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Chang HH, Chang CH, Hsiao CY, Kao SY, Chen JY, Chen TH, Tsai PJ. Diabetes Is the Most Critical Risk Factor of Adverse Complications After Peritoneal Dialysis Catheter Placement. Front Med (Lausanne) 2021; 8:719345. [PMID: 34778285 PMCID: PMC8578184 DOI: 10.3389/fmed.2021.719345] [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: 06/02/2021] [Accepted: 09/29/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Peritoneal dialysis (PD) is a kind of renal replacement therapy for end-stage renal disease (ESRD). While PD has many advantages, various complications may arise. Methods: This retrospective study analyzed the complications of ESRD patients who received PD catheter implantation in a single medical center within 15 years. Results: This study collected 707 patients. In the first 14 days after PD implantation, 54 patients experienced bleeding complications, while 47 patients experienced wound infection. Among all complications, catheter-related infections were the most common complication 14 days after PD implantation (incidence: 38.8%). A total of 323 patients experienced PD catheter removal, of which 162 patients were due to infection, while 96 were intentional due to kidney transplantation. Excluding those whose catheters were removed due to transplantation, the median survival of the PD catheter was 4.1 years; among them, patients without diabetes mellitus (DM) were 7.4 years and patients with DM were 2.5 years (p < 0.001). Further, 50% probability of surviving was beyond 3.5 years in DM patients with HbA1CC < 7 and 1.6 years in DM patients with HbA1C <7 (p ≥ 0.001). Conclusions: Catheter-related infections were the most common complications following PD catheter implantation. DM, especially with HbA1C ≥7, significantly impacted on the catheter-related infection and the survival probability of the PD catheter.
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Affiliation(s)
- Hsiao-Huang Chang
- Division of Cardiovascular Surgery, Department of Surgery, Veterans General Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Chen-Yuan Hsiao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Biology and Anatomy, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Yi Kao
- Ten-Chan General Hospital Zhongli, Taoyuan, Taiwan
| | - Jinn-Yang Chen
- Division of Nephrology, Department of Medicine, Veterans General Hospital, Taipei, Taiwan
| | - Tien-Hua Chen
- School of Medicine, Institute of Anatomy and Cell Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Surgery, Trauma Center, Veterans General Hospital, Taipei, Taiwan.,Division of General Surgery, Department of Surgery, Veterans General Hospital, Taipei, Taiwan
| | - Pei-Jiun Tsai
- School of Medicine, Institute of Anatomy and Cell Biology, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Surgery, Trauma Center, Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Veterans General Hospital, Taipei, Taiwan
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Dao Bui Quy Q, Pham Ngoc Huy T, Nguyen Minh T, Nguyen Duc L, Nguyen Minh T, Nguyen Trung K, Tran Viet T, Do Q, Le Viet T. High Serum Uric Acid and High-Sensitivity C Reactive Protein Concentrations Predict Three-Year Cardiovascular Mortality in Patients Treated With Continuous Ambulatory Peritoneal Dialysis. Cureus 2021; 13:e17900. [PMID: 34532198 PMCID: PMC8435087 DOI: 10.7759/cureus.17900] [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] [Accepted: 09/11/2021] [Indexed: 12/03/2022] Open
Abstract
AIMS This study aims to access the predicting value of serum uric acid (UA) and high-sensitivity C reactive protein (hs-CRP) concentration on three-year cardiovascular-related mortality in patients performing continuous ambulatory peritoneal dialysis (CAPD). METHODS A total of267 CAPD patients [150 male (56.2%); mean age 48.93 ± 13.58 years] were included in our study. All patients had measured serum UA and hs-CRP concentration. A high-sensitivity particle-enhanced immunoturbidimetric assay determined serum hs-CRP; serum UA levels were determined using an enzymatic colorimetric assay. All patients were followed for three years to detect cardiovascular-related mortality by cardiologists and stroke specialists. RESULTS Mean serum UA level was 415.16 ± 84.28 µmol/L, 58.4% of patients had increased serum UA level. Median serum hs-CRP level was 2 (1-4) mg/L, 12.4% of patients had increased serum hs-CRP level. During 36 months of follow-up, 41 patients (15.4%) had cardiovascular-related mortality. The results of Cox proportional hazards regression showed that hypertension, diabetes, high serum UA and hs-CRP were risk factors that related to cardiovascular-related mortality (p<0.05). The receiver operating characteristic (ROC) curve and Kaplan-Meier analysis results showed that UA and hs-CRP level had predictive value for three-year cardiovascular-related mortality in CAPD patients [uric acid: area under the curve (AUC)=0.822; hs-CRP: AUC=0.834, p < 0.001]. CONCLUSION High serum UA and hs-CRP levels were predictive factors of cardiovascular-related mortality in CAPD patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Quyet Do
- Director, Vietnam Military Medical University, Hanoi, VNM
| | - Thang Le Viet
- Nephrology and Hemodialysis, Military Hospital 103, Hanoi, VNM
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Wan S, Tian H, Cheng L, Ding Y, Luo Q, Zhang Y. Baseline serum triglyceride predicts early-onset peritonitis and prognosis in incident CAPD patients. Medicine (Baltimore) 2021; 100:e23673. [PMID: 33466123 PMCID: PMC7808518 DOI: 10.1097/md.0000000000023673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/12/2020] [Indexed: 01/05/2023] Open
Abstract
We aimed to investigate the hypothesis that serum triglyceride (TG) may be an independent predictor of early-onset peritonitis and prognosis in incident continuous ambulatory peritoneal dialysis (CAPD) patients.In this retrospective, observational study, we screened 291 adults admitted to the PD center of the Wuhan No. 1 hospital from August 1, 2013 to November 31, 2017. All biochemical data were collected at the first 1 to 3 months after the initiation of CAPD. Early-onset peritonitis was defined as peritonitis occurring within 6 months after the initiation of PD. All of PD patients were followed up to July 31, 2018. The primary endpoint was the incidence of early-onset peritonitis while the second endpoints included overall mortality and technical failure.A total of 38 patients occurred early-onset PD peritonitis and the Lasso logistic regression selected TG and age in the final model for early-onset peritonitis. We divided patients into two groups based on the median baseline TG levels: TG ≥ 1.4mmo/L group (n = 143) and TG < 1.4mmol/L group (n = 148). There were 34 (11.7%) patients died and 33 (11.3%) patients transferred to hemodialysis during the follow-up, Moreover, a level of TG ≥ 1.4mmol/L at the initiation of CAPD was associated with a significantly increased probability of technical failure (hazard ratio, HR, 1.30; 95% confidence interval, 95% CI, 1.09 to 2.19, P = .043) and overall mortality (HR, 2.33; 95% CI, 1.16-4.72, P = .018).Serum TG levels measured at the initiation of PD therapy is an independent predictor of early-onset peritonitis and prognosis of CAPD patients.
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Okpechi IG, Ekrikpo U, Moloi MW, Noubiap JJ, Okpechi-Samuel US, Bello AK. Prevalence of peritonitis and mortality in patients with ESKD treated with chronic peritoneal dialysis in Africa: a systematic review. BMJ Open 2020; 10:e039970. [PMID: 33361076 PMCID: PMC7768975 DOI: 10.1136/bmjopen-2020-039970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of this study was to report the prevalence of peritonitis and mortality in patients with end-stage kidney disease (ESKD) treated with chronic peritoneal dialysis (PD) in Africa. DESIGN Systematic review. SETTING Africa. PARTICIPANTS Patients with ESKD in Africa. INTERVENTIONS PD in its varied forms. PRIMARY AND SECONDARY OUTCOMES PD-related peritonitis rate (primary outcome), time-to-discontinuation of PD, mortality. DATA SOURCES Four databases, including PubMed, Embase, Web of Science and Africa Journal Online were systematically searched from 1 January 1980 to 31 December 2019. ELIGIBILITY CRITERIA Studies conducted in Africa reporting peritonitis rate and mortality in patients treated with PD. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and synthesised the data using Microsoft Excel. The quality of included data was also assessed. RESULTS We included 17 studies from seven African countries representing 1894 patients treated with PD. The overall median age was 41.4 years (IQR: 38.2-44.7) with a median time on PD of 18.0 months (17.0-22.6). An overall median peritonitis rate of 0.75 (0.56-2.20) episodes per patient-year (PPY) was observed and had declined with time; peritonitis rate was higher in paediatric studies than adult studies (1.78 (1.26-2.25) vs 0.63 (0.55-1.87) episodes PPY). The overall median proportion of deaths was 21.1% (16.2-25.8). Culture negative peritonitis was common in paediatric studies and studies that reported combined outcomes of continuous ambulatory PD and automated PD. Both 1-year and 2-year technique survival were low in all studies (83.6% and 53.0%, respectively) and were responsible for a high proportion of modality switch. CONCLUSIONS Our study identifies that there is still high but declining peritonitis rates as well as low technique and patient survival in PD studies conducted in Africa. Sustained efforts should continue to mitigate factors associated with peritonitis in patients with ESKD treated with PD in Africa. PROSPERO REGISTRATION NUMBER CRD42017072966.
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Affiliation(s)
- Ikechi G Okpechi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, Nigeria
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Udeme Ekrikpo
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Uyo, Uyo, Nigeria
| | - Mothusi W Moloi
- Division of Nephrology and Hypertension, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Botswana, Gaborone, Botswana
| | - Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | | | - Aminu K Bello
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Auguste BL, Girsberger M, Kennedy C, Srithongkul T, McGrath-Chong M, Bargman J, Chan CT. Are adverse events in newly trained home dialysis patients related to learning styles? A single-centre retrospective study from Toronto, Canada. BMJ Open 2020; 10:e033315. [PMID: 31964671 PMCID: PMC7045245 DOI: 10.1136/bmjopen-2019-033315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Home haemodialysis (HD) and peritoneal dialysis (PD) have seen growth in utilisation around the globe over the last few years. However, home dialysis, with its attendant technical complexity and risk of adverse events continues to pose challenges for wider adoption. We examined whether differences in patients' learning styles are associated with differing risk of adverse events in both home HD and PD patients. DESIGN Retrospective cohort study. SETTING Tertiary care hospital in Toronto, Ontario, Canada. PARTICIPANTS One hundred and eighteen prevalent adult (≥18 years) home dialysis patients (40 PD and 78 home HD) were enrolled. Patients on home dialysis for less than 6 months or receiving home nursing assistance for dialysis were excluded from the study. INTERVENTIONS Enrolled patients completed (VARK) Visual, Aural, Reading-writing and Kinesthetic questionnaires to determine learning styles. PRIMARY AND SECONDARY OUTCOME MEASURES Home HD and PD adverse events were identified within 6 months of completing home dialysis training. Event rates were then stratified and compared according to learning styles. RESULTS Thirty patients had a total of 53 adverse events. We used logistic regression analysis to determine unadjusted and adjusted ORs for a single adverse event. Non-visual learners were 4.35 times more likely to have an adverse event (p=0.001). After adjusting for age, gender, dialysis modality, training duration, dialysis vintage, prior renal replacement therapy, visual impairment, education and literacy, an adverse event was still four times more likely among non-visual learners compared to visual learners (p=0.008). A subgroup analysis of home HD patients showed adverse events were more likely among non-visual learners (OR 11.1; p=0.003), whereas PD patients showed a trend for more adverse events in non-visual learners (OR: 1.60; p=0.694). CONCLUSIONS Different learning styles in home dialysis patients exist. Visual learning styles are associated with fewer adverse events in home dialysis patients within the first 6 months of completing training. Individualisation of home dialysis training by learning style is warranted.
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Affiliation(s)
- Bourne Lewis Auguste
- Medicine; Division of Nephrology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Michael Girsberger
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Claire Kennedy
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | | | | | - Joanne Bargman
- Medicine; Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Christopher T Chan
- Medicine; Division of Nephrology, University Health Network, Toronto, Ontario, Canada
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