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Tseng CH, Hu YA, Chen YT, Yu WC, Lin CC, Li SY. Beyond prevalence: significance and differential impact of echocardiographic abnormalities in dialysis patients. J Nephrol 2024:10.1007/s40620-024-01963-2. [PMID: 38831240 DOI: 10.1007/s40620-024-01963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Echocardiography is commonly used to assess hydratation status and cardiac function in kidney failure patients, but the impact of structural or functional abnormalities on the prognosis of kidney failure patients was yet to be investigated. This study aimed to investigate the prevalence and clinical significance of echocardiographic abnormalities in kidney failure patients. METHODS This study included 857 kidney failure patients who underwent echocardiography at dialysis initiation. Patients were followed up for a median of 4.2 years for the occurrence of major adverse cardiovascular events (MACE) and all-cause mortality. RESULTS Among the 857 patients studied, 77% exhibited at least one echocardiographic abnormality. The most common abnormalities were left ventricular hypertrophy and left atrial enlargement, but they were not significantly correlated with poor outcomes. Instead, the primary predictors of both major adverse cardiovascular events and mortality in kidney failure patients were left ventricular systolic function, right ventricular systolic function, left ventricular volume index, and valvular abnormalities. Although diastolic dysfunction was linked to major adverse cardiovascular events, it was not associated with mortality. Furthermore, the study revealed that increased left ventricular volume index and left ventricular systolic dysfunction had a more significant impact on peritoneal dialysis (PD) patients than on hemodialysis (HD) patients. CONCLUSION This study provides insights into the echocardiographic abnormalities and their association with adverse outcomes in kidney failure patients, which can help clinicians optimize the management of patients and closely monitor possible high-risk populations.
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Affiliation(s)
- Chih-Hsueh Tseng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Yi-An Hu
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yung-Tai Chen
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Taipei City Hospital Heping Fuyou Branch, Taipei, Taiwan
| | - Wen-Chung Yu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Chih-Ching Lin
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan
| | - Szu-Yuan Li
- Division of Nephrology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang-Ming Chiao-Tung University, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
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2
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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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3
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Mafra D, Kemp JA, Borges NA, Wong M, Stenvinkel P. Gut Microbiota Interventions to Retain Residual Kidney Function. Toxins (Basel) 2023; 15:499. [PMID: 37624256 PMCID: PMC10467110 DOI: 10.3390/toxins15080499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Residual kidney function for patients with chronic kidney disease (CKD) is associated with better quality of life and outcome; thus, strategies should be implemented to preserve kidney function. Among the multiple causes that promote kidney damage, gut dysbiosis due to increased uremic toxin production and endotoxemia need attention. Several strategies have been proposed to modulate the gut microbiota in these patients, and diet has gained increasing attention in recent years since it is the primary driver of gut dysbiosis. In addition, medications and faecal transplantation may be valid strategies. Modifying gut microbiota composition may mitigate chronic kidney damage and preserve residual kidney function. Although various studies have shown the influential role of diet in modulating gut microbiota composition, the effects of this modulation on residual kidney function remain limited. This review discusses the role of gut microbiota metabolism on residual kidney function and vice versa and how we could preserve the residual kidney function by modulating the gut microbiota balance.
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Affiliation(s)
- Denise Mafra
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niteroi 24020-140, Brazil;
- Graduate Program in Biological Sciences—Physiology, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-902, Brazil
| | - Julie A. Kemp
- Graduate Program in Nutrition Sciences, Fluminense Federal University (UFF), Niteroi 24020-140, Brazil;
| | - Natalia A. Borges
- Institute of Nutrition, Rio de Janeiro State University (UERJ), Rio de Janeiro 20550-170, Brazil;
| | - Michelle Wong
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, BC V6T 1Z1, Canada;
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4
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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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Cupisti A, Bolasco P, D’Alessandro C, Giannese D, Sabatino A, Fiaccadori E. Protection of Residual Renal Function and Nutritional Treatment: First Step Strategy for Reduction of Uremic Toxins in End-Stage Kidney Disease Patients. Toxins (Basel) 2021; 13:toxins13040289. [PMID: 33921862 PMCID: PMC8073165 DOI: 10.3390/toxins13040289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 02/06/2023] Open
Abstract
The retention of uremic toxins and their pathological effects occurs in the advanced phases of chronic kidney disease (CKD), mainly in stage 5, when the implementation of conventional thrice-weekly hemodialysis is the prevalent and life-saving treatment. However, the start of hemodialysis is associated with both an acceleration of the loss of residual kidney function (RKF) and the shift to an increased intake of proteins, which are precursors of uremic toxins. In this phase, hemodialysis treatment is the only way to remove toxins from the body, but it can be largely inefficient in the case of high molecular weight and/or protein-bound molecules. Instead, even very low levels of RKF are crucial for uremic toxins excretion, which in most cases are protein-derived waste products generated by the intestinal microbiota. Protection of RKF can be obtained even in patients with end-stage kidney disease (ESKD) by a gradual and soft shift to kidney replacement therapy (KRT), for example by combining a once-a-week hemodialysis program with a low or very low-protein diet on the extra-dialysis days. This approach could represent a tailored strategy aimed at limiting the retention of both inorganic and organic toxins. In this paper, we discuss the combination of upstream (i.e., reduced production) and downstream (i.e., increased removal) strategies to reduce the concentration of uremic toxins in patients with ESKD during the transition phase from pure conservative management to full hemodialysis treatment.
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Affiliation(s)
- Adamasco Cupisti
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (C.D.); (D.G.)
- “Conservative Treatment of Chronic Kidney Disease” Project Group of the Italian Society of Nephrology, 00185 Rome, Italy;
- Correspondence:
| | - Piergiorgio Bolasco
- “Conservative Treatment of Chronic Kidney Disease” Project Group of the Italian Society of Nephrology, 00185 Rome, Italy;
| | - Claudia D’Alessandro
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (C.D.); (D.G.)
- “Conservative Treatment of Chronic Kidney Disease” Project Group of the Italian Society of Nephrology, 00185 Rome, Italy;
| | - Domenico Giannese
- Department of Clinical and Experimental Medicine, University of Pisa, 56121 Pisa, Italy; (C.D.); (D.G.)
| | - Alice Sabatino
- Department of Medicine and Surgery, University of Parma, Nephrology Unit, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
| | - Enrico Fiaccadori
- Department of Medicine and Surgery, University of Parma, Nephrology Unit, Parma University Hospital, 43121 Parma, Italy; (A.S.); (E.F.)
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6
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[Effect of salt intake on residual renal function in rats receiving peritoneal dialysis]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2021; 41:264-271. [PMID: 33624601 PMCID: PMC7905259 DOI: 10.12122/j.issn.1673-4254.2021.02.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the effect of salt intake on residual renal function in rats and explore the possible mechanism. OBJECTIVE SD rats were 5/6-nephrectomized to induce chronic renal failure followed by peritoneal dialysis for 4 weeks (n=18) or without dialysis treatment (control group; n=18). In both groups, the rats were divided into 3 subgroups and were given lowsalt diet (0.02% NaCl), normal salt diet (0.4% NaCl), and high-salt diet (4% NaCl). After 8 and 12weeks, blood pressure and creatinine and sodium levels in the blood, urine, and peritoneal dialysate of the rats were examined. Glomerular sclerosis, tubulointerstitial fibrosis, and protein expression levels of RAS components (ACE-1, AGT, and AT-1) in renal cortical tissue of the rats were evaluated. OBJECTIVE The residual renal function of the rats all decreased especially in rats with high salt intake for 8and 12 weeks. In peritoneal dialysis group, the rats with high-salt diet showed signficiantly increased renal interstitial fibrosis score (P=0.036), glomerular sclerosis index (P=0.045), systolic blood pressure (P=0.004), diastolic blood pressure (P=0.048), and renal expressions of AGT, ACE-1, and AT1 (P < 0.05) as compared with those with normal salt intake. In the rats fed the same high-salt diet, the renal interstitial fibrosis score, glomerular sclerosis index, diastolic blood pressure increase, and renal AGT and ACE-1 expression levels were significantly lower in the peritoneal dialysis group than in the control group (P < 0.05). A positive correlation was noted between the reduction of residual renal function and sodium intake in the rats. OBJECTIVE In rats with chronic renal failure, high salt intake promotes the activation of the renal RAS system, increases blood pressure, and agrevates renal fibrosis to accelerate the decline of residual renal function, and peritoneal dialysis partially reduces the damage of residual renal function induced by high-salt diets by removing excessive sodium.
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7
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Vareesangthip K, Vongsanim S, Fan S, Davenport A. Comparison between standard single chamber versus dual chamber low glucose degradation product peritoneal dialysis fluids. Artif Organs 2020; 45:88-94. [PMID: 32645750 DOI: 10.1111/aor.13768] [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: 04/26/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 11/30/2022]
Abstract
Dual chamber (DC) peritoneal dialysis (PD) dialysates contain fewer glucose degradation products (GDPs), so potentially reducing advanced glycosylation end products (AGEs), which have been reported to increase inflammation and cardiovascular risk. We wished to determine whether use of DC dialysates resulted in demonstrable patient benefits. Biochemical profiles, body composition, muscle strength, and skin autofluorescence measurements of tissue AGEs (SAF) were compared in patients using DC and standard single chamber dialysates. We studied 263 prevalent PD patients from 2 units, 62.4% male, mean age 61.8 ± 16.1 years, 78 (29.7%) used DC dialysates. DC patients were younger (55.9 ± 16.4 vs. 64.2 ± 15.4 years), and more had lower Davies comorbidity score (median 1 (0-1) vs. 1 (0, 2)), slower peritoneal transport (D/P creatinine 0.67 ± 0.12 vs. 0.73 ± 0.13), greater extracellular water-to-total body water (ECW/TBW) ratio (0.46 ± 0.05 vs. 0.42 ± 0.06), all P < .001, whereas there were no differences in the duration of PD (median (IQR) 19 (8-32) vs. 14 (8-23) months), residual renal function (Kt/Vurea 0.71 ± 0.71 vs. 0.87 ± 0.82), urine volume (642 (175-1200) vs. 648 (300-1200) mL/day), hand grip strength (26.9 ± 10.5 vs. 24.9 ± 10.7 kg), C-reactive protein (4(1-10) vs. 4(2-12) mg/L), and SAF (median 3.60 (3.02, 4.40) vs. 3.50 (3.00, 4.23)) AU. In our cross-sectional observational study, we were not able to show a demonstrable advantage for using low GDP dialysates over conventional glucose dialysates, in terms of biochemical profiles, residual renal function, muscle strength, or tissue AGE deposition. More patients using low GDP dialysates were slower peritoneal transporters with higher ECW/TBW ratios.
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Affiliation(s)
- Kornchanok Vareesangthip
- Renal Division, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Surachet Vongsanim
- Renal Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Stanley Fan
- Department of Renal Medicine, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Andrew Davenport
- UCL Department of Nephrology, Royal Free Hospital, University College London, London, UK
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García E, Merino JL, Mendoza S, Paraiso V, Sánchez V, Moya R. Aspectos clave en el mantenimiento de la diuresis residual en pauta de hemodiálisis incremental. Experiencia de diez años. ENFERMERÍA NEFROLÓGICA 2020. [DOI: 10.37551/s2254-28842020020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: La hemodiálisis incremental o progresiva es una modalidad de inicio de hemodiálisis, basada en la diuresis residual y adaptada a las necesidades del paciente, poco extendida pese a sus potenciales beneficios. Para su correcto seguimiento es necesario establecer unas pautas específicas en cada sesión de hemodiálisis, que deben ser conocidas por el personal que atiende a estos pacientes de forma regular. Objetivo: analizar la evolución de los pacientes que han iniciado tratamiento renal sustitutivo con hemodiálisis incremental. Material y Método: Estudio observacional retrospectivo de pacientes incidentes en tratamiento renal sustitutivo mediante hemodiálisis incremental en nuestro centro en los últimos 10 años. Comparación de resultados basales y a los 12 meses de seguimiento. Resultados: En este periodo de tiempo se han incluido 49 pacientes en técnica de hemodiálisis incremental. Aunque la diuresis residual desciende en el primer año de 2030±600 ml/día a 1300±500 (p<0,05), ésta se mantiene por encima de un litro en la mayoría de los casos. El aclaramiento de urea también desciende de 5,7±1,6 ml/min a 3,4±1,6 ml/min al año (p<0,05). Conclusiones: Iniciar tratamiento renal sustitutivo con hemodiálisis incremental puede mantener más tiempo la diuresis residual, para eso es clave el conocimiento de la técnica y su correcto manejo durante las sesiones de diálisis.
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Affiliation(s)
- Esther García
- Sección Nefrología. Hospital Universitario del Henares. Madrid. España
| | - José Luis Merino
- Sección Nefrología. Hospital Universitario del Henares. Madrid. España
| | - Sonia Mendoza
- Sección Nefrología. Hospital Universitario del Henares. Madrid. España
| | - Vicente Paraiso
- Sección Nefrología. Hospital Universitario del Henares. Madrid. España
| | - Verónica Sánchez
- Sección Nefrología. Hospital Universitario del Henares. Madrid. España
| | - Raquel Moya
- Sección Nefrología. Hospital Universitario del Henares. Madrid. España
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9
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Liu J, Feng Y, Sun C, Zhu W, Zhang QY, Jin B, Shao QY, Xia YY, Xu PF, Zhang M, Jiang CM. Valsartan ameliorates high glucose-induced peritoneal fibrosis by blocking mTORC1 signaling. Exp Biol Med (Maywood) 2020; 245:983-993. [PMID: 32408765 DOI: 10.1177/1535370220919364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPACT STATEMENT Our study provided new insight into the mechanism underlying the preservation of the peritoneum by valsartan. The results demonstrated that the mice receiving chronic high glucose (HG) peritoneal dialysis solution infusion showed a typical feature of peritoneal fibrosis (PF), as well as higher expression of α-smooth muscle actin (α-SMA) and collagen I. In vitro, HG increased the protein expression of α-SMA and collagen I in a dose-dependent manner, while valsartan significantly ameliorated these pathological changes. Interestingly, there was a parallel decrease in the activity of mammalian target of rapamycin complex 1 (mTORC1) and the protein expression levels of α-SMA and collagen I upon treatment with valsartan in vivo and in vitro. Moreover, the mTOR agonist MHY1485 reversed the downregulation of α-SMA and collagen I in vitro, even in the presence of valsartan. Altogether, our findings reported for the first time that valsartan exerts a protective effect against HG-induced PF by inhibiting the activity of the mTORC1 pathway.
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Affiliation(s)
- Jing Liu
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Yuan Feng
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Cheng Sun
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Wei Zhu
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Qing-Yan Zhang
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Bo Jin
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Qiu-Yuan Shao
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Yang-Yang Xia
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Peng-Fei Xu
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Miao Zhang
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
| | - Chun-Ming Jiang
- Institute of Nephrology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing City, Jiangsu Province 210008, China
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10
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Grantham CE, Hull KL, Graham-Brown MP, March DS, Burton JO. The Potential Cardiovascular Benefits of Low-Glucose Degradation Product, Biocompatible Peritoneal Dialysis Fluids: A Review of the Literature. Perit Dial Int 2020; 37:375-383. [DOI: 10.3747/pdi.2016.00228] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/06/2017] [Indexed: 01/08/2023] Open
Abstract
Cardiovascular mortality in the end-stage renal disease (ESRD) population remains the leading cause of death. Targeting traditional cardiovascular risk factors has proven unsuccessful in this patient population, and therefore attention has turned to risk factors related to chronic kidney disease (CKD). The toxicity of high-glucose peritoneal dialysis (PD) solutions has been well documented. The breakdown of glucose into glucose degradation products (GDP) and advanced glycation end-products (AGE) has the ability to alter cell viability and cause premature apoptosis and is strongly correlated with interstitial fibrosis and microvascular sclerosis. Biocompatible solutions have been introduced to combat the hostile milieu to which PD patients are exposed.Given the considerable cardiovascular burden for PD patients, little is known about the cardiovascular impact the new biocompatible solutions may have. This review analyzes the existing literature regarding the mechanisms through which low-GDP solutions may modulate cardiovascular risk. Interventions using low-GDP solutions have provided encouraging changes in structural cardiovascular measures such as left ventricular mass (LVM), although metabolic changes from reduced GDP and AGE exposure yield inconclusive results on vascular remodelling. It is thought that the local effects of reduced glucose exposure may improve membrane integrity and therefore fluid status. Further research in the form of a robust randomized controlled trial should be carried out to assess the true extent of the cardiovascular benefits these biocompatible solutions may hold.
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Affiliation(s)
- Charlotte E. Grantham
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- University of Leicester, Leicester, UK; John Walls Renal Unit, University of Leicester, Leicester, UK
| | - Katherine L. Hull
- University of Leicester, Leicester, UK; John Walls Renal Unit, University of Leicester, Leicester, UK
| | - Matthew P.M. Graham-Brown
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- University of Leicester, Leicester, UK; John Walls Renal Unit, University of Leicester, Leicester, UK
- Leicester General Hospital, Leicester, UK; National College of Sport and Exercise Medicine, University of Leicester, Leicester, UK
| | - Daniel S. March
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- University of Leicester, Leicester, UK; John Walls Renal Unit, University of Leicester, Leicester, UK
| | - James O. Burton
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- University of Leicester, Leicester, UK; John Walls Renal Unit, University of Leicester, Leicester, UK
- University of Loughborough, Loughborough, UK; and Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
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11
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Moeinzadeh F, Naeini EK, Mortazavi M. Allopurinol Effects on Residual Renal Function in End-Stage Renal Disease Patients Undergoing Peritoneal Dialysis: Randomized Controlled Trial. J Res Pharm Pract 2020; 8:189-195. [PMID: 31956631 PMCID: PMC6952759 DOI: 10.4103/jrpp.jrpp_18_72] [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] [Received: 09/13/2018] [Accepted: 08/13/2019] [Indexed: 11/04/2022] Open
Abstract
Objective There is increasing evidence to show that hyperuricemia may have a pathogenic role in the progression of renal diseases. We performed a prospective, randomized, controlled trial to investigate the renal effects of allopurinol treatment in hyperuricemic patients with end-stage renal disease (ESRD) who undergo peritoneal dialysis. Methods This was a unicenter, randomized, controlled clinical trial conducted in "Alzahra Hospital, Isfahan, Iran." Patients were randomly assigned into treatment or control group. Treatment-group patients were administered a starting allopurinol dose of 100 mg/day. The dose was adjusted according to serum uric acid level, aiming to maintain uric acid levels within the normal range. Participants were followed up for 6 months after receiving the medicine. Residual renal function (RRF) was assessed by measuring the renal component of Kt/V urea and estimating the patient's glomerular filtration rate (GFR) by calculating the mean of urea and creatinine clearance. In addition, systolic and diastolic blood pressure and serum level of creatinine were measured every 3 months during the follow-up period. Findings Eighty patients were enrolled in the study and divided into two groups, including 40 ESRD patients receiving allopurinol and 40 ESRD did not receive allopurinol and considered as the control group. GFR measurements showed that there was not a significant difference between patients' RRF of two groups. However, allopurinol group had higher RRF than the control group during the follow-up period. Evaluating RRF by Kt/V showed the same results. Conclusion Our study demonstrated significant effects of allopurinol on decreasing serum levels of uric acid in ESRD patients undergoing peritoneal dialysis. On the other hand, renal residual function of patients under treatment with allopurinol was better than the control group. We recommend that further studies should be conducted on the effects of allopurinol with greater sample size and longer time of follow-up.
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Affiliation(s)
- Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Kabiri Naeini
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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12
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Hanna RM, Kalantar-Zadeh K. Estimating Residual Kidney Function With and Without Urine Clearance Measures: A Useful Tool for Incremental Dosing of Dialysis. Kidney Med 2019; 1:332-334. [PMID: 33015607 PMCID: PMC7525141 DOI: 10.1016/j.xkme.2019.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Ramy M. Hanna
- Division of Nephrology and Hypertension and Kidney Transplantation, and Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology and Hypertension and Kidney Transplantation, and Harold Simmons Center for Kidney Disease Research and Epidemiology, University of California Irvine School of Medicine, Orange, CA
- Nephrology Section, Department of Medicine, Veterans Affairs Long Beach Healthcare System, Long Beach, CA
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13
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Hu J, Hu L, Gong N, Zhang L, Tian J, Jiang J. [Effect of dietary sodium intake on residual renal function in patients undergoing peritoneal dialysis: a prospective study of 33 cases]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2019; 39:657-664. [PMID: 31270043 DOI: 10.12122/j.issn.1673-4254.2019.06.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore the impact of dietary sodium-intake on residual renal function in patients undergoing peritoneal dialysis (PD). METHODS Thirty-three patients on PD with stable dialysis were regularly followed up for 12 months. The daily sodium intake of the patients was calculated based on the 3-day dietary record. Based on the mean daily sodium intake, the patients enrolled were divided into low-salt group (sodium intake≤3.0 g/day, 19 patients) and high-salt group (sodium intake>3.0 g/day, 14 patients). The baseline data of the patients were recorded, and the indicators of residual renal function and peritoneal function were regularly tested. The patients were followed-up at 3-month intervals, and their urine volume, peritoneal ultrafiltration volume and other clinical indicators were recorded and the biochemical indexes were detected to evaluate the changes in the residual renal function and peritoneal function. RESULTS There was a positive correlation between the total sodium excretion and dietary sodium intake in these patients (r=0.536, P=0.0013), and sodium excretion by dialysis was positively correlated with their sodium intake (r=0.901, P=0.000). Regression analysis suggested that the total sodium excretion was correlated with dietary sodium intake (β=0.416, 95% CI: 0.170-0.666; P < 0.0018); sodium excretion by dialysis was associated with dietary sodium intake (β=0.489, 95% CI: 0.395-0.582; P < 0.001). The residual renal function was reduced by 17.48±11.22 L /(w·1.73 m2) in the low-salt group, as compared to 30.20±18.30 L /(w·1.73 m2) in the high-salt group (P=0.032). The reduction in the residual renal function was correlated with sodium intake in the PD patients (r=0.409, P=0.018). Multivariate regression analysis showed that sodium intake was an independent factor contributing to the reduction of residual renal function (β=14.646, 95% CI 7.426-21.866, P < 0.001). CONCLUSIONS Sodium excretion by PD in patients with continuous ambulatory PD is positively correlated with their dietary sodium intake, which contribute to the decrease of residual renal function. A high dietary sodium intake may accelerate the reduction of residual renal function in these patients.
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Affiliation(s)
- Jianxia Hu
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.,Department of Nephrology, Donghua Hospital Affiliated to Sun Yat-sen University, Dongguan 523000, China
| | - Liping Hu
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Nirong Gong
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Lei Zhang
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jianwei Tian
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - Jianping Jiang
- 1Department of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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14
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Abstract
Dialyzer clearance of urea multiplied by dialysis time and normalized for urea distribution volume (Kt/Vurea or simply Kt/V) has been used as an index of dialysis adequacy since more than 30 years. This article reviews the flaws of Kt/V, starting with a lack of proof of concept in three randomized controlled hard outcome trials (RCTs), and continuing with a long list of conditions where the concept of Kt/V was shown to be flawed. This information leaves little room for any conclusion other than that Kt/V, as an indicator of dialysis adequacy, is obsolete. The dialysis patient might benefit more if, instead, the nephrology community concentrates in the future on pursuing the optimal dialysis dose that conforms with adequate quality of life and on factors that are likely to affect outcomes more than Kt/V. These include residual renal function, volume status, dialysis length, ultrafiltration rate, the number of intra-dialytic hypotensive episodes, interdialytic blood pressure, serum potassium and phosphate, serum albumin, and C reactive protein.
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Affiliation(s)
- Raymond Vanholder
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Wim Van Biesen
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Norbert Lameire
- Nephrology Section, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium
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15
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Wang J, Xie X, Yan X, Yang X, Zhang X, Chen J, Han F. A Fast Decline of Residual Renal Function in the First Year is a Predictor for Early Withdrawal from Peritoneal Dialysis in Non-Diabetic Patients. Kidney Blood Press Res 2019; 44:12-21. [PMID: 30808853 DOI: 10.1159/000497807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Little is known about the relationship between residual renal function (RRF) decline in early period and survival in non-diabetic peritoneal dialysis (PD) patients. METHODS A total of 567 non-diabetic patients who began PD from January 1, 2005 to June 30, 2013 was investigated. The rate of RRF decline was determined by the "slope of the trend equation" of serial RRFs. A composite end-point of all-cause mortality and conversion to hemodialysis (HD) was used, survival status was censored on June 30, 2016. RESULTS The median of "the slope of RRF decline equation" was 0.308 (0.001-2.111) ml/min/1.73 m2/ month. In the median follow-up period of 43 months (range 12 to 120 months), 65 (11.5%) patients died, 90 (15.9%) patients converted to HD and 171 (30.2%) patients received kidney transplantation. Multivariate linear regression showed male, high baseline RRF, high baseline peritoneal Kt/V urea, low serum albumin and low uric acid were independently associated with the rate of RRF decline in the first year of PD. Multivariate Cox models revealed that RRF decline in the first year remained a predictor for composite end-point (HR, 2.74, 95% CI, 1.53 to 4.90, P=0.001). The patients were divided into high RRF decline group (> 0.308ml/ min/1.73m2/month) and low RRF decline group (≤0.308 ml/min/1.73m2/month). In the first three years of PD, the rate of end-point events was higher in high RRF decline group (23.2%) than that in low RRF decline group (11.0%) (P< 0.001). There were 189 patients in low RRF decline group and 171 patients in high RRF decline group maintaining PD for more than 3 years, in a median follow-up of 54 months (range 37 to 120 months), the survival rate was 30.9% in high RRF decline group and 46.4% in low RRF decline group (P=0.883). In high RRF decline group, there were 92 patients reaching composited end-point and 112 patients maintaining PD; multivariate Cox model showed high peritoneal Kt/V urea after 1 year of PD and high albumin level were protective factors (HR, 0.29, 95% CI, 0.13 to 0.61, P= 0.001; HR, 0.94, 95% CI, 0.90-0.99, P=0.022, respectively), while fast RRF decline remained risk factor for composite end-point (HR, 3.28, 95% CI,1.48-7.31, P=0.004). CONCLUSION A faster RRF decline in the first year was a predictor for all-cause mortality and conversion to HD in non-diabetic PD patients, mainly in the first three year. For patients with faster RRF decline, increasing PD dose was effective to improve survival.
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Affiliation(s)
- Junni Wang
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Xishao Xie
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Xingqun Yan
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Xin Yang
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Xiaohui Zhang
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Fei Han
- Kidney Disease Center, The First Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, China,
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16
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Abstract
Cardiovascular disease (CVD) is highly prevalent in the peritoneal dialysis (PD) population, affecting up to 60% of cohorts. CVD is the primary cause of death in up to 40% of PD patients in Australia, New Zealand, and the United States. Cardiovascular mortality rates are reported to be approximately 14 per 100 patient-years, which are 10- to 20-fold greater than those of age- and sex-matched controls. The excess risk of CVD is related to a combination of traditional risk factors (such as hypertension, dyslipidemia, obesity, smoking, sedentary lifestyle, and insulin resistance), nontraditional (kidney disease-related) risk factors (such as anemia, chronic volume overload, inflammation, malnutrition, hyperuricemia, and mineral and bone disorder), and PD-specific risk factors (such as dialysis solutions, glycation end products, hypokalemia, residual kidney function, and ultrafiltration failure). Interventions targeting these factors may mitigate cardiovascular risk, although high-level clinical evidence is lacking. This review summarizes the evidence relating to cardiovascular interventions targeting modifiable CVD risk factors in PD patients, as well as highlighting the key recommendations of the International Society for Peritoneal Dialysis Cardiovascular and Metabolic Guidelines.
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17
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Ortiz A, Vinck C. The new Clinical Kidney Journal, 4 years later. Clin Kidney J 2019; 12:1-5. [PMID: 30746126 PMCID: PMC6366135 DOI: 10.1093/ckj/sfy139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022] Open
Abstract
The February 2015 issue of ckj started a new era with renewed efforts to be useful to the training and practicing nephrologists and a new focus on Clinical and Translational Nephrology. Four years later, it has become a truly global journal with contributors and readers from all over the world. The increase in quality of the published material has resulted in a nearly exponential growth of citations. Since 2016, ckj is listed in the new Emerging Sources Citation Index (ESCI) database from Clarivate Analytics and from January 2019 it will be listed in the full Science Citation Index. ckj will therefore receive its first official impact factor based upon 2018 citation to 2016 and 2017 articles. While no official impact factor was awarded for 2017, the estimated impact factors calculated from data available in Clarivate's Web of Science database rose to 2.987 in 2017, which would correspond to an estimated journal impact factor percentile of 72.4% in the Urology and Nephrology field.
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Affiliation(s)
- Alberto Ortiz
- Editor-in-Chief, Clinical Kidney Journal, IIS-Fundacion Jimenez Diaz, School of Medicine, Universidad Autonoma de Madrid; Fundacion Renal Iñigo Alvarez de Toledo-IRSIN and REDINREN, Madrid, Spain
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18
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Raby AC, Labéta MO. Preventing Peritoneal Dialysis-Associated Fibrosis by Therapeutic Blunting of Peritoneal Toll-Like Receptor Activity. Front Physiol 2018; 9:1692. [PMID: 30538643 PMCID: PMC6277495 DOI: 10.3389/fphys.2018.01692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/09/2018] [Indexed: 12/30/2022] Open
Abstract
Peritoneal dialysis (PD) is an essential daily life-saving treatment for end-stage renal failure. PD therapy is limited by peritoneal inflammation, which leads to peritoneal membrane failure as a result of progressive fibrosis. Peritoneal infections, with the concomitant acute inflammatory response and membrane fibrosis development, worsen PD patient outcomes. Patients who remain infection-free, however, also show evidence of inflammation-induced membrane damage and fibrosis, leading to PD cessation. In this case, uraemia, prolonged exposure to bio-incompatible PD solutions and surgical catheter insertion have been reported to induce sterile peritoneal inflammation and fibrosis as a result of cellular stress or tissue injury. Attempts to reduce inflammation (either infection-induced or sterile) and, thus, minimize fibrosis development in PD have been hampered because the immunological mechanisms underlying this PD-associated pathology remain to be fully defined. Toll-like receptors (TLRs) are central to mediating inflammatory responses by recognizing a wide variety of microorganisms and endogenous components released following cellular stress or generated as a consequence of extracellular matrix degradation during tissue injury. Given the close link between inflammation and fibrosis, recent investigations have evaluated the role that TLRs play in infection-induced and sterile peritoneal fibrosis development during PD. Here, we review the findings and discuss the potential of reducing peritoneal TLR activity by using a TLR inhibitor, soluble TLR2, as a therapeutic strategy to prevent PD-associated peritoneal fibrosis.
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Affiliation(s)
- Anne-Catherine Raby
- The Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Mario O Labéta
- The Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
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19
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Targeting Toll-like receptors with soluble Toll-like receptor 2 prevents peritoneal dialysis solution-induced fibrosis. Kidney Int 2018; 94:346-362. [PMID: 29861057 DOI: 10.1016/j.kint.2018.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/05/2018] [Accepted: 03/15/2018] [Indexed: 12/13/2022]
Abstract
Peritoneal membrane failure due to fibrosis limits the use of peritoneal dialysis (PD). Peritoneal fibrosis may potentially be induced by sterile inflammation caused by ongoing cellular stress due to prolonged exposure to PD solutions (PDS). Effective therapies to prevent this process remain to be developed. Toll-like receptors (TLRs) mediate sterile inflammation by recognizing damage-associated molecular patterns (DAMPs) released by cellular stress. We evaluated the involvement of TLRs and DAMPs in PDS-induced fibrosis models and the therapeutic potential of TLR-DAMP targeting for preventing fibrosis. A range of PDS elicited pro-inflammatory and fibrotic responses from PD patient peritoneal leukocytes, mesothelial cells and mouse peritoneal leukocytes. TLR2/4 blockade of human peritoneal cells or TLR2/4 knockouts inhibited these effects. PDS did not induce rapid ERK phosphorylation or IκB-α degradation, suggesting that they do not contain components capable of direct TLR activation. However, PDS increased the release of Hsp70 and hyaluronan, both TLR2/4 DAMP ligands, by human and mouse peritoneal cells, and their blockade decreased PDS-driven inflammation. Soluble TLR2, a TLR inhibitor, reduced PDS-induced pro-inflammatory and fibrotic cytokine release ex vivo. Daily catheter infusion of PDS in mice caused peritoneal fibrosis, but co-administration of soluble TLR2 prevented fibrosis, suppressed pro-fibrotic gene expression and pro-inflammatory cytokine production, reduced leukocyte/neutrophil recruitment, recovered Treg cell levels and increased the Treg:Th17 ratio. Thus, TLR2/4, Hsp70 and hyaluronan showed major roles in PDS-induced peritoneal inflammation and fibrosis. The study demonstrates the therapeutic potential of a TLR-DAMP targeting strategy to prevent PDS-induced fibrosis.
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20
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Sow A, Morelle J, Hautem N, Bettoni C, Wagner CA, Devuyst O. Mechanisms of acid-base regulation in peritoneal dialysis. Nephrol Dial Transplant 2018; 33:864-873. [PMID: 29186492 DOI: 10.1093/ndt/gfx307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/30/2017] [Indexed: 11/13/2022] Open
Abstract
Background Peritoneal dialysis (PD) contributes to restore acid-base homeostasis in patients with end-stage renal disease. The transport pathways for buffers and carbon dioxide (CO2) across the peritoneal membrane remain poorly understood. Methods Combining well-established PD protocols, whole-body plethysmography and renal function studies in mice, we investigated molecular mechanisms of acid-base regulation in PD, including the potential role of the water channel aquaporin-1 (AQP1). Results After instillation in peritoneal cavity, the pH of acidic dialysis solutions increased within minutes to rapidly equilibrate with blood pH, whereas the neutral pH of biocompatible solutions remained constant. Predictions from the three-pore model of peritoneal transport suggested that local production of HCO3- accounts at least in part for the changes in intraperitoneal pH observed with acidic solutions. Carbonic anhydrase (CA) isoforms were evidenced in the peritoneal membrane and their inhibition with acetazolamide significantly decreased local production of HCO3- and delayed changes in intraperitoneal pH. On the contrary, genetic deletion of AQP1 had no effect on peritoneal transport of buffers and diffusion of CO2. Besides intraperitoneal modifications, the use of acidic dialysis solutions enhanced acid excretion both at pulmonary and renal levels. Conclusions These findings suggest that changes in intraperitoneal pH during PD are mediated by bidirectional buffer transport and by CA-mediated production of HCO3- in the membrane. The use of acidic solutions enhances acid excretion through respiratory and renal responses, which should be considered in patients with renal failure.
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Affiliation(s)
- Amadou Sow
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain Medical School, Brussels, Belgium
| | - Johann Morelle
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain Medical School, Brussels, Belgium
| | - Nicolas Hautem
- Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain Medical School, Brussels, Belgium
| | - Carla Bettoni
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Carsten A Wagner
- Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Olivier Devuyst
- Division of Nephrology, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain Medical School, Brussels, Belgium.,Institute of Physiology, Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
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21
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Gorbatkin C, Bass J, Finkelstein FO, Gorbatkin SM. Peritoneal Dialysis in Austere Environments: An Emergent Approach to Renal Failure Management. West J Emerg Med 2018; 19:548-556. [PMID: 29760854 PMCID: PMC5942023 DOI: 10.5811/westjem.2018.3.36762] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 02/16/2018] [Accepted: 03/09/2018] [Indexed: 12/26/2022] Open
Abstract
Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD. PD in austere environments is not without challenges, including catheter placement, availability of dialysate, and medical complications related to the procedure itself. However, when hemodialysis is unavailable, PD can be performed using generally available medical supplies including sterile tubing and intravenous fluids. Amidst the ever-increasing global burden of ESRD and AKI, the ability to perform PD is essential for many medical facilities.
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Affiliation(s)
- Chad Gorbatkin
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - John Bass
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | | | - Steven M. Gorbatkin
- Atlanta VA Medical Center, Emory University, Department of Nephrology, Atlanta, Georgia
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22
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Nongnuch A, Davenport A. The Effect of On-Line Hemodiafiltration, Vegetarian Diet, and Urine Volume on Advanced Glycosylation End Products Measured by Changes in Skin Auto-Fluorescence. Artif Organs 2018; 42:1078-1085. [DOI: 10.1111/aor.13143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 02/09/2018] [Accepted: 02/13/2018] [Indexed: 12/27/2022]
Affiliation(s)
- Arkom Nongnuch
- Renal Unit, Faculty of Medicine, Department of Medicine, Ramathibodi Hospital; Mahidol University; Bangkok Thailand
- Centre for Nephrology, UCL Medical School Royal Free; University College London; London United Kingdom
| | - Andrew Davenport
- Centre for Nephrology, UCL Medical School Royal Free; University College London; London United Kingdom
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23
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Piccoli GB, Moio MR, Fois A, Sofronie A, Gendrot L, Cabiddu G, D'Alessandro C, Cupisti A. The Diet and Haemodialysis Dyad: Three Eras, Four Open Questions and Four Paradoxes. A Narrative Review, Towards a Personalized, Patient-Centered Approach. Nutrients 2017; 9:E372. [PMID: 28394304 PMCID: PMC5409711 DOI: 10.3390/nu9040372] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/17/2017] [Accepted: 03/31/2017] [Indexed: 12/25/2022] Open
Abstract
The history of dialysis and diet can be viewed as a series of battles waged against potential threats to patients' lives. In the early years of dialysis, potassium was identified as "the killer", and the lists patients were given of forbidden foods included most plant-derived nourishment. As soon as dialysis became more efficient and survival increased, hyperphosphatemia, was identified as the enemy, generating an even longer list of banned aliments. Conversely, the "third era" finds us combating protein-energy wasting. This review discusses four questions and four paradoxes, regarding the diet-dialysis dyad: are the "magic numbers" of nutritional requirements (calories: 30-35 kcal/kg; proteins > 1.2 g/kg) still valid? Are the guidelines based on the metabolic needs of patients on "conventional" thrice-weekly bicarbonate dialysis applicable to different dialysis schedules, including daily dialysis or haemodiafiltration? The quantity of phosphate and potassium contained in processed and preserved foods may be significantly different from those in untreated foods: what are we eating? Is malnutrition one condition or a combination of conditions? The paradoxes: obesity is associated with higher survival in dialysis, losing weight is associated with mortality, but high BMI is a contraindication for kidney transplantation; it is difficult to limit phosphate intake when a patient is on a high-protein diet, such as the ones usually prescribed on dialysis; low serum albumin is associated with low dialysis efficiency and reduced survival, but on haemodiafiltration, high efficiency is coupled with albumin losses; banning plant derived food may limit consumption of "vascular healthy" food in a vulnerable population. Tailored approaches and agreed practices are needed so that we can identify attainable goals and pursue them in our fragile haemodialysis populations.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Dipartimento di Scienze Cliniche e Biologiche, University of Torino, 10100 Torino, Italy.
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
| | - Maria Rita Moio
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
| | - Antioco Fois
- Nefrologia, Ospedale Brotzu, 09100 Cagliari, Italy.
| | - Andreea Sofronie
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
| | - Lurlinys Gendrot
- Nephrologie, Centre Hospitalier le Mans, Avenue Roubillard, 72000 Le Mans, France.
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Oka S, Obata Y, Sato S, Torigoe K, Sawa M, Abe S, Muta K, Ota Y, Kitamura M, Kawasaki S, Hirose M, Uramatsu T, Mukae H, Nishino T. Serum Endocan as a Predictive Marker for Decreased Urine Volume in Peritoneal Dialysis Patients. Med Sci Monit 2017; 23:1464-1470. [PMID: 28343234 PMCID: PMC5380193 DOI: 10.12659/msm.900693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Endocan is expressed in vascular endothelial cells, and its expression is enhanced following endothelial injury via inflammatory cytokines. Subsequently, endocan is secreted into the circulation. Thus, serum endocan levels are considered a marker of endothelial injury. However, to the best of our knowledge, no data on the serum endocan levels in peritoneal dialysis (PD) patients are available. Material/Methods This study included 21 PD patients who underwent peritoneal equilibration test (PET) more than once between 2011 and 2015. Serum samples were collected from each patient, and the 24-h urine volume was measured at the time of PET. Serum endocan levels were measured using enzyme-linked immunosorbent assay (ELISA) at the time of the first PET, and their relationship with clinical data or the extent of urine volume decline (mL/year) was analyzed retrospectively. Results Serum endocan levels were positively correlated with proteinuria level, serum creatinine level, serum tumor necrosis factor (TNF)-α level, β2-microglobulin level, and PD drainage volume, but not with urine volume at baseline. The extent of decline in urine volume was significantly associated with serum endocan level, proteinuria level, serum creatinine level, and serum TNF-α level at baseline in a simple linear regression analysis. Moreover, multiple linear regression analysis showed that the serum endocan level and proteinuria level at baseline were independent predictors for the extent of decline in urine volume. Conclusions The results of this study indicate that serum endocan level and proteinuria level may be useful predictive markers for decreased urine volume in PD patients.
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Affiliation(s)
- Satoru Oka
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Yoko Obata
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan.,Medical Educational Development Center, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Shuntaro Sato
- Clinical Research Center, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Kenta Torigoe
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Miki Sawa
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Shinichi Abe
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Kumiko Muta
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Yuki Ota
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Blood Purification, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Satoko Kawasaki
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Misaki Hirose
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Tadashi Uramatsu
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki City, Nagasaki, Japan.,Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, Japan
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25
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Schreiber MJ. Changing Landscape for Peritoneal Dialysis: Optimizing Utilization. Semin Dial 2017; 30:149-157. [PMID: 28144977 DOI: 10.1111/sdi.12576] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The future growth of peritoneal dialysis (PD) will be directly linked to the shift in US healthcare to a value-based payment model due to PD's lower yearly cost, early survival advantage over in-center hemodialysis, and improved quality of life for patients treating their kidney disease in the home. Under this model, nephrology practices will need an increased focus on managing the transition from chronic kidney disease to end-stage renal disease (ESRD), providing patient education with the aim of accomplishing modality selection and access placement ahead of dialysis initiation. Physicians must expand their knowledge base in home therapies and work toward increased technique survival through implementation of specific practice initiatives that highlight PD catheter placement success, preservation of residual renal function, consideration of incremental PD, and competence in urgent start PD. Avoidance of both early and late PD technique failures is also critical to PD program growth. Large dialysis organizations must continue to measure and improve quality metrics for PD, expand their focus beyond the sole provision of PD to holistic patient care, and initiate programs to reduce PD hospitalization rates and encourage physicians to consider the benefits of PD as an initial modality for appropriate patients. New and innovative strategies are needed to address the main reasons for PD technique failure, improve the connectivity of the patient in the home, leverage home biometric data to improve overall outcomes, and develop PD cycler devices that lower patient treatment burden and reduce both treatment fatigue and treatment-dependent complications.
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Affiliation(s)
- Martin J Schreiber
- Clinical Affairs, Home Modalities, DaVita Kidney Care, DaVita Inc, Denver, Colorado
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26
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Davenport A. Is Hemodialysis Patient Survival Dependent upon Small Solute Clearance (Kt/V)?: If So How Can Kt/V be Adjusted to Prevent Under Dialysis in Vulnerable Groups? Semin Dial 2017; 30:86-92. [PMID: 28074616 DOI: 10.1111/sdi.12566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Small solute clearance achieved during a single hemodialysis session has been traditionally evaluated by urea clearance, normalized for total body water (Kt/Vurea) for more than 30 years. By consensus, the target sessional KtVurea for thrice weekly treatments has been increased from 0.9 to 1.2 over the years. Although this is supported by observational studies, there is a fundamental lack of prospective studies to support this threshold target. In clinical practice achieving sessional Kt/Vurea targets are most closely followed in the US. Yet there appears to be a paradox in that by following Kt/Vurea targets in the US hemodialysis patient survival is better for men and the obese, the opposite of what is seen in the general population. Delivery of a lower dose of hemodialysis to women and smaller men can be explained by underestimation of total body water. The advent of bioimpedance techniques which can measure both body water and body composition will potentially allow a rescaling and re-evaluation of the importance of small solute clearances (Kt/Vurea) in the hemodialysis patient population.
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Affiliation(s)
- Andrew Davenport
- University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom
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27
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Aplicación de una pauta de hemodiálisis incremental, basada en la función renal residual, al inicio del tratamiento renal sustitutivo. Nefrologia 2017; 37:39-46. [DOI: 10.1016/j.nefro.2016.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 11/17/2016] [Indexed: 11/23/2022] Open
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28
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Chilcot J, Friedli K, Guirguis A, Wellsted D, Farrington K, Davenport A. C reactive protein and depressive symptoms in hemodialysis patients: A questionable association. Hemodial Int 2016; 21:542-548. [PMID: 27678345 DOI: 10.1111/hdi.12500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/31/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Patients with advanced chronic kidney disease (CKD) on haemodialysis (HD) may have increased C reactive protein (CRP) values and depressive symptoms. There is debate about the strength and nature of previously reported associations. We investigated these issues in a cohort of patients on HD. METHODS We screened for depressive symptoms using two valadiated depression screening tools: the Beck Depression Inventory-II (BDI-II), Patient Health Questionnaire (PHQ-9). Demographic and clinical correlates of depression symptoms were eveluated in adjusted linear and logistic regression models, which included extra renal comorbidity and high CRP (>5 mg/L). FINDINGS Three hundred and ninety-six HD patients were studied; 63.1% male, mean age 63.1 ± 16.4 years, median CRP 6 (5-15) mg/L. Depression scores were similar in those with normal and high CRP (BDI-II (9(5-17) vs. 11(6-20)) or PHQ (4(2-9) vs. 6(2-10)). In adjusted multivariable regression BDI-II scores were associated with previous history of depression (β 10.8, P < 0.001), serum albumin (β 0.41, P < 0.001), anuria (β 2.4, P < 0.037), diabetes (β 2.7, P = 0.033), and age (β -0.10, P = 0.009). High CRP was not independently associated with BDI-II (β 2.20, P = 0.057), though was with PHQ-9 (β 1.20, P = 0.046). In logistic regression those with high CRP were 1.9 times more likely to score ≥16 on BDI-II screening (P = 0.016), but did not relate significantly to a PHQ-score ≥10. DISCUSSION A relationship was observed between CRP and depression symptoms, though the effect was small, of unlikely clinical significance, and inconsistent between depression measures. Previous reports of this association may reflect overlap between symptoms of depression and advanced CKD.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karin Friedli
- Department of Psychology, Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Ayman Guirguis
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK.,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
| | - David Wellsted
- Department of Psychology, Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Ken Farrington
- Renal Unit, Lister Hospital, East & North Herts NHS Trust, Stevenage, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK
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Mizuno M, Suzuki Y, Sakata F, Ito Y. Which clinical conditions are most suitable for induction of automated peritoneal dialysis? RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0057-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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30
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Wang X, Zhang X, Lu S, Liu D, Chen G, Dou Y, Yuan W, Ma S, Li Y, Xiao J, Zhao Z. Protective effect of mycophenolate mofetil on residual renal function in peritoneal dialysis patients: An open label feasibility study. Nephrology (Carlton) 2016; 22:954-960. [PMID: 27558768 DOI: 10.1111/nep.12910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 08/19/2016] [Accepted: 08/23/2016] [Indexed: 11/30/2022]
Abstract
AIM This study aims to evaluate the safety of mycophenolate mofetil (MMF) and its effect on residual renal function (RRF) during peritoneal dialysis (PD). METHODS This is a prospective, randomized study comprising 60 PD patients. The patients were assigned either to the MMF group (MMF dosage: 1.0-1.5 g/day in two divided doses for 6 months, followed by a dose of 0.5-0.75 g/day for another 6 months) or to the control group. The patients close monitoring for 1 year. Variables related to residual renal function, including urine volume, measured glomerular filtration rate (GFR), and renal Kt/V, were measured at four time points. RESULTS There were no significant changes in urinary protein excretion in either group (P > 0.05). The MMF group showed a significantly higher urine volume than the control group (955.38 ± 243.54 vs 786.15 ± 279.62 mL/day, P = 0.024). The renal kt/V was also significantly higher in the MMF group (0.59 ± 0.11 in MMF vs 0.50 ± 0.19 in control group, P = 0.032). There was significant difference in the renal measured GFR between the two groups at 6, 9 and 12 months (MMF vs control at 6 months, 6.14 ± 0.66 vs 5.58 ± 0.65 mL/min per 1.73m2 , P = 0.003; at 9 months, 5.68 ± 0.80 vs 4.78 ± 0.75, P < 0.001; at 12 months, 5.44 ± 0.91 vs 4.43 ± 0.93, P < 0.001). MMF was well tolerated without any serious complications. CONCLUSION The use of MMF in PD patients tends to better preserve RRF.
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Affiliation(s)
- Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Xiaoxue Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Shan Lu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Dong Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Genyang Chen
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Yanna Dou
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Wenming Yuan
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Shuang Ma
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Yansheng Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Nephropathy Research Institutes of Zhengzhou University, Zhengzhou, China
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31
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Mathew AT, Fishbane S, Obi Y, Kalantar-Zadeh K. Preservation of residual kidney function in hemodialysis patients: reviving an old concept. Kidney Int 2016; 90:262-271. [PMID: 27182000 PMCID: PMC5798008 DOI: 10.1016/j.kint.2016.02.037] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/18/2016] [Accepted: 02/24/2016] [Indexed: 12/30/2022]
Abstract
Residual kidney function (RKF) may confer a variety of benefits to patients on maintenance dialysis. RKF provides continuous clearance of middle molecules and protein-bound solutes. Whereas the definition of RKF varies across studies, interdialytic urine volume may emerge as a pragmatic alternative to more cumbersome calculations. RKF preservation is associated with better patient outcomes including survival and quality of life and is a clinical parameter and research focus in peritoneal dialysis. We propose the following practical considerations to preserve RKF, especially in newly transitioned (incident) hemodialysis patients: (1) periodic monitoring of RKF in hemodialysis patients through urine volume and including residual urea clearance with dialysis adequacy and outcome markers such as anemia, fluid gains, minerals and electrolytes, nutritional, status and quality of life; (2) avoidance of nephrotoxic agents such as radiocontrast dye, nonsteroidal anti-inflammatory drugs, and aminoglycosides; (3) more rigorous hypertension control and minimizing intradialytic hypotensive episodes; (4) individualizing the initial dialysis prescription with consideration of an incremental/infrequent approach to hemodialysis initiation (e.g., twice weekly) or peritoneal dialysis; and (5) considering a lower protein diet, especially on nondialysis days. Because RKF appears to be associated with better patient outcomes, it requires more clinical and research focus in the care of hemodialysis and peritoneal dialysis patients.
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Affiliation(s)
- Anna T Mathew
- Hofstra Northwell School of Medicine, Division of Kidney Diseases and Hypertension, Northwell Health, Great Neck, New York, USA
| | - Steven Fishbane
- Hofstra Northwell School of Medicine, Division of Kidney Diseases and Hypertension, Northwell Health, Great Neck, New York, USA.
| | - Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, California, USA; Fielding School of Public Health at UCLA, Los Angeles, California, USA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA
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32
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Taniyama Y. Management of hypertension for patients undergoing dialysis therapy. RENAL REPLACEMENT THERAPY 2016. [DOI: 10.1186/s41100-016-0034-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Chronic kidney disease affects more than 30 million people in the United States, creating a significant disease burden. Peritoneal dialysis, an effective yet underused method of renal replacement therapy, can provide a high quality of life, maintain a patient's residual renal function, and decrease overall healthcare costs with little negative effect on patient morbidity or mortality. Given this, knowledge of the methods, outcomes, and costs of renal replacement therapy is essential to physician assistants.
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He L, Liu X, Li Z, Abreu Z, Malavade T, Lok CE, Bargman JM. Rate of Decline of Residual Kidney Function Before and After the Start of Peritoneal Dialysis. Perit Dial Int 2016; 36:334-9. [PMID: 27044795 DOI: 10.3747/pdi.2016.00024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 01/25/2016] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED ♦ BACKGROUND There is a paucity of information on whether peritoneal dialysis (PD) slows the decline of residual kidney function (RKF) compared to the natural slope of RKF decline prior to dialysis start. Our aim was to analyze the RKF decline before and after initiating PD, and to determine the principal factors affecting this decline during the PD period. ♦ METHODS We determined individual glomerular filtration rates (GFR) for approximately 12 months before and after PD in 77 new PD patients in a large academic medical center (2008 - 2012). The GFR was estimated by the Modification of Diet in Renal Disease (MDRD) equation in the predialysis period and by averaging 24-hour urine creatinine and urea clearances in the PD period. The rate of RKF decline was calculated using unadjusted linear regression analysis. Wilcoxon signed rank test was used to compare RKF decline before and after PD initiation. Multivariate linear regression was used to identify independent risk factors for RKF decline in the PD phase. ♦ RESULTS A significantly slower mean rate of RKF decline was observed in the PD period compared with the predialysis period (-0.21 ± 0.30 vs -0.59 ± 0.55 mL/min/1.73 m(2)/month, p < 0.01). Higher baseline RKF, higher serum phosphate, and older age were independently associated with faster decline of RKF (all p < 0.01). ♦ CONCLUSIONS In patients with advanced chronic kidney disease, initiating PD was associated with a slower rate of RKF decline compared to the rate in the predialysis period.
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Affiliation(s)
- Lian He
- Department of Nephrology, Peking University 3 Hospital, Beijing, P.R. China University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
| | - Xihui Liu
- Division of Nephrology, Linyi People's Hospital, Linyi, Shandong, P.R. China University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
| | - Zi Li
- Department of Nephrology, West China Hospital, Chengdu, Sichuan, P.R. China University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
| | - Zita Abreu
- University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
| | - Tushar Malavade
- University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
| | - Charmaine E Lok
- University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
| | - Joanne M Bargman
- University Health Network, Toronto General Hospital and the University of Toronto, Toronto, ON, Canada
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Firuzi O, Khajehrezaei S, Ezzatzadegan S, Nejati M, Jahanshahi KA, Roozbeh J. Effects of silymarin on biochemical and oxidative stress markers in end-stage renal disease patients undergoing peritoneal dialysis. Hemodial Int 2016; 20:558-563. [PMID: 27040041 DOI: 10.1111/hdi.12413] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction End-stage renal disease (ESRD) patients especially those undergoing dialysis are vulnerable to several complications, in particular those related to oxidative stress. Silymarin is an herbal medicine commonly used as an antioxidant in different pathologies. Methods To evaluate the effect of silymarin on biochemical and oxidative stress markers, 50 ESRD patients undergoing peritoneal dialysis were randomly divided into two groups of silymarin (n = 28) and control (n = 22) and received silymarin (140 mg every 8 hours) or placebo for 2 months, respectively. Ferric reducing antioxidant power and total 8-iso-prostaglandin F2α were measured in plasma, while catalase enzyme activity was measured in erythrocytes of both groups before and after treatment. Findings Ferric reducing antioxidant power values after treatment were significantly decreased in silymarin group compared to before treatment values (17.2 ± 2.9 and 15.9 ± 3.1 µM equivalent of quercetin/dL, respectively, P < 0.05). Conversely, catalase levels were increased 17.3% after silymarin consumption, while it was decreased 9.1% in control group. Further, hemoglobin (from 10.94 ± 2.17 to 11.54 ± 2.03 g/dL, P < 0.05) and albumin levels (from 3.48 ± 0.67 to 3.61 ± 0.53 g/dL, P < 0.05) were significantly increased after silymarin administration. Discussion It is concluded that silymarin could be regarded as a supplementary therapy for ESRD patients undergoing peritoneal dialysis in order to reduce complications.
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Affiliation(s)
- Omidreza Firuzi
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soraya Khajehrezaei
- Department of Internal medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahrokh Ezzatzadegan
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Nejati
- Medicinal and Natural Products Chemistry Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Jamshid Roozbeh
- Shiraz Nephrology-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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36
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Jellouli M, Ferjani M, Abidi K, Hammi Y, Boutiba I, Naija O, Zarrouk C, Ben Abdallah T, Gargah T. [Peritonitis in pediatric patients receiving peritoneal dialysis]. Nephrol Ther 2015; 11:558-63. [PMID: 26520233 DOI: 10.1016/j.nephro.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 06/25/2015] [Accepted: 06/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Peritonitis on catheter of dialysis represents the most frequent complication of the peritoneal dialysis (PD) in the pediatric population. It remains a significant cause of morbidity and mortality. In this study, we investigated the risk factors for peritonitis in children. METHODS In this study, we retrospectively collected the records of 85 patients who were treated with PD within the past ten years in the service of pediatrics of the University Hospital Charles-Nicolle of Tunis. RESULTS Peritonitis rate was 0.75 episode per patient-year. Notably, peritonitis caused by Gram-positive organisms were more common. Analysis of infection risk revealed three significant independent factors: the poor weight (P=0.0045), the non-automated PD (P=0.02) and the short delay from catheter insertion to starting PD (P=0.02). The early onset peritonitis was significantly associated with frequent peritonitis episodes (P=0.0008). The mean duration between the first and second episode of peritonitis was significantly shorter than between PD commencement and the first episode of peritonitis. We revealed a significant association between Gram-negative peritonitis and the presence of ureterostomy (0.018) and between Gram-positive peritonitis and the presence of exit-site and tunnel infections (0.02). Transition to permanent hemodialysis was needed in many children but no death occurred in patients with peritonitis. CONCLUSION Considering the important incidence of peritonitis in our patients, it is imperative to establish a targeted primary prevention. Nutritional care must be provided to children to avoid poor weight. The automated dialysis has to be the modality of choice.
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Affiliation(s)
- Manel Jellouli
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie.
| | - Meriem Ferjani
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Kamel Abidi
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Yosra Hammi
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Ilhem Boutiba
- Service de bactériologie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Ouns Naija
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Chokri Zarrouk
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Taieb Ben Abdallah
- Service de médecine interne et de néphrologie, hôpital Charles-Nicolles, Tunis, Tunisie
| | - Tahar Gargah
- Service de pédiatrie, hôpital Charles-Nicolles, Tunis, Tunisie
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Vega-Diaz N, Gonzalez-Cabrera F, Marrero-Robayna S, Santana-Estupiñan R, Gallego-Samper R, Henriquez-Palop F, Perez-Borges P, Rodriguez-Perez JC. Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients. J Clin Med 2015; 4:1518-35. [PMID: 26239689 PMCID: PMC4519803 DOI: 10.3390/jcm4071518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD), a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF) in patients on peritoneal dialysis (PD) is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD) patients, with end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in comparison to non-diabetic nephropathy (NDN), using different PD solutions in combination. DESIGN Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. RESULTS The fraction of renal urea clearance (Kt) relative to distribution volume (V) (or total body water) (Kt/V), or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl) decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively), and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively). Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0.22, 12 months 1.63 ± 0.39, 24 months 1.73 ± 0.47; NDN: baseline 1.59 ± 0.40, 12 months 1.76 ± 0.47, 24 months 1.80 ± 0.46), in order to maintain the net water balance. The daytime dwell contribution, the fraction of day and the renal fraction of studies parameters provide sustained benefit in the follow-up time, above 30%. CONCLUSIONS The wet day and residual renal function are determinants in the achievement of the objective dose of dialysis, as well as in the water and sodium balance. The cause of chronic kidney disease (CKD) does not seem to influence the cleansing effectiveness of the technique.
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Affiliation(s)
- Nicanor Vega-Diaz
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Fayna Gonzalez-Cabrera
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Silvia Marrero-Robayna
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Raquel Santana-Estupiñan
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Roberto Gallego-Samper
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Fernando Henriquez-Palop
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Patricia Perez-Borges
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - José Carlos Rodriguez-Perez
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
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Wong J, Vilar E, Davenport A, Farrington K. Incremental haemodialysis. Nephrol Dial Transplant 2015; 30:1639-48. [DOI: 10.1093/ndt/gfv231] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 04/21/2015] [Indexed: 12/15/2022] Open
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