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Danneville I, Beaumier M, Boyer A, Chatelet V, Monnet E, Edet S, Lanot A, Bechade C, Lobbedez T. Sex disparities in the utilization of nurse-assisted peritoneal dialysis: a mediation analysis using data from the REIN registry. Clin Kidney J 2024; 17:sfad301. [PMID: 38213499 PMCID: PMC10783235 DOI: 10.1093/ckj/sfad301] [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: 08/10/2023] [Indexed: 01/13/2024] Open
Abstract
Background This study was carried out to evaluate the association between patient sex and the proportion of nurse-assisted peritoneal dialysis (PD) at dialysis initiation and to explore whether sex disparities in nurse-assisted PD utilization was explained by predialysis care and/or by social deprivation using mediation analysis. Methods This was a retrospective study using data from the Renal Epidemiology and Information Network (REIN) registry linked to the French National Healthcare Database (SNDS) of incident patients between 1 January 2017 and 30 June 2018. A regression logistic was used for statistical analysis. A mediation analysis explored the direct effect of sex on nurse-assisted PD proportion and the indirect effect through the European Deprivation Index (EDI), and the number of general practitioner (GP) and nephrologist visits before dialysis initiation. Results Among 1706 patients on PD, there were 637 women (37.3%) and 1069 men (62.7%). Nurse-assisted PD proportion was 332/610 (54.4%) for women vs 464/1036 (44.8%) for men. In the multivariable analysis women were more likely to be treated by nurse-assisted PD {odds ratio (OR) 1.92 [95% confidence interval (CI) 1.46-2.52]}. Nurse-assisted PD was associated with the median number of GP visits [OR 1.44 (95% CI 1.11-1.86)] and with the median number of nephrologist visits [OR 0.59 (95% CI 0.46-0.76)]. The mediation analysis showed a direct effect of sex on nurse-assisted PD [OR 1.90 (95% CI 1.80-2.01)] and an indirect effect through the median number of GP visits [OR 1.05 (95% CI 1.04-1.06], the median number of nephrologist visits [OR 1.02 (95% CI 1.02-1.03)] and quintile 5 of the EDI [OR 1.03 (95% CI 1.02-1.03)]. Conclusion Women were more frequently treated by nurse-assisted PD than men. Differences between women and men in predialysis care and social deprivation could explain the greater utilization of nurse-assisted PD among women.
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Affiliation(s)
- Isabelle Danneville
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
| | - Mathilde Beaumier
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Annabel Boyer
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Valérie Chatelet
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Elisabeth Monnet
- CIC-1431 INSERM, CHU Besançon, Université de Franche-Comté, Besançon Cedex, France
| | - Stéphane Edet
- Department of Nephrology and Haemodialysis, Rouen University Hospital, France – ANIDER Rouen Normandie, Rouen, France
| | - Antoine Lanot
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Clémence Bechade
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
| | - Thierry Lobbedez
- CHU de Caen Normandie, Centre Universitaire des Maladies Rénales, Caen, France
- Normandie Université, UNICAEN, UFR de Médecine, Caen, France
- «ANTICIPE», U1086 Inserm-UCN, Centre de Lutte Contre le Cancer François Baclesse, Caen, France
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Baralić M, Pažitná L, Brković V, Laušević M, Gligorijević N, Katrlík J, Nedić O, Robajac D. Prediction of Mortality in Patients on Peritoneal Dialysis Based on the Fibrinogen Mannosylation. Cells 2023; 12:cells12030351. [PMID: 36766693 PMCID: PMC9913213 DOI: 10.3390/cells12030351] [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: 11/17/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
As we already reported, fibrinogen fucosylation emerged as a prognostic marker of peritoneal membrane function in end-stage renal disease (ESRD) patients on peritoneal dialysis. After a follow-up period of 18 months, we estimated the ability of employed lectins, as well as other biochemical parameters, to serve as mortality predictors in these patients. Following a univariate Cox regression analysis, ferritin, urea clearance, residual diuresis, hyperglycemia, and an increase in the signal intensity obtained with Galanthus nivalis lectin (GNL) emerged as potential mortality predictors, but additional multivariate Cox regression analysis pointed only to glucose concentration and GNL as mortality predictors. Higher signal intensity obtained with GNL in patients that died suggested the importance of paucimannosidic/highly mannosidic N-glycan structures on fibrinogen as factors that are related to unwanted cardiovascular events and all-cause mortality and can possibly be seen as a prediction tool. Altered glycan structures composed of mannose residues are expected to affect the reactivity of mannosylated glycoproteins with mannose-binding lectin and possibly the entire cascade of events linked to this lectin. Since patients with ESRD are prone to cardiovascular complications and the formation of atherosclerotic plaques, one can hypothesize that fibrinogen with increasingly exposed mannose residues may contribute to the unwanted events.
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Affiliation(s)
- Marko Baralić
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Lucia Pažitná
- Institute of Chemistry, Slovak Academy of Sciences, 84538 Bratislava, Slovakia
| | - Voin Brković
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Mirjana Laušević
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Nikola Gligorijević
- Institute for the Application of Nuclear Energy (INEP), University of Belgrade, 11080 Belgrade, Serbia
| | - Jaroslav Katrlík
- Institute of Chemistry, Slovak Academy of Sciences, 84538 Bratislava, Slovakia
| | - Olgica Nedić
- Institute for the Application of Nuclear Energy (INEP), University of Belgrade, 11080 Belgrade, Serbia
| | - Dragana Robajac
- Institute for the Application of Nuclear Energy (INEP), University of Belgrade, 11080 Belgrade, Serbia
- Correspondence:
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Is the measurement of tissue advanced glycosylation products by skin autofluorescence associated with mortality in patients treated by peritoneal dialysis? J Nephrol 2023; 36:217-224. [PMID: 35980536 PMCID: PMC9895012 DOI: 10.1007/s40620-022-01415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND Advanced glycosylated end-products (AGEs) have been shown to cause cardiovascular disease, and tissue AGE accumulation can be measured by skin autofluorescence (SAF). AGEs are cleared by the kidney, and thus accumulate in dialysis patients. However, as the results of SAF measurements in peritoneal dialysis patients (PD) have been ambiguous, we examined the association between mortality and SAF. METHODS We reviewed SAF measurements in PD patients attending a university associated PD program, along with standard measurements of dialysis adequacy and peritoneal membrane function. RESULTS We studied 341 prevalent PD patients, 61.9% male, mean age 61.2 ± 16 years, and 31.4% of all patients died during a median follow-up of 27.2 (23.3-36.3) months. Patients who died were older, mean age 72 ± 10.5 years, were more often diabetic (60.7%), and had higher median SAF 3.8 (3.2-4.5) AU. On logistic regression, mortality was independently associated with age (odds ratio (OR) 1.1 (95% confidence limits 1.06-1.16), diabetes OR 10.1 (3.1-33.4), SAF OR 3.3 (1.8-6.2), all p < 0.001, and male gender OR 5.2 (1.6-17.4), p = 0.007; and negatively associated with weight OR 0.91 (0.86-0.95), p < 0..001, normalised nitrogen appearance rate (nPNA) OR 0.05 (0.01-0.4), p = 0.005 and mean arterial blood pressure (MAP) OR 0.96 (0.93-0.96), p = 0.03. CONCLUSIONS In this observational study, SAF was independently associated with mortality. However, other factors were also associated with mortality, including age, diabetes and malnutrition which have all been reported to affect SAF measurements. Thus, the additional predictive value of measuring SAF compared to standard risk factors for mortality remains to be determined.
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Abstract
Peritoneal dialysis (PD) is an important home-based treatment for kidney failure and accounts for 11% of all dialysis and 9% of all kidney replacement therapy globally. Although PD is available in 81% of countries, this provision ranges from 96% in high-income countries to 32% in low-income countries. Compared with haemodialysis, PD has numerous potential advantages, including a simpler technique, greater feasibility of use in remote communities, generally lower cost, lesser need for trained staff, fewer management challenges during natural disasters, possibly better survival in the first few years, greater ability to travel, fewer dietary restrictions, better preservation of residual kidney function, greater treatment satisfaction, better quality of life, better outcomes following subsequent kidney transplantation, delayed need for vascular access (especially in small children), reduced need for erythropoiesis-stimulating agents, and lower risk of blood-borne virus infections and of SARS-CoV-2 infection. PD outcomes have been improving over time but with great variability, driven by individual and system-level inequities and by centre effects; this variation is exacerbated by a lack of standardized outcome definitions. Potential strategies for outcome improvement include enhanced standardization, monitoring and reporting of PD outcomes, and the implementation of continuous quality improvement programmes and of PD-specific interventions, such as incremental PD, the use of biocompatible PD solutions and remote PD monitoring. The use of peritoneal dialysis (PD) can be advantageous compared with haemodialysis treatment, although several barriers limit its broad implementation. This review examines the epidemiology of peritoneal dialysis (PD) outcomes, including clinical, patient-reported and surrogate PD outcomes. Peritoneal dialysis (PD) has distinct advantages compared with haemodialysis, including the convenience of home treatment, improved quality of life, technical simplicity, lesser need for trained staff, greater cost-effectiveness in most countries, improved equity of access to dialysis in resource-limited settings, and improved survival, particularly in the first few years of initiating therapy. Important barriers can hamper PD utilization in low-income settings, including the high costs of PD fluids (owing to the inability to manufacture them locally and the exorbitant costs of their import), limited workforce availability and a practice culture that limits optimal PD use, often leading to suboptimal outcomes. PD outcomes are highly variable around the world owing in part to the use of variable outcome definitions, a heterogeneous practice culture, the lack of standardized monitoring and reporting of quality indicators, and kidney failure care gaps (including health care workforce shortages, inadequate health care financing, suboptimal governance and a lack of good health care information systems). Key outcomes include not only clinical outcomes (typically defined as medical outcomes based on clinician assessment or diagnosis) — for example, PD-related infections, technique survival, mechanical complications, hospitalizations and PD-related mortality — but also patient-reported outcomes. These outcomes are directly reported by patients and focus on how they function or feel, typically in relation to quality of life or symptoms; patient-reported outcomes are used less frequently than clinical outcomes in day-to-day routine care.
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Liu S, Zhang L, Ma S, Xiao J, Liu D, Ding R, Li Z, Zhao Z. Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients. Ren Fail 2022; 44:482-489. [PMID: 35285393 PMCID: PMC8928818 DOI: 10.1080/0886022x.2022.2048854] [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: 11/13/2022] Open
Abstract
Background The urea clearance index (Kt/V) is an important index for predicting the clinical outcome of peritoneal dialysis (PD) patients, but it changes with time depending on the clinical condition. This study aimed to investigate the association between the Kt/V reach rate (defined as the percentage of Kt/V measurements that reached ≥ 1.70) and clinical outcome in incident PD patients. Methods In this retrospective cohort study, 210 patients were enrolled from the First Affiliated Hospital of Zhengzhou University from 1 January 2013 to 31 October 2019. The target Kt/V reach rate in the first year was applied as the predictor variable. Kaplan-Meier survival curves were drawn to evaluate differences in prognosis. The association between Kt/V reach rate and the composite clinical outcome (death or transfer to hemodialysis) was tested by Cox regression analysis. Results The dialysis adequacy group (Kt/V reach rate 3/3 times) and the dialysis intermittent adequacy group (1/3 or 2/3 times) had significantly better clinical outcomes than the dialysis inadequacy group (0/3 times). There was no difference in clinical outcome between the lower-rate group (reach rate 1/3 times) and the higher-rate group (2/3 times). Compared with the dialysis inadequacy group, the dialysis intermittent adequacy group and dialysis adequacy group had significantly lower risks of the composite outcome (HR 0.487, 95% CI 0.244–0.971, p = 0.041; HR 0.150, 95% CI 0.043–0.520, p = 0.003) in the fully adjusted analysis. Conclusion Higher Kt/V reach rates are associated with a better prognosis in incident PD patients.
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Affiliation(s)
- Shuang Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijie Zhang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuang Ma
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Rui Ding
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Danneville I, Beaumier M, Chatelet V, Boyer A, Lanot A, Bechade C, Lobbedez T. Are sex differences in the outcome of peritoneal dialysis explained by nurse-assistance? A cohort study with data from the RDPLF. Nephrol Dial Transplant 2021; 37:1520-1528. [PMID: 34893901 DOI: 10.1093/ndt/gfab354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We aimed to evaluate sex differences in peritoneal dialysis (PD) outcomes and to explore direct and indirect effects of nurse-assisted PD on outcomes. METHODS This was a retrospective study using data from the French Language Peritoneal Dialysis Registry of incident PD patients between 2005 and 2016. Cox proportional hazard modelling was used to analyse transfer to haemodialysis (HD), death, PD failure, peritonitis and renal transplantation. Mediation analyses with a counterfactual approach were carried out to evaluate natural direct and indirect effects of sex on transfer to HD and peritonitis, with nurse-assisted PD as a mediator a priori. RESULTS Of the 14659 patients included, they were 5970 females (41%) and 8689 males (59%). Women were more frequently treated by nurse-assisted PD than men ((2926/5970 (49.1%) vs. 3357/8689 (38.7%)). In the multivariable analysis, women had a lower risk of transfer to HD (cause-specific hazard ratio(cs-HR): 0.82[95% confidence interval(CI): 0.77-0.88]), death (cs-HR: 0.90[95%CI: 0.85-0.95]), peritonitis (cs-HR: 0.82[95%CI: 0.78-0.87]), PD failure (cs-HR: 0.86[95%CI: 0.83-0.90]) and a lower chance of undergoing transplant (cs-HR: 0.83[95%CI: 0.77-0.90]) than men. There was a direct effect of sex on the risk of transfer to HD (cs-HR: 0.82[95%CI: 0.82-0.83]) with an indirect effect of nurse-assisted PD (cs-HR: 0.97[95%CI: 0.96-0.99]). Nurse-assisted PD had no indirect effect on the risk of peritonitis. CONCLUSIONS Our results suggest that compared with men, women have both a lower risk of transfer to HD and peritonitis. Mediation analysis showed that nurse assistance was a potential mediator in the causal pathway between sex and transfer to HD.
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Affiliation(s)
- Isabelle Danneville
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France
| | - Mathilde Beaumier
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France.,UNICAEN, UFR de Médecine, Normandie Université, Caen, France.,Centre de Lutte Contre le Cancer François Baclesse, « ANTICIPE », U1086 Inserm-UCN, 3, Avenue du Général Harris, Caen, France
| | - Valérie Chatelet
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France.,UNICAEN, UFR de Médecine, Normandie Université, Caen, France.,Centre de Lutte Contre le Cancer François Baclesse, « ANTICIPE », U1086 Inserm-UCN, 3, Avenue du Général Harris, Caen, France
| | - Annabel Boyer
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France.,UNICAEN, UFR de Médecine, Normandie Université, Caen, France.,Centre de Lutte Contre le Cancer François Baclesse, « ANTICIPE », U1086 Inserm-UCN, 3, Avenue du Général Harris, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France.,UNICAEN, UFR de Médecine, Normandie Université, Caen, France.,Centre de Lutte Contre le Cancer François Baclesse, « ANTICIPE », U1086 Inserm-UCN, 3, Avenue du Général Harris, Caen, France
| | - Clémence Bechade
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France.,UNICAEN, UFR de Médecine, Normandie Université, Caen, France.,Centre de Lutte Contre le Cancer François Baclesse, « ANTICIPE », U1086 Inserm-UCN, 3, Avenue du Général Harris, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, UNICAEN, CHU de Caen Normandie, Normandie Univ, 14000 CAEN, France.,UNICAEN, UFR de Médecine, Normandie Université, Caen, France.,Centre de Lutte Contre le Cancer François Baclesse, « ANTICIPE », U1086 Inserm-UCN, 3, Avenue du Général Harris, Caen, France
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Sutherland TE, Shaw TN, Lennon R, Herrick SE, Rückerl D. Ongoing Exposure to Peritoneal Dialysis Fluid Alters Resident Peritoneal Macrophage Phenotype and Activation Propensity. Front Immunol 2021; 12:715209. [PMID: 34386014 PMCID: PMC8353194 DOI: 10.3389/fimmu.2021.715209] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/09/2021] [Indexed: 01/22/2023] Open
Abstract
Peritoneal dialysis (PD) is a more continuous alternative to haemodialysis, for patients with chronic kidney disease, with considerable initial benefits for survival, patient independence and healthcare costs. However, long-term PD is associated with significant pathology, negating the positive effects over haemodialysis. Importantly, peritonitis and activation of macrophages is closely associated with disease progression and treatment failure. However, recent advances in macrophage biology suggest opposite functions for macrophages of different cellular origins. While monocyte-derived macrophages promote disease progression in some models of fibrosis, tissue resident macrophages have rather been associated with protective roles. Thus, we aimed to identify the relative contribution of tissue resident macrophages to PD induced inflammation in mice. Unexpectedly, we found an incremental loss of homeostatic characteristics, anti-inflammatory and efferocytic functionality in peritoneal resident macrophages, accompanied by enhanced inflammatory responses to external stimuli. Moreover, presence of glucose degradation products within the dialysis fluid led to markedly enhanced inflammation and almost complete disappearance of tissue resident cells. Thus, alterations in tissue resident macrophages may render long-term PD patients sensitive to developing peritonitis and consequently fibrosis/sclerosis.
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Affiliation(s)
- Tara E. Sutherland
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Manchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, United Kingdom
- Wellcome Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom
| | - Tovah N. Shaw
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Manchester Collaborative Centre for Inflammation Research (MCCIR), University of Manchester, Manchester, United Kingdom
- Institute of Immunology and Infection Research, School of Biological Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Rachel Lennon
- Wellcome Centre for Cell-Matrix Research, University of Manchester, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Sarah E. Herrick
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
- Division of Cell Matrix Biology and Regenerative Medicine, Faculty of Biology Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Dominik Rückerl
- Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, United Kingdom
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Sudrajat A, Yetti K, Waluyo A. The effect of the range of motion exercises combined with tai chi intradialysis on the adequacy of hemodialysis in patients at lebak district hospital. ENFERMERIA CLINICA 2021. [PMID: 33849142 DOI: 10.1016/j.enfcli.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
End-stage renal disease (ESRD) has become a global problem. ESRD occurs due to kidney disorders in filtering blood, thus requiring hemodialysis. This study aims to determine the effect of the range of motion (ROM) and Tai Chi intradialysis on the adequacy of hemodialysis undergone by ESRD patients. The design of this study included a quasi-experiment with a pretest-posttest control group approach. The sample selection was performed using a consecutive sampling technique and involved 64 respondents. The results showed that there were differences in adequacy before and after the intervention. Wilcoxon test (p=0.005) showed that there was a significant effect on adequacy before and after ROM and Tai Chi interventions (1.67-1.73). The control and intervention groups were found to have a significant difference (p=0.045). In conclusion, ROM and Tai Chi intradialysis exercises were more effective in increasing the adequacy of hemodialysis undergone by ESRD patients.
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Affiliation(s)
- Andi Sudrajat
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
| | - Krisna Yetti
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia.
| | - Agung Waluyo
- Faculty of Nursing Universitas Indonesia, Depok, West Java, Indonesia
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Li L, Pei H, Liu Z, Zhang J. Analysis of risk factors and construction of prediction model of drop out from peritoneal dialysis. Medicine (Baltimore) 2021; 100:e24195. [PMID: 33546035 PMCID: PMC7837897 DOI: 10.1097/md.0000000000024195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/15/2020] [Indexed: 12/05/2022] Open
Abstract
This study is to investigate the risk factors for the drop out from peritoneal dialysis.We retrospectively analyzed patients who underwent catheterization between January 1, 2009 and September 30, 2019. The follow-up period ended on November 30, 2019. End point events were the cessation of peritoneal dialysis, including death, conversion to hemodialysis, and kidney transplantation. Kaplan-Meier method was used to analyze peritoneal dialysis curve. Significant factors were included in the multivariate Cox proportional hazards model. Calibration curve was plotted.A total of 377 patients were included in this study. The dropout rate of peritoneal dialysis was 41.38%. The main drop out reason was conversion to hemodialysis, accounting for 41.67% of the total number of drop out, followed by kidney transplantation (28.21%) and death (25%). According to multivariable Cox proportional hazards model analysis, the medium education level (hazard ratio (HR): 2.53, 95% confidence interval (CI): 1.08-5.91, P = .03), high education level (HR: 2.47, 95% CI: 1.03-5.93, P = .04), diabetes (HR: 1.87, 95% CI: 1.24-2.83, P < .03), hypertension (HR: 2.40, 95% CI: 1.64-3.51, P < .01), repeated peritonitis (HR: 5.18, 95% CI: 3.04-8.80, P < .01), and repeated chest complications (HR: 4.98, 95% CI: 2.79-8.89, P < .01) were independent risk factors for dropping out from peritoneal dialysis, while the number of hospitalizations after catheterization (HR: 0.94, 95% CI: 0.89-0.98, P = .01) was protective factor for maintenance of peritoneal dialysis. The C index of the prediction model was 0.74.Higher education level, diabetes, hypertension, repeated peritonitis, and repeated chest complications were the risk factors of dropping out from peritoneal dialysis, while higher number of hospitalizations after catheterization was a protective factor for the maintenance of peritoneal dialysis. The nomogram could predict the probability of dropping out from peritoneal dialysis.
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Affiliation(s)
- Li Li
- Department of Nephrology
- Department of Urological Surgery, First Affiliated Hospital of Xinjiang Medical University
| | - Hualian Pei
- RICU of First Affiliated Hospital of Xinjiang Medical University
| | - Zhenhui Liu
- Department of Microrepair and Reconstruction, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Zhang S, Cao J, Zhang X, Qiao Z, Xie Y. Relationship between serum cystatin C and prognosis of nondiabetic peritoneal dialysis patients. Ther Apher Dial 2020; 24:703-708. [PMID: 31989792 DOI: 10.1111/1744-9987.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 11/30/2022]
Abstract
We investigated whether serum cystatin C predicted treatment failure and mortality in nondiabetic peritoneal dialysis (PD) patients. We studied 163 new-onset, nondiabetic PD patients between January 2010 and January 2019. Patients were followed up until death or 1 July 2019. Serum cystatin C was measured within 1 week before PD. Basic demographic and laboratory test data were collected. Patients were divided into low (<5.54 mg/L) and high (≥5.54 mg/L) serum cystatin C groups. The Kaplan-Meier method and log-rank test showed that the technical survival rate of the low cystatin C group was higher than that of the high cystatin C group. There was no difference in overall survival between the two groups. Multivariate Cox model showed that serum cystatin C was an independent risk factor for PD failure. Serum cystatin C could predict PD failure but was not associated with mortality in nondiabetic PD patients.
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Affiliation(s)
- Suojian Zhang
- Department of Geriatrics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Juan Cao
- Department of Nephrology, The First People's Hospital of Taixing District, Taizhou, China
| | - Xu Zhang
- Department of Nephrology, The First People's Hospital of Taixing District, Taizhou, China
| | - Zhenguo Qiao
- Department of Gastroenterology, The First People's Hospital of Wujiang District, Suzhou, China
| | - Yan Xie
- Department of Geriatrics, The First Affiliated Hospital of Soochow University, Suzhou, China
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11
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Koniman R, Foo MWY, Johnson DW, Wu SY, Hao Y, Jayaballa M, Phang CC, Oei EL, Htay H. Early technique failure in peritoneal dialysis patients in a multi-ethnic Asian country. Int Urol Nephrol 2020; 52:1987-1994. [PMID: 32729098 DOI: 10.1007/s11255-020-02570-3] [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] [Received: 04/12/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Early technique failure is a serious complication for peritoneal dialysis (PD) patients. The study aimed to examine the incidence, causes, and risk factors associated with early technique failure. METHODS: This retrospective study included all incident PD patients in a hospital in Singapore from 2013 to 2017. The primary outcome was early technique failure, which was defined as transfer to hemodialysis for ≥ 30 days or death, within the first year of PD initiation. Secondary outcomes were death, technique failure due to PD infection, and death-censored technique failure. RESULTS Overall, 517 patients were included in the study. Of these, 98 patients (19.0%) developed early technique failure. The common causes of early technique failure were death (41.8%) and infection (40.8%). Peripheral vascular disease was significantly associated with a higher hazard of early technique failure [hazard ratio (HR) 1.95, 95% confidence interval (CI) 1.04-3.63] and death (HR 3.75, 95% CI 1.71-8.21), whilst glomerulonephritis as a cause of end-stage kidney disease (compared with hypertension) was associated with a lower hazard of early technique failure (HR 0.38, 95% CI 0.18-0.77) and death (HR 0.08, 95% CI 0.02-0.37). Male gender was associated with early technique failure due to PD infection (HR 2.55, 95% CI 1.32-4.95). No specific factor was associated with death-censored early technique failure. CONCLUSION Technique failure in the first year of PD initiation occurs in one-fifth of PD patients and is associated with peripheral vascular disease and cause of end-stage kidney disease.
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Affiliation(s)
- Riece Koniman
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Brisbane, Australia
| | - Sin Yan Wu
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Ying Hao
- Singapore Health Services, Health Services Research Centre (HSRC), Singapore, Singapore
| | - Mathini Jayaballa
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Chee Chin Phang
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Htay Htay
- Department of Renal Medicine, Academia, Singapore General Hospital, Level 3, 20 College Road, Singapore, 169856, Singapore.
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12
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van Daal M, Muntinga ME, Steffens S, Halsema A, Verdonk P. Sex and Gender Bias in Kidney Transplantation: 3D Bioprinting as a Challenge to Personalized Medicine. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2020; 1:218-223. [PMID: 33786482 PMCID: PMC7784814 DOI: 10.1089/whr.2020.0047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/26/2020] [Indexed: 12/17/2022]
Abstract
In this article, we explore to what extent sex and gender differences may be reproduced in the 3D bioprinting of kidneys. Sex and gender differences have been observed in kidney function, anatomy, and physiology, and play a role in kidney donation and transplantation through differences in kidney size (sex aspect) and altruism (gender aspect). As a form of personalized medicine, 3D bioprinting might be expected to eliminate sex and gender bias. On the basis of an analysis of recent literature, we conclude that personalized techniques such as 3D bioprinting of kidneys alone do not mean that sex and gender bias does not happen. Therefore, sex and gender considerations should be included into every step of developing and using 3D-bioprinted kidneys: in the choice of design, cells, biomaterials, and X-chromosome-activated cells.
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Affiliation(s)
- Manon van Daal
- Department Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Maaike E. Muntinga
- Department Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
| | - Sandra Steffens
- Department of Curriculum Development, Hannover Medical School, Hannover, Germany
| | - Annemie Halsema
- Faculty of Humanities/Philosophy, Amsterdam VU, Amsterdam, The Netherlands
| | - Petra Verdonk
- Department Medical Humanities, Amsterdam Public Health Research Institute, Amsterdam UMC-VUmc, Amsterdam, The Netherlands
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13
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Tsujikawa H, Tanaka S, Matsukuma Y, Kanai H, Torisu K, Nakano T, Tsuruya K, Kitazono T. Development of a risk prediction model for infection-related mortality in patients undergoing peritoneal dialysis. PLoS One 2019; 14:e0213922. [PMID: 30893369 PMCID: PMC6426225 DOI: 10.1371/journal.pone.0213922] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/04/2019] [Indexed: 02/07/2023] Open
Abstract
Background Assessment of infection-related mortality remains inadequate in patients undergoing peritoneal dialysis. This study was performed to develop a risk model for predicting the 2-year infection-related mortality risk in patients undergoing peritoneal dialysis. Methods The study cohort comprised 606 patients who started and continued peritoneal dialysis for 90 at least days and was drawn from the Fukuoka Peritoneal Dialysis Database Registry Study in Japan. The patients were registered from 1 January 2006 to 31 December 2016 and followed up until 31 December 2017. To generate a prediction rule, the score for each variable was weighted by the regression coefficients calculated using a Cox proportional hazard model adjusted by risk factors for infection-related mortality, including patient characteristics, comorbidities, and laboratory data. Results During the follow-up period (median, 2.2 years), 138 patients died; 58 of them of infectious disease. The final model for infection-related mortality comprises six factors: age, sex, serum albumin, serum creatinine, total cholesterol, and weekly renal Kt/V. The incidence of infection-related mortality increased linearly with increasing total risk score (P for trend <0.001). Furthermore, the prediction model showed adequate discrimination (c-statistic = 0.79 [0.72–0.86]) and calibration (Hosmer–Lemeshow test, P = 0.47). Conclusion In this study, we developed a new model using clinical measures for predicting infection-related mortality in patients undergoing peritoneal dialysis.
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Affiliation(s)
- Hiroaki Tsujikawa
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
| | | | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
| | | | - Kumiko Torisu
- Department of Integrated Therapy for Chronic Kidney Disease, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
- * E-mail:
| | - Kazuhiko Tsuruya
- Department of Integrated Therapy for Chronic Kidney Disease, Kyushu University, Fukuoka, Japan
- Department of Nephrology, Nara Medical University, Nara, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Kyushu University, Fukuoka, Japan
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14
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Jiang J, Wang LH, Fei YY, Zhou XW, Peng L, Lan L, Ren W. Serum Albumin at Start of Peritoneal Dialysis Predicts Long-Term Outcomes in Anhui Han Patients on Continuous Ambulatory Peritoneal Dialysis: A Retrospective Cohort Study. KIDNEY DISEASES 2018; 4:262-268. [PMID: 30574503 DOI: 10.1159/000492426] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 07/25/2018] [Indexed: 12/14/2022]
Abstract
Objective This study assessed the relationship between serum albumin (ALB) at start of peritoneal dialysis (PD) and long-term outcomes of continuous ambulatory PD (CAPD) in Anhui Han patients. Methods A total of 149 Anhui Han CAPD patients were enrolled in this study and followed up for 3 years. They were initially diagnosed with the end-stage renal disease and underwent surgical PD catheter placement from January 2009 to December 2013. According to serum ALB at start of PD, the patients were divided into two groups: low ALB group (ALB < 35 g/L) and high ALB group (ALB ≥35 g/L). Demographic, hematologic, biochemical, and dialysis-related data were collected. Kaplan-Meier survival analysis and log-rank test were conducted to compare patient mortality, cardiovascular mortality and technique failure between the low ALB group and the high ALB group. Cox regression analysis was performed to analyze the risk factors, calculate the hazard ratio (HR), adjusted HR (AHR) and 95% confidence interval (CI). Results The low ALB group showed a greater number of diabetes mellitus compared with the high ALB group. Patient mortality, cardiovascular mortality, and technique failure in the high ALB group were significantly lower than those in the low ALB group. In Cox regression analysis, serum ALB < 35 g/L was an independent predictor of patient mortality (AHR 3.043, 95% CI 1.085-8.536, p = 0.034), cardiovascular mortality (AHR 11.587, 95% CI 1.466-91.574, p = 0.020), and technique failure (AHR 3.148, 95% CI 1.603-6.182, p = 0.001) in CAPD patients after adjustment for sex, age, estimated glomerular filtration rate, primary renal disease, diabetes mellitus, and cardiovascular disease. Conclusions In Anhui Han patients on CAPD, the levels of serum ALB at start of PD are inversely correlated with patient mortality, cardiovascular mortality, and technique failure, and the long-term outcomes of patients with hypoalbuminemia at start of PD are poor. To improve the long-term outcomes of Anhui Han CAPD patients, patients with hypoalbuminemia at start of PD should be closely monitored.
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Affiliation(s)
- Jun Jiang
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li-Hua Wang
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Yun-Yun Fei
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Xiao-Wan Zhou
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Li Peng
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Lei Lan
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
| | - Wei Ren
- Department of Nephrology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
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15
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Fang P, Lu J, Liu YH, Deng HM, Zhang L, Zhang HQ. Benefit of an operating vehicle preventing peritonitis in peritoneal dialysis patients: a retrospective, case-controlled study. Int Urol Nephrol 2018; 50:1163-1170. [PMID: 29508173 DOI: 10.1007/s11255-018-1823-z] [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: 10/25/2017] [Accepted: 02/10/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Peritonitis, which is one of the leading complications of peritoneal dialysis (PD) worldwide, severely affected morbidity and mortality of the PD patients. Although many efforts have been made to prevent PD-related peritonitis, it seems impossible to prevent it completely. Many causes have been reported to lead to peritonitis, and contamination during bag exchange is one of the important risk factors for peritonitis. METHODS Here, we introduce an operating vehicle, which we invented to provide a sterile and safe space for bag exchange. A single-center, retrospective, case-control study was undertaken to determine whether this operating vehicle has a protective role in preventing peritonitis. In total, 462 continuous ambulatory peritoneal dialysis patients were included in this study from October 2014 to March 2017. According to their personal will, these patients chose to use operating vehicle or traditional method during their bag exchange. The demographic, clinical and laboratory data of these patients in the two groups were collected, analyzed and compared. RESULTS Of 462 patients with home dialysis, operating vehicle group consisted of 61 patients, and control group consisted of 401 patients. In the control group, over 677 patient-years, peritonitis occurred in 69 of 401 patients (17.2%), while in the operating vehicle group, over 60 patient-years, only 4 of 61 patients (6.6%) had episodes of peritonitis. The number of patients suffered from peritonitis was significantly decreased in the operating vehicle group (P = 0.034). Besides, there were a total of 99 episodes of peritonitis, and the rate was 1 episode every 7.2 patient-years in control group and 1 episode every 12 patient-years in the operating vehicle group. There was significant difference between the two groups (0.013). Positive dialysate cultures were obtained in majority of the peritonitis episodes (60.6%). CONCLUSION Operating vehicle might help to reduce PD-related peritonitis by preventing contamination during bag exchange. Further studies are still needed to demonstrate the protective role of the operating vehicle in preventing peritonitis.
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Affiliation(s)
- Pan Fang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Jia Lu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Ying-Hong Liu
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Hong-Mei Deng
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Lei Zhang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China.,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China
| | - Hong-Qing Zhang
- Department of Nephrology, The Second Xiangya Hospital, Central South University, 139 Renmin Road, Changsha, 410011, Hunan, China. .,Institute of Nephrology, Central South University, Changsha, 410011, Hunan, China.
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16
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Schanz M, Ketteler M, Heck M, Dippon J, Alscher MD, Kimmel M. Impact of an in-Hospital Patient Education Program on Choice of Renal Replacement Modality in Unplanned Dialysis Initiation. Kidney Blood Press Res 2017; 42:865-876. [PMID: 29161686 DOI: 10.1159/000484531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/21/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Up to 50% patients requiring dialysis receive an urgent, unplanned start (UPS) to renal replacement therapy (RRT). Most of these are initiated with an intravenous catheter and commenced and maintained on hemodialysis (HD). Although peritoneal dialysis (PD) could be an equipotent initial modality for RRT, it is used less frequently as long-term RRT in UPS patients. This multicenter-study aimed to evaluate the impact of a structured, in-hospital education program and factors influencing PD rates, especially in UPS patients. METHODS Three German nephrology departments collaborated to implement an in-hospital education program. Retrospective analysis included 336 subjects and compared the rates of HD and PD in consecutive patients who started RRT 12 months prior (two centers) and for 12 months after (three centers) implementing the education program. RESULTS PD rates increased significantly (p < 0.05) by 66% in all planned and unplanned dialysis starts after implementation of a structured, patient-centered education program. A highly significant (p < 0.0001) rise in utilization of PD was found, especially in UPS patients. In logistic regression analysis, PD modality choice was significantly influenced by age (p < 0.0001) and gender (p = 0.006). CONCLUSIONS A structured, patient-centered in-hospital education program increases the frequency of PD in patients needing unplanned RRT. PD modality choice is significantly higher in young (p < 0.0001) and male (p = 0.006) patients.
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Affiliation(s)
- Moritz Schanz
- Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
| | | | - Markus Heck
- Nephrological Center Emsland, Lingen, Germany
| | - Juergen Dippon
- Department of Mathematics, University of Stuttgart, Stuttgart, Germany
| | - Mark Dominik Alscher
- Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
| | - Martin Kimmel
- Department of Internal Medicine, Division of General Internal Medicine and Nephrology, Robert-Bosch Hospital, Stuttgart, Germany
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