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Cheng XBJ, Bargman J. Complications of Peritoneal Dialysis Part II: Nonmechanical Complications. Clin J Am Soc Nephrol 2024; 19:791-799. [PMID: 38190143 PMCID: PMC11168822 DOI: 10.2215/cjn.0000000000000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/21/2023] [Indexed: 01/09/2024]
Abstract
Peritoneal dialysis (PD) is a form of KRT that offers flexibility and autonomy to patients with ESKD. It is associated with lower costs compared with hemodialysis in many countries. Unlike mechanical complications that typical arise early in the course of treatment, noninfectious, nonmechanical complications often present late in patients who are established on PD. In this review, we first discuss abnormal-appearing drained dialysate, including hemoperitoneum, chyloperitoneum, and noninfectious cloudy dialysate. The underlying cause is frequently unrelated to PD. We then discuss encapsulating peritoneal sclerosis, a rare complication of PD. Finally, we review metabolic changes associated with PD and methods to mitigate its effects.
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Affiliation(s)
- Xin Bo Justin Cheng
- University Health Network, Toronto, Ontario, Canada
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - Joanne Bargman
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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2
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Zhang F, Shi T, Feng X, Shi Y, Zhang G, Liu Y, Fu P. Visit-to-visit HbA1c variability is associated with poor prognosis in peritoneal dialysis patients with type 2 diabetes mellitus. BMC Nephrol 2023; 24:288. [PMID: 37775768 PMCID: PMC10542698 DOI: 10.1186/s12882-023-03348-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/23/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The prognosis of diabetic peritoneal dialysis patients is poor. HbA1c serves as a crucial indicator for monitoring blood glucose control in patients with diabetes. Nevertheless, the relationship between visit-to-visit HbA1c variability and prognosis in peritoneal dialysis with diabetes remains unclear. METHODS All participants were categorized into 3 groups based on the HbA1c variability score (HVS), which is the frequency of 0.5% (5.5 mmol/mol) alter in visit-to-visit HbA1c values. Then, the hazard ratio to HVS with all-cause mortality was analyzed using the Cox hazard model, followed by the Fine-Gray competing risk model for major adverse cardiovascular events. Subgroup and sensitivity analysis were conducted to ascertain the robustness of the findings. RESULTS Eight hundred twenty patients with type 2 diabetes were finally enrolled in this study from 2,855 participants with a mean age of 56.9 ± 14.6 years and a median follow-up time of 44 months [IQR: 27-70], death occurred in 496 (60.2%) individuals. Compared with the lowest category (HVS < 1/3) after being adjusted by potential confounding factors, the hazard ratio for all-cause mortality was 4.59 (3.74-5.64) and the sub-distribution hazard ratio for major adverse cardiovascular events was 1.91 (1.46-2.51) of the highest category (HVS ≥ 2/3). Subgroup interaction and sensitivity analysis, including the adjustment for variables such as time-weighted average HbA1c, HbA1c measurement times and expansion, confirmed the reliability of the results. CONCLUSION The HVS is related to the risk of poor prognosis in peritoneal dialysis with type 2 diabetes mellitus, independently of clinical multiple variables, and is a novel indicator with clinical guidance.
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Affiliation(s)
- Fengping Zhang
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Jiujiang NO.1 People's Hospital, Jiujiang, China
| | - Taotao Shi
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Jiujiang NO.1 People's Hospital, Jiujiang, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang NO.1 People's Hospital, Jiujiang, China
| | - Yunying Shi
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China
| | - Guilin Zhang
- Department of Nephrology, The NO.1 Affiliatedffiliated Hospital of Nanchang University, Nanchang, China
| | - Yu Liu
- Department of Nephrology, Pingxiang People's Hospital, Pingxiang, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu, China.
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3
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Afghahi H, Nasic S, Peters B, Rydell H, Hadimeri H, Svensson J. Long-term glycemic variability and the risk of mortality in diabetic patients receiving peritoneal dialysis. PLoS One 2022; 17:e0262880. [PMID: 35077471 PMCID: PMC8789125 DOI: 10.1371/journal.pone.0262880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background
The large amount of glucose in the dialysate used in peritoneal dialysis (PD) likely affects the glycemic control. The aim of this study was to investigate the association between HbA1c variability, as a measure of long-term glycemic variability, and the risk of all-cause mortality in diabetic patients with PD.
Methods
325 patients with diabetes and ESRD were followed (2008–2018) in the Swedish Renal Registry. Patients were separated in seven groups according to level of HbA1c variability. The group with the lowest variability was denoted the reference. The ratio of the standard deviation (SD) to the mean of HbA1c, HbA1c (SD)/HbA1c (mean), i.e. the coefficient of variation (CV), was defined as HbA1c variability. Hazard ratios (HR) and 95% confidence intervals (CI) were examined using Cox regression analyses.
Results
During follow-up, 170 (52%) deaths occurred. The highest mortality was among patients with the second highest HbA1c variability, CV≥2.83 [n = 44 of which 68% patients died]. In the multivariate analyses where lowest HbA1c variability (CV≤0.51) was used as the reference group, HbA1c CV 2.83–4.60 (HR 3.15, 95% CI 1.78–5.55; p<0.001) and CV> 4.6 (HR 2.48, 95% CI 1.21–5.11; p = 0.014) were associated with increased risk of death.
Conclusion
The high risk of all-cause mortality in patients with diabetes and PD increased significantly with elevated HbA1c variability, as measure of long-term glycemic control. This indicates that stable glycemia is associated with an improvement of survival; whereas more severe glycemic fluctuations, possibly caused by radical changes in dialysis regimes or peritonitis, are associated with a higher risk of mortality in diabetic patients with PD.
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Affiliation(s)
- Hanri Afghahi
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Salmir Nasic
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Research and Development Center at Skaraborg Hospital, Skövde, Sweden
| | - Björn Peters
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Helena Rydell
- Division of Renal Medicine, Department of Clinical Sciences Intervention and Technology, Karolinska Institute, Stockholm, Sweden
- Department of Internal Medicine, Swedish Renal Registry, Ryhov Regional Hospital, Jönköping, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Johan Svensson
- Research and Development Center at Skaraborg Hospital, Skövde, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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4
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Zeighami S, Dehghankhalili S, Heiran K, Azarchehry SP, Heiran A, Sayadi M, Azadian F. Comparison of Male and Female Sexual Dysfunction between Hemodialysis and Peritoneal Dialysis in Patients with End-Stage Renal Disease: An Analytical Cross-Sectional Study. Int J Endocrinol 2022; 2022:9404025. [PMID: 35479663 PMCID: PMC9038412 DOI: 10.1155/2022/9404025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 03/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maintenance dialysis is the most common treatment for end-stage renal disease (ESRD) patients. One of the most ignored but important health issue among dialysis patients is sexual dysfunction, which interferes with quality of life (QoL). Studies showed that the side effects of the two conventional methods of dialysis (hemodialysis (HD) and peritoneal dialysis (PD)) are different on a patient's health. Therefore, we sought to compare the sexual dysfunction score, both male and female, between patients undergoing HD and PD. METHODS One hundred seventy adults (85 HD and 85 PD) subject with end-stage renal disease (ESRD) on dialysis for at least 2 months were included. For male subjects, the erectile function (EF) domain of the International Index of Erectile Function (IIEF) questionnaire was calculated. Moreover, the Female Sexual Function Index (FSFI) questionnaire was calculated for females. Data were analyzed via SPSS software. Two independent sample t-test with two-sided significance level of 5% was used for comparing the sexual dysfunction score between HD and PD patients. RESULTS Out of 170 patients with mean age of 49.34 ± 11.7 years, 52.9% were female. Better sexual function scores were obtained in the HD group's females for desire, orgasm, and satisfaction domains, as well as the total score (P = 0.03, 0.016, 0.02, and 0.039, respectively). The erectile function was significantly better in the PD group's males (P). CONCLUSION We found better sexual life in the HD group's females and PD group's males. Considering dialysis as a life-long treatment of CKD patients, this part of a patient's life must be taken seriously by the healthcare providers to choose the most suitable method for patients based on their personalized conditions.
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Affiliation(s)
- Shahryar Zeighami
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Khadije Heiran
- Department of Midwifery, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Seyede Pegah Azarchehry
- Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, Iran
| | - Alireza Heiran
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrab Sayadi
- Cardiovascular Research Center, Mohammad Rasoolallah Research Tower, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Azadian
- Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Buades JM, Craver L, Del Pino MD, Prieto-Velasco M, Ruiz JC, Salgueira M, de Sequera P, Vega N. Management of Kidney Failure in Patients with Diabetes Mellitus: What Are the Best Options? J Clin Med 2021; 10:2943. [PMID: 34209083 PMCID: PMC8268456 DOI: 10.3390/jcm10132943] [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: 05/23/2021] [Revised: 06/22/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Diabetic kidney disease (DKD) is the most frequent cause of kidney failure (KF). There are large variations in the incidence rates of kidney replacement therapy (KRT). Late referral to nephrology services has been associated with an increased risk of adverse outcomes. In many countries, when patients reach severely reduced glomerular filtration rate (GFR), they are managed by multidisciplinary teams led by nephrologists. In these clinics, efforts will continue to halt chronic kidney disease (CKD) progression and to prevent cardiovascular mortality and morbidity. In patients with diabetes and severely reduced GFR and KF, treating hyperglycemia is a challenge, since some drugs are contraindicated and most of them require dose adjustments. Even more, a decision-making process will help in deciding whether the patient would prefer comprehensive conservative care or KRT. On many occasions, this decision will be conditioned by diabetes mellitus itself. Effective education should cover the necessary information for the patient and family to answer these questions: 1. Should I go for KRT or not? 2. If the answer is KRT, dialysis and/or transplantation? 3. Dialysis at home or in center? 4. If dialysis at home, peritoneal dialysis or home hemodialysis? 5. If transplantation is desired, discuss the options of whether the donation would be from a living or deceased donor. This review addresses the determinant factors with an impact on DKD, aiming to shed light on the specific needs that arise in the management and recommendations on how to achieve a comprehensive approach to the diabetic patient with chronic kidney disease.
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Affiliation(s)
- Juan M. Buades
- Department of Nephrology, Hospital Universitario Son Llàtzer, Balearic Islands, 07198 Palma de Mallorca, Spain
- Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
| | - Lourdes Craver
- Department of Nephrology, Hospital Universitario Arnau de Vilanova, 25198 Lleida, Spain;
| | - Maria Dolores Del Pino
- Department of Nephrology, Complejo Hospitalario Torrecárdenas de Almería, 04009 Almería, Spain;
| | - Mario Prieto-Velasco
- Department of Nephrology, Complejo Asistencial Universitario de Leon, 24001 León, Spain;
| | - Juan C. Ruiz
- Department of Nephrology, Valdecilla Hospital, University of Cantabria, 39008 Santander, Spain;
- Valdecilla Biomedical Research Institute (IDIVAL), Cardenal Herrera Oria S/N, 39011 Santander, Spain
| | - Mercedes Salgueira
- Department of Nephrology, Hospital Universitario Virgen Macarena, 41009 Seville, Spain;
- Biomedical Engineering Group, Medicine Department, University of Seville, 41092 Seville, Spain
- Center for Biomedical Research Network in Bioengineering Biomaterials and Nanomedicina (CIBER-BBN), 28029 Madrid, Spain
| | - Patricia de Sequera
- Department of Nephrology, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
- Medicine Department, Universidad Complutense de Madrid, 28031 Madrid, Spain
| | - Nicanor Vega
- Department of Nephrology, Hospital Universitario de Gran Canaria Dr. Negrín, 35010 Las Palmas de Gran Canaria, Spain;
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Copur S, Siriopol D, Afsar B, Comert MC, Uzunkopru G, Sag AA, Ortiz A, Covic A, van Raalte DH, Cherney DZ, Rossing P, Kanbay M. Serum glycated albumin predicts all-cause mortality in dialysis patients with diabetes mellitus: meta-analysis and systematic review of a predictive biomarker. Acta Diabetol 2021; 58:81-91. [PMID: 32862262 DOI: 10.1007/s00592-020-01581-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/16/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM HbA1c, the traditional and current gold standard biomarker guiding diabetic management, has been scrutinized for low predictive value for patients with chronic kidney disease due to variables affecting erythrocyte number and turnover. Glycated albumin, the precursor to advanced glycation end products, reflects glycemic status over the preceding 2-3 week period and already outperforms HbA1c for glycemic monitoring. Our aim was to establish whether serum GA can be further used to predict mortality risk in dialysis patients with diabetes mellitus (DM) METHODS: We did systematic review of the literature in PubMed/Medline, Web of Science, Embase (Elsevier) and the Cochrane Central Register of Controlled Trials (Wiley) up to and including February 2020. RESULTS This meta-analysis included 25,932 dialysis patients across 12 studies with maximum follow-up of 11 years. Higher GA levels were associated with the risk of all-cause mortality in dialysis patients with DM (HR 1.02, 95% CI 1.01 to 1.03, P < 0.001) irrespective of the type of dialysis, whereas higher GA was not associated with cardiovascular mortality (HR 1.03, 95% CI 0.99 to 1.06, P = 0.15) and cardiovascular events (both fatal and non-fatal) (HR 1.03, 95% CI 0.97 to 1.09, P = 0.31) in dialysis patients with DM. CONCLUSION Serum glycated albumin predicts all-cause mortality risk in dialysis patients with DM. The endpoints of cardiovascular mortality and cardiovascular events trended similarly, but did not reach significance at the current sample size.
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Affiliation(s)
- Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Dimitrie Siriopol
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Melis C Comert
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Gizem Uzunkopru
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Division of Vascular and Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040, Madrid, Spain
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Daniel H van Raalte
- Diabetes Center, Department of Internal Medicine, Amsterdam University Medical Center, Loaction VUMC, Amsterdam, The Netherlands
| | - David Z Cherney
- Toronto General Hospital Research Institute, UHN, Toronto, Canada
- Departments of Physiology and Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Copenhagen Denmark and University of Copenhagen, Copenhagen, Denmark
| | - Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, 34010, Istanbul, Turkey.
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7
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Yarragudi R, Gessl A, Vychytil A. New-Onset Diabetes Mellitus in Peritoneal Dialysis and Hemodialysis Patients: Frequency, Risk Factors, and Prognosis-A Review. Ther Apher Dial 2019; 23:497-506. [PMID: 30854792 PMCID: PMC6916572 DOI: 10.1111/1744-9987.12800] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/03/2019] [Accepted: 03/08/2019] [Indexed: 12/23/2022]
Abstract
New-onset diabetes mellitus (NODM) is observed in both hemodialysis (HD) and peritoneal dialysis (PD) patients. The prevalence of NODM in dialysis patients is slightly higher compared to subjects of the general population. Based on currently published data there is no convincing evidence that the risk of NODM is different between HD and PD patients. Data on the effect of glucose load on risk of NODM in dialysis patients remain controversial. PD modality (automated or continuous ambulatory PD) has no significant influence on NODM incidence. Chronic inflammation is associated with NODM in dialysis patients. Reported differences in NODM between PD and HD patients are possibly also influenced by differences in demographic factors between these patient groups. Mortality in NODM patients is lower than mortality in patients with preexisting DM. This may be partly explained by the younger age and lower number of comorbidities in patients with NODM.
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Affiliation(s)
- Rajashri Yarragudi
- Clinical Division of Nephrology and Dialysis, Department of Medicine IIIMedical University of ViennaViennaAustria
| | - Alois Gessl
- Clinical Division of Endocrinology and Metabolism, Department of Medicine IIIMedical University of ViennaViennaAustria
| | - Andreas Vychytil
- Clinical Division of Nephrology and Dialysis, Department of Medicine IIIMedical University of ViennaViennaAustria
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8
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Yajima T, Yasuda K. Plausible role of glycated albumin to predict 'burnt-out diabetes' in peritoneal dialysis patients. Diabetes Res Clin Pract 2019; 147:172-173. [PMID: 30391335 DOI: 10.1016/j.diabres.2018.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 10/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Takahiro Yajima
- Department of Nephrology, Matsunami General Hospital, Gifu 501-6062, Japan.
| | - Keigo Yasuda
- Department of Internal Medicine, Matsunami General Hospital, Gifu 501-6062, Japan
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9
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Abe M, Hamano T, Hoshino J, Wada A, Nakai S, Masakane I. Rate of the "burnt-out diabetes" phenomenon in patients on peritoneal dialysis. Diabetes Res Clin Pract 2018; 143:254-262. [PMID: 30056189 DOI: 10.1016/j.diabres.2018.07.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/14/2018] [Accepted: 07/23/2018] [Indexed: 10/28/2022]
Abstract
AIMS In some diabetes patients on dialysis, glycemic control improves spontaneously, leading to normal HbA1c levels; this phenomenon is known as "burnt-out diabetes." Glycated albumin (GA) might be a better indicator of glycemic control than HbA1c in hemodialysis patients, but it has not been assessed in peritoneal dialysis (PD) patients. METHODS This study involved diabetes patients on PD, with HbA1c level and antidiabetes therapy records. First, the "burnt-out diabetes" phenomenon was investigated in patients with HbA1c measurements alone (HbA1c cohort). Then, it was investigated in patients with both HbA1c and GA measurements (GA cohort). RESULTS A total of 1296 patients were included in the HbA1c cohort. When "burnt-out diabetes" was defined as HbA1c < 6.0% without treatment, it was noted in 269 patients (20.8%). A total of 413 patients were subsequently included in the GA cohort. "Burnt-out diabetes," using the same definition, was found in 73 patients (17.7%). However, when defined as HbA1c < 6.0% and GA < 16.0% without treatment, "burnt-out diabetes" was found in 45 patients (10.9%). CONCLUSIONS Although the "burnt-out diabetes" phenomenon was present in 17.7% of patients with diabetes on PD based on HbA1c, the rate was significantly decreased to 10.9% when taking GA into account.
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Affiliation(s)
- Masanori Abe
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
| | - Takayuki Hamano
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junichi Hoshino
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wada
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Department of Nephrology, Kitasaito Hospital, Asahikawa, Japan
| | - Shigeru Nakai
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Department of Clinical Engineering, Fujita Health University, Aichi, Japan
| | - Ikuto Masakane
- JSDT Renal Data Registry Committee (JRDR Committee), Japanese Society for Dialysis Therapy (JSDT), Tokyo, Japan; Yabuki Hospital, Yamagata, Japan
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10
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Dozio E, Corradi V, Proglio M, Vianello E, Menicanti L, Rigolini R, Caprara C, de Cal M, Corsi Romanelli MM, Ronco C. Usefulness of glycated albumin as a biomarker for glucose control and prognostic factor in chronic kidney disease patients on dialysis (CKD-G5D). Diabetes Res Clin Pract 2018; 140:9-17. [PMID: 29596954 DOI: 10.1016/j.diabres.2018.03.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 03/08/2018] [Indexed: 12/17/2022]
Abstract
In chronic kidney disease patients on dialysis (CKD-G5D) accurate assessment of glycemic control is vital to improve their outcome and survival. The best glycemic marker for glucose control in these patients is still debated because several clinical and pharmacological factors may affect the ability of the available biomarkers to reflect the patient's glycemic status properly. This review discusses the role of glycated albumin (GA) both as a biomarker for glucose control and as a prognostic factor in CKD-G5D; it also looks at the pros and cons of GA in comparison to the other markers and its usefulness in hemodialysis and peritoneal dialysis.
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Affiliation(s)
- Elena Dozio
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy.
| | - Valentina Corradi
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Marta Proglio
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Elena Vianello
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy
| | - Lorenzo Menicanti
- Department of Cardiac Surgery, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Roberta Rigolini
- Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Carlotta Caprara
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
| | - Massimiliano M Corsi Romanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy; Service of Laboratory Medicine1-Clinical Pathology, I.R.C.C.S. Policlinico San Donato, 20097 San Donato Milanese, Milan, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis & Transplantation, San Bortolo Hospital, 36100 Vicenza, Italy; International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy
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11
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Abstract
Diabetes is highly and increasingly prevalent in the dialysis population and negatively impacts both quality and quantity of life. Nevertheless, the best approach to these patients is still debatable. The question of whether the management of diabetes should be different in dialysis patients does not have a clear yes or no answer but is divided into too many sub-issues that should be carefully considered. In this review, lifestyle, cardiovascular risk, and hyperglycemia management are explored, emphasizing the possible pros and cons of a similar approach to diabetes in dialysis patients compared to the general population.
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Affiliation(s)
- Silvia Coelho
- Nephrology and Intensive Care Departments, Hospital Fernando Fonseca, Amadora, Portugal.,CEDOC - Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
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12
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Udo A, Goodlad C, Davenport A. Impact of Diabetes on Extracellular Volume Status in Patients Initiating Peritoneal Dialysis. Am J Nephrol 2017; 46:18-25. [PMID: 28564640 DOI: 10.1159/000477326] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/31/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Recent reports have highlighted that diabetic patients with kidney failure are at increased risk of technique failure and transfer to haemodialysis within 90 days of initiating peritoneal dialysis (PD). We wished to determine whether there were differences between diabetic and non-diabetic patients within the first 3 months of starting PD. METHODS We reviewed results of corresponding bioimpedance and the 1st test of peritoneal membrane function (PET) in consecutive patients, 6-10 weeks after initiating PD electively. RESULTS Adult patients numbering 386 - 230 males (59.6%), 152 (39.4%) diabetic, 188 (48.7%) white, mean age 57.3 ±16.9 years - were studied. Although weight, residual renal function and peritoneal clearances were not different, diabetic patients had greater extracellular water to total body water (ECW/TBW; 40.4 ± 1.1 vs. 39.2 ± 1.4) and % ECW excess (9.6 [6.3-12.3] vs. 4.9 [0.7-8.9]), lower serum albumin (35.2 ± 4.7 vs. 37.8 ± 4.9 g/L), greater fat mass index (9.5 ± 4.2 vs. 7.7 ± 4.2), and although mean arterial blood pressure was similar, arterial pulse pressure was greater (66.9 ± 10.8 vs. 54.3 ± 17.3 mm Hg, all p < 0.001). On multivariate analysis, glycated haemoglobin was associated with pulse pressure (standardised β 0.24, p < 0.001), N terminal brain natriuretic peptide (β 0.24, p < 0.001), ECW/TBW (β 0.19, p = 0.012) and negatively with serum albumin (β -0.14, p = 0.033) and creatinine (β -0.18, p = 0.02). CONCLUSION Diabetic patients electively starting PD were found to have greater ECW/TBW ratios and ECW excess 6-10 weeks after starting PD compared to non-diabetics, despite similar PET. Increased ECW could predispose diabetic patients to be at greater risk of volume overload.
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Affiliation(s)
- Aniema Udo
- Dialysis Unit, University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria
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Rivara MB, Mehrotra R. New-Onset Diabetes in Peritoneal Dialysis Patients - Which Predictors Really Matter? Perit Dial Int 2016; 36:243-6. [PMID: 27230599 DOI: 10.3747/pdi.2015.00251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Matthew B Rivara
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, WA
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, University of Washington, Seattle, WA
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14
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Kobayashi H, Abe M, Yoshida Y, Suzuki H, Maruyama N, Okada K. Glycated Albumin versus Glycated Hemoglobin as a Glycemic Indicator in Diabetic Patients on Peritoneal Dialysis. Int J Mol Sci 2016; 17:ijms17050619. [PMID: 27120597 PMCID: PMC4881445 DOI: 10.3390/ijms17050619] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 01/20/2023] Open
Abstract
Compared with glycated hemoglobin (HbA1c), glycated albumin (GA) is superior in estimating glycemic control in diabetic patients on hemodialysis (HD). However, the better index for assessment of glycemic control in diabetic patients on peritoneal dialysis (PD) and the impact of protein loss on GA are unknown. Twenty diabetic patients on HD were matched by age, sex, and baseline postprandial plasma glucose (PG) levels to 20 PD patients. PG, HbA1c, GA, and serum albumin levels were measured for six months. Protein loss in PD patients was estimated by measuring the protein concentration in the peritoneal dialysate and by 24 h urine collection. Although PG and HbA1c did not differ significantly between the groups, the PD group had significantly lower GA (17.8% versus 20.8%, p < 0.001) and GA/HbA1c ratio (2.95% versus 3.45%, p < 0.0001) than the HD group. Although the PG level correlated significantly with the GA levels in both groups, it was not correlated with the HbA1c levels in both groups. HbA1c level was negatively associated with erythropoiesis-stimulating agent (ESA) dose in both groups, whereas GA was not significantly associated with serum albumin, hemoglobin concentration, ESA dose, and protein loss. Multiple regression analysis identified GA as the only independent factor associated with PG in PD patients. Our results suggested that GA was not significantly associated with protein loss, hemoglobin, serum albumin, and ESA dose. Although GA might underestimate glycemic status, it provided a significantly better measure for estimating glycemic control than HbA1c, even in PD patients.
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Affiliation(s)
- Hiroki Kobayashi
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
| | - Masanori Abe
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
| | - Yoshinori Yoshida
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
| | - Hiroko Suzuki
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
| | - Noriaki Maruyama
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
| | - Kazuyoshi Okada
- Division of Nephrology, Hypertension and Endocrinology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo 173-8610, Japan.
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Abstract
The definition of a good glycemic control in patients with diabetes mellitus on hemodialysis is far from settled. In the general population, hemoglobin A1c is highly correlated with the average glycemia of the last 8-12 weeks. However, in hemodialysis patients, the correlation of hbA1c with glycemia is weaker as it also reflects changes in hemoglobin characteristics and red blood cells half-life. As expected, studies show that the association between HbA1c and outcomes in these patients differ from the general population. Therefore, the value of HbA1c in the treatment of hemodialysis patients has been questioned. Guidelines are generally cautious in their recommendations about possible targets of HbA1c in this population. Indeed, the risk of not treating hyperglycemia should be weighed against the particularly high risk of precipitating hypoglycemia in dialysis patients. In this review, a critical analysis of the current role of HbA1c in the care of hemodialysis patients is presented.
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Affiliation(s)
- Silvia Coelho
- Nephrology and Critical Care Departments, Fernando Fonseca Hospital, Amadora, Portugal.,Center for Chronic Diseases (CEDOC), Faculty of Medical Sciences, New University of Lisbon, Lisbon, Portugal
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