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Chen Y, Zhang M, Li Y, Xie Q, Dai S, Ge X, Hao CM, Zhu T. Retroperitoneal leakage as an important cause of acquired ultrafiltration decline in peritoneal dialysis: clinical characteristics and related risk factors. J Nephrol 2024:10.1007/s40620-024-02009-3. [PMID: 38997573 DOI: 10.1007/s40620-024-02009-3] [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: 12/07/2023] [Accepted: 06/13/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. METHODS This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. RESULTS The cohort was followed up for up to 125.0 months (median: 46.4 months; interquartile range: 16.6 months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. CONCLUSIONS Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.
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Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Min Zhang
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Yuan Li
- Division of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qionghong Xie
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Chuan-Ming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China.
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Cheng XBJ, Chan CT. Systems Innovations to Increase Home Dialysis Utilization. Clin J Am Soc Nephrol 2024; 19:108-114. [PMID: 37651291 PMCID: PMC10843223 DOI: 10.2215/cjn.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Globally, there is an interest to increase home dialysis utilization. The most recent United States Renal Data System (USRDS) data report that 13.3% of incident dialysis patients in the United States are started on home dialysis, while most patients continue to initiate KRT with in-center hemodialysis. To effect meaningful change, a multifaceted innovative approach will be needed to substantially increase the use of home dialysis. Patient and provider education is the first step to enhance home dialysis knowledge awareness. Ideally, one should maximize the number of patients with CKD stage 5 transitioning to home therapies. If this is not possible, infrastructures including transitional dialysis units and community dialysis houses may help patients increase self-care efficacy and eventually transition care to home. From a policy perspective, adopting a home dialysis preference mandate and providing financial support to recuperate increased costs for patients and providers have led to higher uptake in home dialysis. Finally, respite care and planned home-to-home transitions can reduce the incidence of transitioning to in-center hemodialysis. We speculate that an ecosystem of complementary system innovations is needed to cause a sufficient change in patient and provider behavior, which will ultimately modify overall home dialysis utilization.
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Affiliation(s)
- Xin Bo Justin Cheng
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Coca A, Arias-Cabrales C, Pérez-Sáez MJ, Fidalgo V, González P, Acosta-Ochoa I, Lorenzo A, Rollán MJ, Mendiluce A, Crespo M, Pascual J, Bustamante-Munguira J. Impact of intra-abdominal pressure on early kidney transplant outcomes. Sci Rep 2022; 12:2257. [PMID: 35145181 PMCID: PMC8831606 DOI: 10.1038/s41598-022-06268-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/06/2022] [Indexed: 12/13/2022] Open
Abstract
Increased intra-abdominal pressure (IAP) is common among post-surgical patients and may cause organ dysfunction. However, its impact after kidney transplantation on early postoperative complications and graft recovery remains unclear. We designed a prospective, observational cohort study to describe the prevalence and determinants of IAP, as well as its effect on delayed graft function, postoperative complications, and graft recovery. IAP was measured in 205 kidney transplant recipients every 8 h during the first 72 h after surgery using the urinary bladder technique. Intra-abdominal hypertension was defined as IAP ≥ 12 mmHg. Patients were followed for 6 months or until graft failure/death. Mean IAP was 12 ± 3.3 mmHg within the first 24 h. 78% of subjects presented with intra-abdominal hypertension during the first 72 h. Increased IAP was associated with higher renal resistive index [r = 0.213; P = 0.003] and lower urine output [r = - 0.237; P < 0.001]. 72 h mean IAP was an independent risk factor for delayed graft function [OR: 1.31; 95% CI: 1.13-1.51], postoperative complications [OR: 1.17; 95% CI: 1.03-1.33], and absence of graft function recovery [HR for graft function recovery: 0.94; 95% CI: 0.88-0.99]. Increased IAP was highly prevalent after transplantation and was independently associated with delayed graft function, postoperative complications, and absence of graft function recovery. Routine IAP monitoring should be considered post-transplantation to facilitate early recognition of relevant complications.
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Affiliation(s)
- Armando Coca
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain.
| | - Carlos Arias-Cabrales
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - María José Pérez-Sáez
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Verónica Fidalgo
- Department of Nephrology, Hospital General, C/ Luis Erik Clavería Neurólogo s/n, 40002, Segovia, Spain
| | - Pablo González
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Isabel Acosta-Ochoa
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Arturo Lorenzo
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - María Jesús Rollán
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Alicia Mendiluce
- Department of Nephrology, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
| | - Marta Crespo
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar, Paseo Marítimo de la Barceloneta 25-29, 08003, Barcelona, Spain
| | - Juan Bustamante-Munguira
- Department of Cardiac Surgery, Hospital Clínico Universitario, Avda. Ramón y Cajal 3, 47003, Valladolid, Spain
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Bennett PN, Bohm C, Harasemiw O, Brown L, Gabrys I, Jegatheesan D, Johnson DW, Lambert K, Lightfoot CJ, MacRae J, Meade A, Parker K, Scholes-Robertson N, Stewart K, Tarca B, Verdin N, Wang AYM, Warren M, West M, Zimmerman D, Li PKT, Thompson S. Physical activity and exercise in peritoneal dialysis: International Society for Peritoneal Dialysis and the Global Renal Exercise Network practice recommendations. Perit Dial Int 2021; 42:8-24. [PMID: 34743628 DOI: 10.1177/08968608211055290] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Life participation requiring physical activity and physical function is a key patient-reported outcome for people receiving peritoneal dialysis (PD). Clinician guidance is required from multidisciplinary sources regarding exercise and activity advice to address the specific needs of this group. From August 2020 through to June 2021, the Global Renal Exercise Network and the International Society for Peritoneal Dialysis reviewed the published literature and international clinical experience to develop a set of clinical practice points. A set of questions relevant to physical activity and exercise were developed from the perspective of a person receiving PD and were the basis for the practice point development. The GRADE framework was used to evaluate the quality of evidence and to guide clinical practice points. The review of the literature found sparse quality evidence, and thus the clinical practice points are generally based on the expert consensus of people receiving PD, PD exercise expert clinicians and experienced PD exercise researchers. Clinical practice points address timing of exercise and activity (post-catheter insertion, peritoneal space empty or full), the uptake of specific activities (work, sex, swimming, core exercise), potential adverse outcomes related to activity and exercise (exit site care, perspiration, cardiovascular compromise, fatigue, intra-abdominal pressure), the effect of exercise and activity on conditions of interest (mental health, obesity, frailty, low fitness) and exercise nutrition.
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Affiliation(s)
- Paul N Bennett
- Clinical Health Sciences, University of South Australia, Australia.,Satellite Healthcare, USA
| | - Clara Bohm
- Chronic Disease Innovation Centre, Canada.,University of Manitoba, Canada
| | - Oksana Harasemiw
- Chronic Disease Innovation Centre, Canada.,University of Manitoba, Canada
| | | | | | - Dev Jegatheesan
- Princess Alexandra Hospital, Australia.,The University Queensland, Australia
| | - David W Johnson
- Princess Alexandra Hospital, Australia.,The University Queensland, Australia
| | | | | | | | | | | | | | | | - Brett Tarca
- Clinical Health Sciences, University of South Australia, Australia
| | - Nancy Verdin
- The Global Renal Exercise Network Patient Engagement Council, AB, USA
| | | | - Madeleine Warren
- The Global Renal Exercise Network Patient Engagement Council, AB, USA.,Warren-Charnock Associates, UK
| | | | | | - Philip Kam-Tao Li
- Prince of Wales Hospital, Hong Kong.,Chinese University of Hong Kong
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Duquennoy S, Leduc V, Podevin E. Imaging and leaks in peritoneal dialysis. BULLETIN DE LA DIALYSE À DOMICILE 2021. [DOI: 10.25796/bdd.v4i2.61763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Dialysate leaks are non-rare mechanical but dreaded complications in peritoneal dialysis (PD). They usually occur at the beginning of PD, with various clinical events depending on their location. Use of imaging tests such as computed tomography (CT) peritoneography, or magnetic resonance imaging (MRI) peritoneography, or scintigraphic peritoneography, can confirm the diagnosis and guide surgical intervention if needed. These simple, non-invasive, and accessible tests can be done in collaboration between the radiological et peritoneal teams. Depending on the leakage site, PD can be pursued with small volumes with a cycler. In other cases, it must be interrupted and the patient transferred to hemodialysis, in order to permit the peritoneal cavity to regain its integrity by cicatrization or with surgical intervention. Imaging can help to make sure peritoneal cavity has regained its integrity after this period of transition. Early leaks can be avoided by delaying PD start with by 14 days. Intraperitoneal pressure does not seem to contribute significantly. Prevention of PD leaks essentially depends on individual risk factors such as obesity or anterior abdominal surgeries. This article reviews the characteristics of dialysate leaks in PD and the imagery tests to limit transfer to hemodialysis.
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Weng HY, Ou CH. Retroperitoneoscopic nephroureterectomy and ipsilateral bladder cuff resection in peritoneal dialysis-dependent patients: tips for immediate reinstitution. Int Urol Nephrol 2020; 52:2275-2279. [PMID: 32749553 DOI: 10.1007/s11255-020-02556-1] [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: 05/22/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To maximize the chance of maintaining peritoneal dialysis (PD) after retroperitoneoscopic nephroureterectomy without interruption in PD-dependent patients who were suspected as having upper tract urothelial carcinoma (UTUC). METHODS During 2005-2018 at our hospital, 10 PD-dependent patients who were suspected as having UTUC underwent hand-assisted retroperitoneoscopic nephroureterectomy (HARN) and bladder cuff resection by a single surgeon. The medical record and post-operative outcomes were retrospectively analyzed. Our surgical tips aiming at staying on PD including keeping adequate but relatively lower insufflation pressure during the operation, reducing the negative pressure of the drain tube post-operatively and initiating PD at a low volume with gradual titration, were also presented in the article. RESULTS A total of ten patients were enrolled in our study. The first five patients failed to resume PD and need interim hemodialysis due to various reasons. After some technique modifications, all the following five patients have PD reinstitution immediately after the operation without increasing the incidence of post-operative complications. CONCLUSION Staying on PD wound be beneficial for those ESRD patients who underwent retroperitoneoscopic nephroureterectomy due to UTUC, mainly to avoid hemodynamic interference and possible complications related to hemodialysis during the peri-operative period. However, it remains challenging for surgeons. We concluded the key points to minimize peritoneal violation. By adherence to our tips, retroperitoneoscopic nephroureterectomy should be strongly considered in PD patients with suspicious UTUC if feasible.
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Affiliation(s)
- Han-Yu Weng
- Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 704, Taiwan
| | - Chien-Hui Ou
- Department of Urology, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng Li Road, Tainan, 704, Taiwan.
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Schneditz D, Sauseng N, Pütün E, Rosenkranz AR, Ribitsch W. Supine equilibration of extracellular fluid in peritoneal dialysis varies with intra-abdominal pressure. Perit Dial Int 2020; 40:477-486. [PMID: 32063186 DOI: 10.1177/0896860819895176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Increased intra-abdominal pressure (PIA) leads to venous congestion in splanchnic and adjoining circulations. The aim is to examine whether PIA in peritoneal dialysis (PD) affects the mobilization of extracellular fluid from the lower body in supine body position. METHODS Patients were studied during a regular peritoneal equilibration test (PET) in supine body position using multifrequency bioimpedance analysis to determine extracellular resistance and absolute volume overload (AVO) in wrist-to-ankle (W2A) as well as in ankle-to-ankle (A2A) configurations. Measurements were taken at baseline (T0) after draining the peritoneal cavity, at T1 shortly after filling with 2 L of standard dialysate, and at T2 before taking the 2 h PET samples. PIA was measured from the column height in the PD catheter. Extracellular resistance in the lower extremities (RL) was taken as half of the A2A resistance. RESULTS Eighteen patients (56 ± 15 years, 76 ± 21 kg, body mass index (BMI) 26.4 ± 7 kg/m2, 13 men) were studied. After having assumed a supine body position for the duration of 17, 77, and 155 min, AVO continuously decreased from 1.6 ± 1.3 (T0) to 1.2 ± 1.5 (T1) and 1.0 ± 1.4 L (T2). RL significantly increased from 238 ± 57 (T0) to 254 ± 62 (T1) and 264 ± 67 Ohm (T2). This increase was negatively correlated to BMI and PIA measured at any time point, but not to net ultrafiltration volume. CONCLUSIONS Orthostatic fluid shifts from the lower limbs may take up to 2 h in supine PD patients, especially with high BMI and PIA because of venous congestion in splanchnic and adjoining circulations.
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Affiliation(s)
- Daniel Schneditz
- Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria
| | - Notburga Sauseng
- Division of Physiology, Otto Loewi Research Center, 31475Medical University of Graz, Graz, Austria
| | - Ezgi Pütün
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| | - Alexander R Rosenkranz
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
| | - Werner Ribitsch
- Division of Nephrology, Department of Internal Medicine, 31475Medical University of Graz, Graz, Austria
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