain and Cloudy Peritoneal Dialysate. Mayo Clin Proc 2023; 98:1386-1391. [PMID: 37661146 DOI: 10.1016/j.mayocp.2023.01.026] [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: 11/04/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Alexander Xiao
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Saam Dilmaghani
- Fellow in Gastroenterology and Hepatology, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - M Nadir Bhuiyan
- Advisor to residents and Consultant in General Internal Medicine, Mayo Clinic, Rochester, MN.
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Tanriover C, Copur S, Basile C, Ucku D, Kanbay M. Dialysis after kidney transplant failure: how to deal with this daunting task? J Nephrol 2023; 36:1777-1787. [PMID: 37676635 DOI: 10.1007/s40620-023-01758-x] [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: 12/06/2022] [Accepted: 08/06/2023] [Indexed: 09/08/2023]
Abstract
The best treatment for patients with end-stage kidney disease is kidney transplantation, which, if successful provides both a reduction in mortality and a better quality of life compared to dialysis. Although there has been significant improvement in short-term outcomes after kidney transplantation, long-term graft survival still remains insufficient. As a result, there has been an increase in the number of individuals who need dialysis again after kidney transplant failure, and increasingly contribute to kidney transplant waiting lists. Starting dialysis after graft failure is a difficult task not only for the patients, but also for the nephrologists and the care team. Furthermore, recommendations for management of dialysis after kidney graft loss are lacking. Aim of this narrative review is to provide a perspective on the role of dialysis in the management of patients with failed kidney allograft. Although numerous studies have reported higher mortality in patients undergoing dialysis following kidney allograft failure, reports are contrasting. A patient-centered, individualized approach should drive the choices of initiating dialysis, dialysis modality, maintenance of immunosuppressive drugs and vascular access.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Via Battisti 192, 74121, Taranto, Italy.
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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Tian N, Meng H, Fung WWS, Ng JKC, Chan GCK, Kwong VWK, Pang WF, Chow KM, Li PKT, Szeto CC. Peritoneal dialysis after failed kidney allograft: Comparing patients with and without pd before transplant. PLoS One 2023; 18:e0284152. [PMID: 37463181 DOI: 10.1371/journal.pone.0284152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/26/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The result of published studies on the clinical outcome of peritoneal dialysis (PD) after kidney allograft failure is conflicting. There are also few published data on the outcome of patients who had PD before kidney transplant and then return to PD after allograft failure. METHODS We reviewed 100 patients who were started on PD after kidney allograft failure between 2001 and 2020 (failed transplant group); 50 of them received PD before transplant. We compared the clinical outcome to 200 new PD patients matched for age, sex, and diabetic status (control group). RESULTS The patients were followed for 45.8 ± 40.5 months. the 2-year patient survival rate was 83.3% and 87.8% for the failed transplant and control groups, respectively (log rank test, p = 0.2). The corresponding 2-year technique survival rate 66.5% and 71.7% (p = 0.5). The failed transplant and control groups also had similar hospitalization rate and peritonitis rate. In the failed transplant group, there was also no difference in patient survival, technique survival, hospitalization, or peritonitis rate between those with and without PD before transplant. In the failed transplant group, patients who had PD before transplant and then returned to PD after allograft failure had substantial increase in D/P4 (0.585 ± 0.130 to 0.659 ± 0.111, paired t-test, p = 0.032) and MTAC creatinine (7.74 ± 3.68 to 9.73 ± 3.00 ml/min/1.73m2, p = 0.047) from the time before the transplant to the time after PD was resumed after failed allograft. CONCLUSIONS The clinical outcome of PD patients with a failed kidney allograft is similar to other PD patients. However, patients who have a history of PD before kidney transplant and then return to PD after allograft failure have increased peritoneal transport parameters.
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Affiliation(s)
- Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Han Meng
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia
| | - Winston W S Fung
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Jack K C Ng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Gordon C K Chan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Vickie W K Kwong
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Wing-Fai Pang
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kai-Ming Chow
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Philip K T Li
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Cheuk Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
- Li Ka Shing Institute of Health Sciences (LiHS), Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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Gursu M, Shehaj L, Elcioglu OC, Kazancioglu R. The optimization of peritoneal dialysis training in long-term. FRONTIERS IN NEPHROLOGY 2023; 3:1108030. [PMID: 37675347 PMCID: PMC10479566 DOI: 10.3389/fneph.2023.1108030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/20/2023] [Indexed: 09/08/2023]
Abstract
Peritoneal dialysis is a home based therapy for patients with advanced chronic kidney disease. This method provides adequate clearance of uremic toxins and removal of excess fluid when a proper dialysis prescription is combined with patient adherence. Peritonitis is the most frequent infectious complication among these patients and may render the continuity of the treatment. Training patients and their caregivers have prime importance to provide proper treatment and prevent complications including infectious ones. The training methods before the onset of treatment are relatively well established. However, patients may break the rules in the long term and tend to take shortcuts. So, retraining may be necessary during follow-up. There are no established guidelines to guide the retraining of PD patients yet. This review tends to summarize data in the literature about retraining programs and also proposes a structured program for this purpose.
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Affiliation(s)
- Meltem Gursu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Larisa Shehaj
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
- Department of Internal Medicine, Salus Hospital, Tirana, Albania
- ISN fellow in Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Omer Celal Elcioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
| | - Rumeyza Kazancioglu
- Department of Nephrology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Türkiye
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Hamidi S, Auguste BL. Continuous quality improvement in peritoneal dialysis: Your questions answered. Perit Dial Int 2023:8968608231156924. [PMID: 36843355 DOI: 10.1177/08968608231156924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
Peritoneal dialysis (PD) uptake around the globe has steadily increased over the last several decades as a viable alternative to haemodialysis. Continued success of this technique for patients is contingent on the application of continuous quality improvement (CQI) principles in PD practice which can improve patient outcomes and in turn lead to more successful PD programmes worldwide. In this installation of 'Your Questions Answered', we will outline an approach to quality improvement initiatives and examine the importance of CQI principles in PD practice. We will also highlight common pitfalls and provide strategies to identify potential targets for improvement within your PD programme.
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Affiliation(s)
- Shabnam Hamidi
- Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Bourne L Auguste
- Department of Medicine, University of Toronto, ON, Canada.,Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Centre for Quality Improvement and Patient Safety, University of Toronto, ON, Canada
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Cosmatos A, McCormick B, Blew B, Brown PA. Pre-Peritoneal Dialysis Peritonitis After Saline Infusion Sonohysterogram in a Patient With an Embedded Catheter: A Case Report. Can J Kidney Health Dis 2023; 10:20543581231156854. [PMID: 36814965 PMCID: PMC9940227 DOI: 10.1177/20543581231156854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 02/19/2023] Open
Abstract
Rationale Clear guidelines currently exist regarding antibiotic prophylaxis for patients on peritoneal dialysis (PD) prior to common diagnostic procedures. However, these guidelines do not include patients with subcutaneously embedded PD catheters who are awaiting PD initiation although both these populations share a great deal of risk factors for infections. Issues regarding antibiotic prophylaxis and avoidable infections are bound to keep occurring if physicians are not conscious of the risks of infections shared by all patients suffering from renal failure. Presenting concerns Two weeks after a saline infusion sonohysterography (SIS), a 48-year-old woman with chronic kidney disease (CKD) G5 ND, type 2 diabetes, a subcutaneously embedded PD catheter, and prior abnormal uterine bleeding presented to the emergency department complaining of nausea, vomiting, diarrhea, weakness, and abdominal pain. The patient received no antibiotic prophylaxis prior to her SIS. Diagnoses The final diagnosis of peritonitis was established after acute kidney injury, gastroenteritis, and small bowel obstruction were considered and ruled out. A delay in the final diagnosis occurred because of the complex presentation, the fact that the patient had not yet initiated PD, and the presence of concomitant anion gap metabolic acidosis and an acute elevation of the patient's creatinine. Interventions The patient was started on broad-spectrum intravenous antibiotics when the diagnosis of peritonitis was established. Insulin and intravenous bicarbonate infusions were used to correct the patient's anion gap metabolic acidosis. Surgical debridement of the necrotic subcutaneous tissue and removal of the embedded PD catheter were necessary. Outcomes The patient's infection resolved completely as did her anion gap metabolic acidosis. The patient had to transfer permanently from PD to hemodialysis for her renal replacement therapy. Teaching points This case report serves as a good reminder that physicians should keep in mind the possibility of peritonitis in patients with embedded PD catheters. As these patients are also at risk of infections, antibiotic prophylaxis should be used in patients with embedded catheters in the same way it is used for PD patients prior to obstetrical, gynecological, or gastrointestinal procedures.
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Affiliation(s)
| | - Brendan McCormick
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada,Kidney Research Centre, Ottawa Hospital Research Institute, ON, Canada
| | - Brian Blew
- Division of Urology, Department of Surgery, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Pierre Antoine Brown
- Division of Nephrology, Department of Medicine, University of Ottawa, ON, Canada,Kidney Research Centre, Ottawa Hospital Research Institute, ON, Canada,Pierre Antoine Brown, Division of Nephrology, Department of Medicine, University of Ottawa, 1967 Riverside Dr, Ottawa, ON K1H 7W9, Canada.
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Grubić M, Vuković M, Radić J. Peritoneal dialysis in Dalmatian County, Croatia: 21 years of a single-center experience. Ther Apher Dial 2023; 27:91-99. [PMID: 35561066 DOI: 10.1111/1744-9987.13884] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 04/25/2022] [Accepted: 05/11/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION With end-stage renal disease becoming more prevalent, the importance of continuous ambulatory peritoneal dialysis (CAPD) is expected to rise even more. However, CAPD is associated with several infections with peritonitis being of the biggest importance. METHODS We collected data regarding acute peritonitis episodes (APEs), date of birth and CAPD start, BMI, diabetes mellitus (DM) prevalence, year of renal disease discovery, and details about renal replacement therapies. Primary outcomes included death, transplantation, and a switch to hemodialysis (HD). RESULTS Hundred and twenty-nine men and 123 women were analyzed. 63 patients had DM. The median age at the start of CAPD was 56. The median length of CAPD treatment was 24 months. In the end, 147 patients were still alive of which 97 were transplanted, 33 were on CAPD, and 26 were switched to HD. A total of 327 APE were observed. CONCLUSION Although the incidence is decreasing, efforts are required to enhance the prevention and treatment of APE.
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Affiliation(s)
- Marina Grubić
- University of Split School of Medicine, Split, Croatia
| | - Miro Vuković
- University of Split School of Medicine, Split, Croatia
| | - Josipa Radić
- University of Split School of Medicine, Split, Croatia.,University Hospital Center Split, Split, Croatia
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Su N, Zheng Y, Zhang X, Tang X, Tang LW, Wang Q, Chen X, Wang X, Wen Y, Feng X, Zhou Q, Zhou J, Li Y, Shang S. Platelet-to-lymphocyte ratio and the first occurrence of peritonitis in peritoneal dialysis patients. BMC Nephrol 2022; 23:415. [PMID: 36585653 PMCID: PMC9803258 DOI: 10.1186/s12882-022-03038-5] [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: 01/17/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Platelet-to-lymphocyte ratio (PLR) has been used as a potential biomarker of inflammation-related diseases, but its role in the peritoneal dialysis-related peritonitis (PDRP) is still uncertain. This study was aimed to investigate the association between PLR and the new-onset PDRP in peritoneal dialysis (PD) patients. METHODS In this multicenter retrospective study, 1378 PD Chinese PD patients were recruited from four centers, who were divided into the high PLR group (HPG) and the low PLR group (LPG) according to the cutoff value of PLR. The correlation between PLR and the new-onset PDRP was assessed using the Cox regression model analysis. RESULTS During follow-up, 121 new-onset PDRP events were recorded. Kaplan-Meier survival curve showed a higher risk of new-onset PDRP in the HPG (log-rank test, P < 0.001). After adjusting for confounding factors, the Cox regression model showed the risk of new-onset PDRP was higher in the HPG than that in the LPG (HR 1.689, 95%CI 1.096-2.602, P = 0.017). Competitive risk model analysis showed that significant differences still existed between the two PLR groups in the presence of other competitive events (P < 0.001). CONCLUSION PLR is independently associated with the new-onset PDRP in PD patients.
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Affiliation(s)
- Ning Su
- grid.488525.6Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China ,grid.488525.6Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yijia Zheng
- grid.488525.6Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xing Zhang
- grid.488525.6Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xingming Tang
- Department of Nephrology, DongGuan SongShan Lake Hospital, Dongguan, China
| | - Li-wen Tang
- Department of Nephrology, DongGuan SongShan Lake Hospital, Dongguan, China
| | - Qinqin Wang
- grid.488525.6Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xingyu Chen
- grid.488525.6Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyang Wang
- grid.412633.10000 0004 1799 0733Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yueqiang Wen
- grid.412534.5Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Qian Zhou
- grid.412615.50000 0004 1803 6239Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jiafan Zhou
- grid.488525.6Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yafang Li
- grid.488525.6Department of Intensive Care Unit, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Sijia Shang
- grid.488525.6Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
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Keskin Gözmen Ş, Serdaroğlu E, Dinçel N, Erturgut P, Başaran C, Devrim F, Pehlivan Zorlu B, Dur Ö, Deniz Kara O, Bekiroğlu Yilmaz E. Automated complete blood counter, urine analyzer and urine dipstick test results are correlated with thoma cell counting chamber counts in the diagnosis of dialysis related peritonitis in children. Nephrol Ther 2022; 18:611-615. [PMID: 36435740 DOI: 10.1016/j.nephro.2022.10.001] [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: 04/18/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Peritoneal dialysis is the treatment of choice for end-stage renal disease. Peritoneal dialysis related peritonitis is of great importance for patient and technical survival. The aim of our study was to evaluate the accuracy and the correlation between the three methods (complete blood count, urinalysis device, urine dipstick test) and with the reference manual method (Thoma Cell Counter Chamber). MATERIALS AND METHODS We retrospectively analyzed 167 peritoneal fluid samples taken from 25 patients receiving peritoneal dialysis treatment. Leukocyte counts were evaluated with Thoma Cell Counter Chamber, complete blood count, urinalysis device and urine dipstick test. RESULTS There was a significant positive correlation between Thoma Cell Counter Chamber and complete blood count results (Spearman's rho=0.70), between Thoma Cell Counter Chamber and urinalysis device (Spearman's rho=0.73), and between Thoma Cell Counter Chamber and urine dipstick test (Spearman's rho=0.71). Area under curve for complete blood count, urinalysis device and urine dipstick test were 0.93, 0.94 and 0.89 respectively, indicating good accuracy. Sensitivity and specificity were 89.7% and 86.7% in the complete blood count analysis (associated criterion: 130 cells/mm3). Sensitivity and specificity were 89.7% and 86.7% in the urinalysis device (associated criterion: 10 cells/HPF). Sensitivity and specificity were 79.6% and 91.4% when in the urine dipstick test analysis (associated criterion: +1 positivity). The Bland-Altman plot showed good agreement. CONCLUSION Automatic complete blood count and urinalysis devices have good correlation and agreement with manual method in the diagnosis of peritonitis in the pediatric age group. Urine dipstick test in the home setting can be useful for screening patients with suspected peritonitis.
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Affiliation(s)
- Şükran Keskin Gözmen
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey.
| | - Erkin Serdaroğlu
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
| | - Nida Dinçel
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
| | - Pınar Erturgut
- Pediatric Nephrology, University of Health Sciencies, Antalya Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Cemaliye Başaran
- Pediatric Nephrology, University of Health Sciencies, Tepecik Training and Research Hospital, Department of Pediatric Nephrology, Izmir, Turkey
| | - Fatma Devrim
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
| | - Betül Pehlivan Zorlu
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
| | - Özlem Dur
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
| | - Orhan Deniz Kara
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
| | - Ebru Bekiroğlu Yilmaz
- Pediatric Nephrology, University of Health Sciencies, Dr. Behçet Uz Children's Hospital; Department of Pediatric Nephrology, Ismet Kaptan Mh. Sezer Dogan Sk. No: 11, 35210 Izmir, Turkey
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Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
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Hama EY, Uchiyama K, Nagasaka T, Kusahana E, Nakayama T, Yasuda I, Morimoto K, Washida N, Itoh H. High body mass index is a risk factor for transition to hemodialysis or hybrid therapy and peritoneal dialysis-related infection in Japanese patients undergoing peritoneal dialysis. Int Urol Nephrol 2022; 54:3193-3202. [PMID: 35759207 DOI: 10.1007/s11255-022-03252-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Obesity may negatively impact the clinical outcomes of patients undergoing peritoneal dialysis (PD). However, the impact of obesity on PD-related outcomes remains unclear. We herein examined the association of high body mass index (BMI) with complete hemodialysis (HD) transfer, transition to HD and PD/HD hybrid therapy, peritonitis, catheter exit-site and tunnel infection (ESI/TI), and heart failure-related hospitalization. METHODS This retrospective cohort study included 120 patients who underwent PD-catheter insertion between January 2008 and June 2018. BMI ≥ 25 kg/m2 at the time of PD-catheter insertion was defined as high BMI, and its association with outcomes was analyzed using the log-rank test and Cox proportional hazards models. RESULTS The follow-up duration was 46.2 (23.3-75.3) months. The time until transfer to HD and hybrid therapy was significantly shorter in the high BMI group than that in the low BMI group, whereas the time until HD transfer was not significantly different between the two groups (P < 0.001 and 0.18, respectively). Peritonitis-free and ESI/TI-free survivals were significantly shorter in the high BMI group than those in the low BMI group (P = 0.006 and 0.03, respectively). After adjusting for age, sex, diabetes mellitus, and estimated glomerular filtration rate, high BMI remained a significant risk factor for transferring to HD and hybrid therapy, peritonitis, and ESI/TI (hazard ratio [HR] 2.60, P < 0.001; HR 2.08, P = 0.01; HR 2.64, P = 0.02, respectively). CONCLUSION BMI ≥ 25 kg/m2 is a risk factor for transition to HD and hybrid therapy, peritonitis, and ESI/TI, but not for complete HD transfer in Japanese patients with PD.
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Affiliation(s)
- Eriko Yoshida Hama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kiyotaka Uchiyama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
| | - Tomoki Nagasaka
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Ei Kusahana
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Takashin Nakayama
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Itaru Yasuda
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
| | - Kohkichi Morimoto
- Apheresis and Dialysis Center, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, Japan
| | - Naoki Washida
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, 4-3, Kozunomori, Narita, Chiba, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan
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Pessoa RBG, de Oliveira WF, Correia MTDS, Fontes A, Coelho LCBB. Aeromonas and Human Health Disorders: Clinical Approaches. Front Microbiol 2022; 13:868890. [PMID: 35711774 PMCID: PMC9195132 DOI: 10.3389/fmicb.2022.868890] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 03/23/2022] [Indexed: 11/16/2022] Open
Abstract
The genus Aeromonas comprises more than 30 Gram-negative bacterial species and naturally inhabitants from aquatic environments. These microorganisms, commonly regarded as pathogens of fish and several other animals, have been gaining prominence on medical trial due to its ability to colonize and infect human beings. Besides water, Aeromonas are widely spreaded on most varied sources like soil, vegetables, and food; Although its opportunistic nature, they are able to cause infections on immunocompromised or immunocompetent patients. Aeromonas species regarded as potential human pathogens are usually A. hydrophila, A. caviae, and A. veronii biovar sobria. The main clinical manifestations are gastrointestinal tract disorders, wound, and soft tissue infections, as well as septicemia. Regarding to antibiotic responses, the bacteria present a diversified susceptibility profile and show inherence resistance to ampicillin. Aeromonas, as an ascending genus in microbiology, has been carefully studied aiming comprehension and development of methods for detection and medical intervention of infectious processes, not fully elucidated in medicine. This review focuses on current clinical knowledge related to human health disorders caused by Aeromonas to contribute on development of efficient approaches able to recognize and impair the pathological processes.
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Affiliation(s)
| | - Weslley Felix de Oliveira
- Departamento de Bioquímica, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Brazil
| | | | - Adriana Fontes
- Departamento de Biofísica e Radiobiologia, Centro de Biociências, Universidade Federal de Pernambuco, Recife, Brazil
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The relationship between the prognostic nutritional index and new-onset pneumonia in peritoneal dialysis patients. Int Urol Nephrol 2022; 54:3017-3024. [PMID: 35701571 PMCID: PMC9197727 DOI: 10.1007/s11255-022-03233-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 04/24/2022] [Indexed: 11/18/2022]
Abstract
Purpose As an indicator of nutrition and immunity, the prognostic value of the prognostic nutritional index (PNI) has been confirmed in various diseases. However, the relationship between PNI and the incidence of pneumonia in peritoneal dialysis (PD) patients remains unknown. The purpose of this study was to investigate the relationship between PNI and new-onset pneumonia in patients undergoing PD. Methods Thousand two hundred and nighty eight patients were enrolled in this multicenter retrospective study from February 1, 2010, to February 28, 2020. A total of 899 patients were included in the final statistical analysis. The patients were stratified into two groups by PNI quartiles. The primary endpoint was a new-onset pneumonia event. Cox regression model analysis was used to explore the association between PNI and the first occurrence of pneumonia. Results During a mean follow-up of 41.43 months, 147 patients developed new-onset pneumonia. Kaplan–Meier survival curves showed a significant difference in the incidence of the first presentation of pneumonia between the two groups, that patients in the low PNI group had a higher risk of pneumonia (P = 0.016). By adjusting for demographic parameters, comorbidities, and laboratory indicators, the Cox regression model showed that the high PNI group had less risk compared to the low PNI group (HR 0.479 95% CI 0.297–0.772, P = 0.003). There were no interactions in the subgroups as follows: diabetes, hypertension, age, and sex. Conclusions Low PNI levels were independently associated with the first occurrence of pneumonia in PD patients. PNI was an independent predictor of new-onset pneumonia in PD patients.
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Zhang R, Zhang X, Tang X, Tang L, Shang S, Wang X, Wen Y, Feng X, Zhou Q, Su N, Huang Y. The association between diabetes coexisting with low levels of high-density lipoprotein cholesterol and peritoneal dialysis-related peritonitis. Diabetol Metab Syndr 2022; 14:60. [PMID: 35488249 PMCID: PMC9052536 DOI: 10.1186/s13098-022-00832-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low levels of high-density lipoprotein cholesterol (HDL-C) and diabetes are common in patients undergoing peritoneal dialysis (PD). The aim of this study was to investigate the association between the coexistence of diabetes with a low level of HDL-C and the first episode of peritoneal dialysis-related peritonitis (PDRP) in patients with PD. METHODS We retrospectively investigated patients with PD from January 1, 2003, to May 31, 2020, in four PD centers. Patients with PD were divided into four groups: no comorbidities, low HDL-C only, diabetes only, and diabetes plus low HDL-C. The clinical and laboratory baseline data of the four groups were collected and compared. The association between diabetes coexisting with low HDL-C levels and the first episode of PDRP was analyzed by multivariate Cox regression analysis. RESULTS A total of 1013 patients with PD were included in our study. The mean age was 49.94 ± 14.32 years, and 597 (58.99%) patients were males. A total of 301 (29.7%) patients had their first episodes of PDRP, and low HDL-C levels coexisted with diabetes in 72 patients with PD. After adjusting for confounding factors, a low level of HDL-C coexisting with diabetes was significantly associated with the first episode of PDRP in our study (hazard ratio: 2.81, 95% CI 1.32 ~ 4.73, p = 0.005). The associations among HDL-C, diabetes and PDRP were consistent in the following subgroups: sex, age, and pre-existing CVD (all P interaction > 0.05). CONCLUSIONS Patients with both diabetes and low HDL-C levels were at higher risk for PDRP in patients with PD.
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Affiliation(s)
- Rui Zhang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xing Zhang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xingming Tang
- Department of Nephrology, The Affiliated Tung Wah Hospital of Sun Yat-Sen University, Dongguan, China
| | - Liwen Tang
- Department of Nephrology, The Affiliated Tung Wah Hospital of Sun Yat-Sen University, Dongguan, China
| | - Sijia Shang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Univeristy, ZhengZhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People's Hospital, Jiujiang, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Ning Su
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
| | - Yajuan Huang
- Department of Nephrology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510655, China.
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40
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Guía clínica de la Sociedad Española de Nefrología para la prevención y tratamiento de la infección peritoneal en diálisis peritoneal. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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41
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Yekinni IO, Viker T, Hunter R, Tucker A, Elfering S, Rheault MN, Erdman A. Design and proof-of-concept evaluation of a touchless connector system for preventing peritoneal dialysis-associated peritonitis. BMJ INNOVATIONS 2022; 8:98-104. [PMID: 35677314 PMCID: PMC9173658 DOI: 10.1136/bmjinnov-2021-000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION In this paper, we describe the design of a touchless peritoneal dialysis connector system and how we evaluated its potential for preventing peritoneal dialysis-associated peritonitis, in comparison to the standard of care. The unique feature of this system is an enclosure within which patients can connect and disconnect for therapy, protecting their peritoneal catheters from touch or aerosols. METHODS We simulated a worst-case contamination scenario by spraying 40mL of a standardized inoculum [ 1×107 colony-forming units (CFU) per milliliter] of test organisms, Staphylococcus epidermidis ATCC1228 and Pseudomonas aeruginosa ATCC39327, while test participants made mock connections for therapy. We then compared the incidence of fluid path contamination by test organisms in the touchless connector system and the standard of care. 4 participants were recruited to perform a total of 56 tests, divided in a 1:1 ratio between both systems. Peritoneal dialysis fluid sample from each test was collected and maintained at body temperature (37° C) for 16 hours before being plated on Luria Bertani agar, Mannitol Salts Agar and Pseudomonas isolation agar for enumeration. RESULTS No contamination was observed in test samples from the touchless connector system, compared to 65%, 75% and 70% incidence contamination for the standard of care on Luria Bertani agar, Mannitol Salts Agar and Pseudomonas isolation agar respectively. CONCLUSION Results show that the touchless connector system can prevent fluid path contamination even in heavy bacterial exposures and may help reduce peritoneal dialysis-associated peritonitis risks from inadvertent contamination with further development.
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Affiliation(s)
| | | | - Ryan Hunter
- Department of Microbiology and Immunology, University of Minnesota Medical School, Minnesota, USA
| | - Aaron Tucker
- Bakken Medical Devices Center, University of Minnesota, Minnesota, USA
| | - Sarah Elfering
- Department of Medicine, University of Minnesota Medical School, Minnesota, USA
| | - Michelle N. Rheault
- Department of Pediatrics, University of Minnesota Medical School, Minnesota, USA
| | - Arthur Erdman
- Bakken Medical Devices Center, University of Minnesota, Minnesota, USA
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Chou YH, Chen YT, Chen JY, Tarng DC, Lin CC, Li SY. Baseline Peritoneal Membrane Transport Characteristics Are Associated with Peritonitis Risk in Incident Peritoneal Dialysis Patients. MEMBRANES 2022; 12:membranes12030276. [PMID: 35323751 PMCID: PMC8954606 DOI: 10.3390/membranes12030276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022]
Abstract
The peritoneal equilibration test (PET) is a semi-quantitative measurement that characterizes the rate of transfer of solutes and the water transfer rate across the peritoneum in patients treated with peritoneal dialysis (PD). The results of the PET are used to maximize daily peritoneal ultrafiltration and solute clearances. Previous studies have shown that high transport status is associated with ultrafiltration failure, malnutrition, and reduced survival; however, the way in which peritoneum transport characteristics affect peritonitis risk is unknown. In the current cohort study, we recruited 898 incident-PD patients and used intention-to-treat analysis to test if baseline PET affected the subsequent 3-year peritonitis rate. Among all recruited PD patients, 308 (34.2%) developed peritonitis within three years. Multivariate Cox regression analysis showed that the high-transport group has the greatest peritonitis risk (HR 1.98, 95% CI: 1.08–3.62) even after an adjustment for demographics, comorbid diseases, and biochemical measurements. We concluded that a baseline high peritoneal membrane transport rate is an independent risk factor for peritonitis in incident PD patients.
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Affiliation(s)
- Yi-Hsin Chou
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
| | - Yung-Tai Chen
- Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei 11217, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Der-Cherng Tarng
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
- Department and Institute of Physiology, National Yang-Ming University, Taipei 11217, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (Y.-H.C.); (J.-Y.C.); (D.-C.T.); (C.-C.L.)
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei 11217, Taiwan
- Correspondence:
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The Impact of Preoperative Risk Factors on Peritoneal Dialysis-Related Peritonitis: A Single-Center Prospective Study in Japan. Medicina (B Aires) 2022; 58:medicina58020313. [PMID: 35208636 PMCID: PMC8878486 DOI: 10.3390/medicina58020313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Peritoneal dialysis (PD)-related peritonitis is a critical problem. However, preoperative risk factors for PD-related peritonitis have not been established. Thus, we aimed to determine the preoperative risk factors for PD-related peritonitis. Materials and Methods: This is a single-center prospective observational study. All peritonitis episodes during the study period were recorded, and preoperative and intraoperative clinical parameters were compared between patients with and without peritonitis to examine risk factors for PD-related peritonitis. Furthermore, subcutaneous and abdominal fat volumes were evaluated using computed tomography. Results: Among a total of 118 patients, 24 patients developed peritonitis. The proportion of male patients (83% vs. 61%, p = 0.04), body mass index (25 vs. 22 kg/m2, p = 0.04), and subcutaneous fat area (120 vs. 102 cm2, p = 0.01) were significantly higher and the proportion of patients living with family members (75% vs. 94%, p = 0.02) was significantly lower in the peritonitis group than in the non-peritonitis group. There were no significant differences in age, operation method, surgeon experience, previous abdominal surgery, medical history of diabetic nephropathy, serum albumin level, and renal function between the two groups. Conclusions: Male patients with high subcutaneous fat who are living alone might be at higher risk of PD-related peritonitis. These characteristics might be useful in risk assessment and patient education before PD induction.
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He S, Xiong Q, Li L, Lin X, Zhao J, Guo X, He Y, Liang W, Ying C, Zuo X. Increased risk of modality failure with higher serum uric acid level in continuous ambulatory peritoneal dialysis patients: a prospective cohort study. Ren Fail 2022; 44:272-281. [PMID: 35172675 PMCID: PMC8856069 DOI: 10.1080/0886022x.2022.2035762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is one of the most important kidney replacement therapies for patients with end-stage kidney disease (ESKD). PD technique failure can lead to an escalated cost and increased infectious and cardiovascular risk, up and including to death. The accumulation of uric acid (UA) was associated with adverse outcomes in ESKD patients. However, the relationship between serum UA and technique failure is little explored. METHODS Here, a total of 266 continuous ambulatory peritoneal dialysis (CAPD) patients (age, 41.8 ± 12.6 years; 125 males) were enrolled and followed up for 31.7 months. Serum UA levels were examined at baseline and each visit. Subjects were divided into three groups according to their baseline serum UA concentrations. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of PD technique failure. RESULTS The level of serum UA increased gradually as time prolonged. During the follow-up period, 77 (28.9%) patients occurred PD technique failure, of which 56 (21.1%) transferred to hemodialysis (HD) and 21 (7.9%) died. Compared to the lowest UA tertile, after adjusting for potential confounders, HRs of technique failure in tertile 2 and tertile 3 were 1.82 (95% CI: 0.95-3.49) and 2.03 (95% CI: 1.05-3.92), respectively, and p for trend was 0.043. Adjusted HRs of all-cause technique failure, transferring to HD and mortality with each 1 mg/dL increase in serum UA were 1.20 (95% CI: 1.03-1.40, p = 0.019), 1.22 (95% CI: 1.01-1.48, p = 0.039), and 1.25 (95% CI: 0.94-1.67, p = 0.128), respectively. CONCLUSION Higher serum UA level predicted higher risk of technique failure in CAPD patients.
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Affiliation(s)
- Shuiqing He
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianqian Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Li
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqin He
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wangqun Liang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Peritoneal Dialysis-Related Peritonitis: Rate, Clinical Outcomes and Patient Survival. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2021; 42:47-55. [PMID: 35032377 DOI: 10.2478/prilozi-2021-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Peritoneal dialysis-related peritonitis remains the major complication and primary challenge to the long-term success of peritoneal dialysis (PD). The study aimed to analyze the peritonitis rate, the cause, the outcomes, and the association of peritonitis with the survival of patients on peritoneal dialysis. Patient data were collected retrospectively from medical charts. A total of 96 patients received peritoneal dialysis in the PD center from 1 January 1999 to 31 December 2018. Episodes of peritonitis (n=159) were registered in 54 (56.3%) patients. The study population was divided into two groups, a group of patients (n=54) who experienced peritonitis and a group of patients free of peritonitis (n=42). The peritonitis rate was 0.47 episodes per patient year. The majority of causative microorganisms were gram-positive bacteria (53.5%). Outcomes of the episodes of peritonitis were resolved infection in 84.9% of episodes, catheter removal in 11.3% of episodes, and death in 3.8% of the episodes of peritonitis. A Kaplan-Meier analysis and log-rank test revealed that the group with peritonitis tended to survive significantly longer than the peritonitis-free group. A 67% reduction rate in the risk of patient mortality was observed for the peritonitis group compared with the peritonitis-free group (hazard ratio: 0.33, 95% CI 0.19-0.57, P=0.000). The prevention and management of PD-related infections, resulted in their worldwide reduction, supporting the use of PD as a first-line dialysis modality.
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46
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Muthucumarana K, Howson P, Burrows S, Swaminathan S, Irish A. The effect of radiological imaging on treatment delay and hospitalisation in patients with peritoneal dialysis-related peritonitis: A secondary analysis of the PROMPT study. Perit Dial Int 2021; 42:154-161. [PMID: 34931574 DOI: 10.1177/08968608211065871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In peritoneal dialysis-related peritonitis (peritonitis), delayed antibiotic therapy is associated with adverse outcomes. Identifying barriers to timely treatment may improve outcomes. AIM To determine the impact of radiological investigations on treatment delay and predictors of hospitalisation and length of stay (LOS). METHODS Retrospective review of patients with presumed peritonitis in Western Australia. RESULTS In 153 episodes of peritonitis, 79 (51.6%) resulted in admission with a median LOS of 3 days (Q1, Q3: 1, 6). In a multivariable model, significant predictors of admission were abnormal exit-site (odds ration (OR) 5.7; 95% confidence interval (CI): 1.4, 23.6; p = 0.02), failure to detect a cloudy bag (OR 11.9; 95%CI: 3.2, 44.7; p < 0.001), female sex (OR 3.3; 95% CI: 1.4, 9.7; p = 0.027), radiological imaging within 24 h (OR 8.8; 95% CI: 2.2, 34.8; p = 0.002) and contact with ambulant care facility (OR 0.32, 95% CI: 0.11, 0.98; p = 0.04). Imaging within 24 h of presentation occurred in 41 (27%) episodes of peritonitis, mostly plain X-rays (91%), of which 83% were clinically irrelevant. Imaging performed within 24 h of presentation increased the median time to antibiotic treatment (2.9 h (Q1, Q3: 1.6, 6.4) vs 2.0 h (Q1, Q3: 1, 3.8; p = 0.046)). Imaging performed prior to administering antibiotics significantly increased the median time to treatment (4.7 h (Q1, Q3: 2.9, 25) vs 1.5 h (Q1, Q3: 0.75, 2.5; p < 0.001)) in those where imaging followed antibiotic treatment. CONCLUSIONS Half of all presentations with peritonitis result in hospital admission. Radiological imaging was associated with an increased risk of hospitalisation, potentially contributes to treatment delay, and was mostly clinically unnecessary. When required, imaging should follow antibiotic therapy.
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Affiliation(s)
- K Muthucumarana
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - P Howson
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - S Burrows
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Royal Perth Hospital Research Foundation, Perth, Western Australia, Australia
| | - S Swaminathan
- Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - A Irish
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Nephrology, Fiona Stanley Hospital, Perth, Western Australia, Australia
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47
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Xu H, Lindholm B, Lundström UH, Heimbürger O, Stendahl M, Rydell H, Segelmark M, Carrero JJ, Evans M. Treatment practices and outcomes in incident peritoneal dialysis patients: the Swedish Renal Registry 2006-2015. Clin Kidney J 2021; 14:2539-2547. [PMID: 34950465 PMCID: PMC8690080 DOI: 10.1093/ckj/sfab130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Therapeutic developments have contributed to markedly improved clinical outcomes in peritoneal dialysis (PD) during the 1990s and 2000s. We investigated whether recent advances in PD treatment are implemented in routine Swedish care and whether their implementation parallels improved patient outcomes. METHODS We conducted an observational study of 3122 patients initiating PD in Sweden from 2006 to 2015. We evaluated trends of treatment practices (medications, PD-related procedures) and outcomes [patient survival, major adverse cardiovascular events (MACEs), peritonitis, transfer to haemodialysis (HD) and kidney transplantation] and analysed associations of changes of treatment practices with changes in outcomes. RESULTS Over the 10-year period, demographics (mean age 63 years, 33% women) and comorbidities remained essentially stable. There were changes in clinical characteristics (body mass index and diastolic blood pressure increased), prescribed drugs (calcium channel blockers, non-calcium phosphate binders and cinacalcet increased and the use of renin-angiotensin system inhibitors, erythropoietin and iron decreased) and dialysis treatment (increased use of automated PD, icodextrin and assisted PD). The standardized 1- and 2-year mortality and MACE risk did not change over the period. Compared with the general population, the risk of 1-year mortality was 4.1 times higher in 2006-2007 and remained stable throughout follow-up. However, the standardized 1- and 2-year peritonitis rate decreased and the incidence of kidney transplantation increased while transfers to HD did not change. CONCLUSIONS Over the last decade, treatment advances in PD patients were accompanied by a substantial decline in peritonitis frequency and an increased rate of kidney transplantations, while 1- and 2-year survival and MACE risk did not change.
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Affiliation(s)
- Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Ulrika Hahn Lundström
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Stendahl
- Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden
| | - Helena Rydell
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mårten Segelmark
- Division of Nephrology, Department of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden
| | - Juan-Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marie Evans
- Division of Renal Medicine and Baxter Novum, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Kojima S, Yamada S, Fujishima R, Koitabashi K, Shibagaki Y, Sakurada T. Evaluation of modifiable risk factors for peritoneal dialysis-related peritonitis: a single-center retrospective cohort study. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Peritoneal dialysis (PD)-related peritonitis risk factors can be categorized as modifiable and uncorrectable. We aimed to identify modifiable risk factors for PD-related peritonitis in our facility to prevent PD-related peritonitis and continue quality improvement.
Methods
This retrospective, observational study included 90 patients who started receiving PD after 2008 and who were continued for over 1 year. Twenty-three patients experienced 40 episodes of peritonitis. Several clinical factors identified at peritonitis onset among patients with a peritonitis history were compared with those identified 1 year after PD initiation among patients without a peritonitis history, and a multivariate analysis was performed. Several serum parameter levels were evaluated as time-average concentrations (TACs; from PD initiation to 1 month before peritonitis onset or to 1 year later). The clinical factors to be investigated were selected based on previous studies.
Results
There were no significant between-group differences in baseline characteristics regarding uncorrectable factors and TAC values for serum parameters. Use of exchange devices was significantly higher (95.7% vs 71.6%; p = 0.054) whereas administration of renin-angiotensin-aldosterone system (RAS) blockers, calcium channel blockers (CCBs), or oral vitamin D was significantly lower (35.0% vs 65.7%, p = 0.002; 55.0% vs 74.6%, p = 0.036; and 55.0% vs 74.6%, p = 0.036, respectively) in the patients with history of peritonitis, although we did not find a factor independently associated with peritonitis in multivariable logistic regression.
Conclusions
Although hypokalemia, hypoalbuminemia, and exchange device use which are considered as risk factors did not affect peritonitis, administration of RAS blockers, CCBs, and oral vitamin D is significantly larger in patients without peritonitis.
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Noppakun K, Narongchai T, Chaiwarith R, Wongsawad U, Vongsanim S, Ruengorn C, Nochaiwong S. Comparative effectiveness of lactulose and sennosides for the prevention of peritoneal dialysis-related peritonitis: an open-label, randomized, active-controlled trial. Ann Med 2021; 53:365-374. [PMID: 33596746 PMCID: PMC7894424 DOI: 10.1080/07853890.2021.1889023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND To the best of our knowledge, the effectiveness and safety of lactulose in comparison to sennosides, for the prevention of peritoneal dialysis (PD)-related peritonitis, has never been tested in a randomized study. METHODS We conducted an open-label, randomized, active-controlled trial in a PD-center in Northern Thailand. Adult patients on PD were enrolled and randomly assigned in a 1:1 ratio into two groups; one group received lactulose 15 mL once daily (n = 50) and the other group received sennosides two tablets daily (n = 50). The primary outcome was time-to-first bacterial peritonitis. The secondary outcomes included a composite of bacterial peritonitis and all-cause mortality. Cox proportional hazards regression was calculated and presented as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS One hundred PD patients were recruited (50.0% men; mean age 55.5 ± 13.0 years) in this study. The baseline characteristics of the study participants were similar in both groups. No significant trend towards a higher risk of PD-related peritonitis was observed in the lactulose group (HR, 2.32 [95% CI, 0.92-5.83]; p = .051) compared to the sennosides group. Nevertheless, the secondary outcome was significantly higher in the lactulose group (HR, 2.77 [95% CI, 1.20-6.41]; p = .010). The incidence of adverse events was not substantially different between the two groups; however, diarrhoea was more frequent in the lactulose group (38.0% vs. 18.0%; p = .030) than in the sennosides group. CONCLUSIONS Treatment with lactulose is not more effective than sennosides and cannot be routinely recommended for the prevention of peritonitis among the PD population. TRIAL REGISTRATION Thai Clinical Trial Registry (clinicaltrials.in.th); ID: TCTR20171012001 KEY MESSAGE To the best of our knowledge, no randomized controlled trial that compares the efficacy and safety profiles of lactulose versus sennosides for the prevention of PD-related peritonitis among the PD population has been conducted. In this open-label, randomized, active-controlled trial, treatment with lactulose is not more effective than sennosides in the prevention of PD-related peritonitis, and it could increase the risk of bacterial PD-related peritonitis. Further studies with a larger sample size by incorporated real-world evidence are needed to confirm our findings and to explore strategies to prevent peritonitis among PD patients.
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Affiliation(s)
- Kajohnsak Noppakun
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Acute Dialysis Unit, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand
| | - Tichanun Narongchai
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Division of Infectious Disease and Tropical Medicine, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Uraiwan Wongsawad
- Acute Dialysis Unit, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surachet Vongsanim
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.,Acute Dialysis Unit, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chidchanok Ruengorn
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Thailand
| | - Surapon Nochaiwong
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand.,Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, Thailand
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50
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Guo Q, Chen Y, Wu R, Yang L, Zhu X, Zhao Q, Zhuang X, Wu Y, Luo P, Cui W. Poorer clinical outcomes of early-onset peritonitis in elderly peritoneal dialysis patients: A longitudinal and multicenter study. Ther Apher Dial 2021; 26:815-821. [PMID: 34806829 DOI: 10.1111/1744-9987.13762] [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: 05/06/2021] [Revised: 11/08/2021] [Accepted: 11/18/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Early-onset peritonitis (EOP) is a risk factor for mortality in peritoneal dialysis (PD) patients. This study investigates the clinical features and outcomes of EOP in elderly patients. METHODS This multicenter retrospective study evaluated 433 elderly PD patients with end-stage renal disease. The cohort was divided into nonperitonitis group (n = 239), EOP group (≤12 months, n = 109) and late-onset peritonitis (LOP) group (>12 months, n = 85). Clinical data, treatment results, and outcomes were compared between the groups. RESULTS Compared with LOP group, there were no significant intergroup differences in the rate of primary recovery, complete cure, relapse, catheter removal, or death from PDAP (p >0.05) in the most recent PDAP episode. However, Kaplan-Meier analysis showed that patients in the EOP group were likely to have multiple episodes of PD-associated peritonitis (PDAP), technique failure, all-cause death, and composite endpoint in the long-term prognostic outcomes (p <0.001). CONCLUSIONS EOP is significantly associated with poorer clinical outcomes in older PD patients.
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Affiliation(s)
- Qiaoyan Guo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yangyang Chen
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ren Wu
- Department of Nephrology, Jilin FAW General Hospital, Changchun, Jilin, China
| | - Liming Yang
- Department of Nephrology, Second Part of the First Hospital of Jilin University, Changchun, Jilin, China
| | - Xueyan Zhu
- Department of Nephrology, Jilin Central Hospital, Jilin, Jilin, China
| | - Qiao Zhao
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xiaohua Zhuang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yanfeng Wu
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ping Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wenpeng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
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