1
|
Giuliani A, Milan Manani S, Crepaldi C, Domenici A, Gastaldon F, Corradi V, Ronco C. Intraperitoneal Pressure in Polycystic and Non-Polycystic Kidney Disease Patients, Treated by Peritoneal Dialysis. Blood Purif 2020; 49:670-676. [PMID: 32841944 DOI: 10.1159/000506177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Intraperitoneal volume (IPV) should be individualized and aimed to maintain an intraperitoneal pressure (IPP) lower than 17 cm H2O. IPP is very variable, given its relation with body size. However, it is not yet fully understood which anthropometric variable mostly affects IPP and the relation between IPP and organomegaly in polycystic kidney disease (PKD) patients is not known. OBJECTIVES The aim of the present study was to analyse the relation between antropometric variables and IPP in a large cohort of peritoneal dialysis (PD) patients and to identify if a relation between nephromegaly and IPP exists in PKD patients. METHODS IPP was measured in PD patients and data was retrospectively collected. In PKD patients, total kidney volumes were measured in CT scans, and normalized with height (hTKV). RESULTS Seventy-seven patients were included in the study, 18% affected by PKD. Mean IPP was 14.9 ± 2.9 cm H2O and it showed significant positive correlation with body mass index (BMI; ρ = 0.42, p < 0.001). No correlation was found between IPP and absolute IPV; conversely, IPP has a significant inverse correlation with IPV normalized with BMI and body surface area (ρ -0.38, p = 0.001 and ρ -0.25, p = 0.02, -respectively). Patients with IPP >17 cm H2O have significant larger BMI and lower IPV/BMI compared to those with IPP <17 cm H2O (29 ± 3.6 vs. 26 ± 4 kg/m2, p < 0.05 and 97 ± 15.5 vs. 109 ± 22 mL/kg/m2, p < 0.05). PKD patients have a wide variability in hTKV (range 645-3,787 mL/m2) and it showed a significant correlation with IPP/IPV (ρ = 0.6, p < 0.05). CONCLUSIONS Patients with larger BMI have greater IPP, irrespectively to IPV. In PKD patients, hTKV correlate with IPP/IPV ratio. However, given the wide range of distribution of hTKV, increased IPP cannot be presumed because of pre-existing polycystic kidney, but need to be quantified.
Collapse
Affiliation(s)
- Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy,
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Alessandro Domenici
- Division of Nephrology, Department of Clinical and Molecular Medicine, Sant' Andrea University Hospital, "Sapienza" University of Rome, Rome, Italy
| | - Fiorella Gastaldon
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Valentina Corradi
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine, University of Padua, Padua, Italy
| |
Collapse
|
2
|
Milan Manani S, Baretta M, Giuliani A, Virzì GM, Martino F, Crepaldi C, Ronco C. Remote monitoring in peritoneal dialysis: benefits on clinical outcomes and on quality of life. J Nephrol 2020; 33:1301-1308. [PMID: 32779144 PMCID: PMC7416995 DOI: 10.1007/s40620-020-00812-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
Background Automated peritoneal dialysis (APD) has been proved benefit from remote monitoring (RM), but evidences are limited. In this study, we compared clinical outcomes and quality of life (QoL) in two group of patients undergoing APD, with and without exposure of RM. Methods This is a retrospective cohort study, comparing outcomes in two groups of APD patients monitored during 6 months with RM (group A: n = 35) or standard care (group B: n = 38 patients). In our clinical practice, we assign the RM system to patients who live more distant from the PD center or difficulty in moving. We evaluated emergency visits, hospitalizations, peritonitis, overhydration, and dropout. QoL was assessed with the Kidney Disease Quality of life-Short Form (KDQOL-SF). We included four additional questions focused on patient’s perception of monitoring, safety and timely problems solution (Do you think that home-therapy monitoring could interfere with your privacy? Do you think that your dialysis sessions are monitored frequently enough? Do you think that dialysis-related issues are solved timely? Do you feel comfortable carrying out your home-based therapy?). Results The case group presented a higher comorbidity score, according to Charlson Comorbidity Index (group A: 5.0; IQR 4.0–8.0 versus group B: 4.0; IQR 3.0–6.0) (p = 0.042). The results in group A showed a reduction in the urgent visits due to acute overhydration (group A: 0.17 ± 0.45 versus group B: 0.66 ± 1.36) (p: 0.042) and in the number of disease-specific hospitalization (group A n = 2.0; 18.2% versus group B n = 7.0; 77.8%) (p = 0.022). We did not find any difference between the two groups in terms of hospitalization because of all-cause, peritonitis, overhydration, and dropout. The analysis of KDQOL-SF subscales was similar in the two groups; on the contrary, the answers of our pointed questions have showed a significant difference between the two groups (group A: 100 IQR 87.5–100.0 versus group B 87.5; IQR 75.0–100.0) (p: 0.018). Conclusion RM improved clinical outcomes in PD patients, reducing the emergency visits and the hospitalizations, related to nephrological problems, especially in patients with higher comorbidity score. The acceptance and satisfaction of care were better in patients monitored with RM than with standard APD.
Collapse
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy.
| | - Michele Baretta
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Francesca Martino
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV - International Renal Research Institute of Vicenza, Via Rodolfi, 37, 36100, Vicenza, Italy.,Università degli Studi di Padova, Via 8 Febbraio 1848, 2, 35122, Padova, Italy
| |
Collapse
|
3
|
Caron-Lienert RS, Poli-de-Figueiredo CE, Figueiredo AEPL, da Costa BEP, Crepaldi C, Pizzato AC, Ferrari F, Giuliani A, Ronco C. The Influence of Glucose Exposure Load and Peritoneal Membrane Transport on Body Composition and Nutritional Status Changes after 1 Year on Peritoneal Dialysis. Perit Dial Int 2020; 37:458-463. [DOI: 10.3747/pdi.2016.00265] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/14/2017] [Indexed: 12/20/2022] Open
Abstract
BackgroundThe characteristics of peritoneal membrane transport differ among patients, affecting the prescription of peritoneal dialysis (PD) modality and glucose exposure in order to achieve an effective dialysis. This study aims to verify the influence of glucose exposure load and peritoneal membrane transport on body composition and nutritional status changes after the first year of PD.MethodsWe examined a cohort of 85 incident PD patients during the first year of treatment. We established a cut-off of 5% to define changes in dry weight (DW), lean tissue mass (LTM), and fat mass (FM).ResultsIn total, 50.6% of the patients presented DW gain, 41.2% showed LTM loss, and 65.9% presented FM gain. Over the time (T0 – T12), we found significant differences in DW, body mass index (BMI), adipose tissue mass (ATM), FM and fat tissue index (FTI). Patients with lower dialysate-to-plasma creatinine ratio showed DW and FM gain. We observed a higher percentage of nonfast transporters in DW gain when comparing with DW no gain. As for glucose exposure load, no body composition changes were seen.ConclusionsMost patients presented DW gain, FM gain, and LTM loss. The characteristics of peritoneal membrane transport affected DW during the first year, changes being greater in nonfast than in fast transporters.
Collapse
Affiliation(s)
- Rafaela Siviero Caron-Lienert
- Pontifical Catholic University of Rio Grande do Sul, Rio Grande do Sul, Brazil
- International Renal Research Institute of Vicenza, Italy
| | | | | | | | - Carlo Crepaldi
- International Renal Research Institute of Vicenza, Italy
| | | | | | - Anna Giuliani
- International Renal Research Institute of Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza, Italy
| |
Collapse
|
4
|
Milan Manani S, Virzì GM, Giuliani A, Baretta M, Corradi V, De Cal M, Biasi C, Crepaldi C, Ronco C. Lipopolysaccharide Evaluation in Peritoneal Dialysis Patients with Peritonitis. Blood Purif 2020; 49:434-439. [PMID: 31914448 DOI: 10.1159/000505388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/06/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Lipopolysaccharide (LPS), also known as endotoxin, is cell wall component of Gram-negative (GN) bacteria, which may contribute to the progression of a local infection to sepsis. Previous studies demonstrate that LBP is detectable in peritoneal effluents of peritoneal dialysis (PD) patients and it is significantly elevated in PD patients with peritonitis caused by both GN and Gram-positive (GP) bacteria. AIM The aim of this study was to evaluate LPS levels in PD patients; in particular, we investigated different LPS levels in the context of GP and GN peritonitis. MATERIAL AND METHODS We enrolled 49PD (61% Continuous Ambulatory PD and 39% Automated PD) patients: 37 with peritonitis and 12 without. Quantitative determination of LPS was performed by Enzyme-linked Immunosorbent Assay Kitin peritoneal and plasma samples. RESULTS Quantitative analysis of peritoneal and plasma LPS showed significantly higher levels in PD patients with peritonitis compared to patients without (p = 0.001). Furthermore, we divided patients with peritonitis in 2 groups on the basis of Gram staining (GP 27; GN 12). Peritoneal and plasma LPS levels showed significantly lower levels in PD patients with GP peritonitis than in patients with GN (p = 0.001). The median level of LPS showed no significant differences between patients without peritonitis and with GP peritonitis (p = 0.195). On the contrary, LPS levels showed significantly higher levels in PD patients with GN peritonitis compared to patients without peritonitis (p = 0.001). A significant positive correlation was observed between peritoneal white blood cells count (pWBC) and peritoneal LPS (Spearman's rho = 0,412, p = 0.013). However, no statistically significant correlation was observed between plasma LPS and WBC count. CONCLUSION We observed LPS presence in all PD patients. In particular, our results demonstrated that LPS is significantly elevated in PD patients with GN peritonitis. Furthermore, pWBC and LPS levels increased proportionally in PD patients with peritonitis. Peritoneal and plasma LPS levels could be a useful marker for diagnosis and management of GN peritonitis in PD patients.
Collapse
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy, .,IRRIV, International Renal Research Institute, Vicenza, Italy,
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Michele Baretta
- IRRIV, International Renal Research Institute, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
| | - Valentina Corradi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Massimo De Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Caterina Biasi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,Department of Medicine, University of Verona, Verona, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,IRRIV, International Renal Research Institute, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
5
|
Veniero P, Zarantonello D, Axia M, Bandera A, Bosco M, Boscutti G, Crepaldi C, Dugo M, Martimbianco L, Martone M, Scaparrotta G, Tabbì MG, Valente F, Fiorini F. [Vascular access survey in the Triveneto area: data analysis for the year 2017]. G Ital Nefrol 2019; 36:36-5-2019-10. [PMID: 31580549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2017 the Italian Society of Nephrology operating in the Triveneto area investigated through a questionnaire, distributed to the various nephrological centers in the regions of Friuli Venezia Giulia, Trentino Alto Adige and Veneto, the differences concerning organizational models, choice of dialysis, creation and management of vascular access. The results emerging from the analysis of the collected data are presented.
Collapse
Affiliation(s)
| | | | | | | | | | - Giuliano Boscutti
- Ospedale Santa Maria della Misericordia di Udine, UO di Nefrologia, Dialisi e Trapianto renale
| | - Carlo Crepaldi
- Ospedale San Bortolo di Vicenza UO di Nefrologia, Dialisi e Trapianto renale
| | - Mauro Dugo
- Ospedale di Treviso USC Nefrologia e Dialisi
| | | | | | - Giuseppe Scaparrotta
- UO di Nefrologia, Dialisi e Trapianto Azienda Ospedaliera-Universitaria di Padova
| | | | | | | |
Collapse
|
6
|
Cipponeri E, Vitturi N, Mariano V, Boscari F, Galasso S, Crepaldi C, Fadini GP, Vigili de Kreutzenberg S, Marescotti MC, Iori E, Cavallin F, Sartori L, Baritussio A, Avogaro A, Bruttomesso D. Vitamin D status and non-alcoholic fatty liver disease in patients with type 1 diabetes. J Endocrinol Invest 2019; 42:1099-1107. [PMID: 30847862 DOI: 10.1007/s40618-019-01031-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE In patients with type 1 diabetes (T1D), the prevalence of non-alcoholic fatty liver disease (NAFLD) ranges from 10 to 53% and contrasting evidence suggests that vitamin D deficiency may favor liver fat accumulation. Here, we investigated the association between vitamin D status and NAFLD in adults with T1D. METHODS 220 consecutive adult T1D patients on multiple daily injections or continuous subcutaneous insulin infusion and not taking calcium or vitamin D supplements were included. Patient characteristics, 25(OH)D serum levels, and metabolic parameters were analyzed. Vitamin D status was defined as sufficiency ( ≥ 75 nmol/L; 30 ng/ml), insufficiency (50-75 nmol/L; 20-30 ng/ml), or deficiency ( < 50 nmol/L; 20 ng/ml). NAFLD was diagnosed at ultrasound examination and graded 0-3. RESULTS NAFLD was present in 57 patients (29.5%): 51 grade 1, 5 grade 2, and 1 grade 3. Median 25(OH)D levels were 53 nmol/L (IQR 38-70) in patients with NAFLD and 50 nmol/L (34-69) in patients without (p = 0.46). At multivariable analysis, NAFLD was not associated with 25(OH)D levels (p = 0.42) or vitamin D deficiency (p = 0.55), while BMI (OR 1.16, 95% CI 1.07-1.27) and serum triglycerides (OR 1.02, 95% CI 1.01-1.03) were independently associated with NAFLD. CONCLUSIONS Vitamin D status appears to have no link with low-grade NAFLD in patients with type 1 diabetes.
Collapse
Affiliation(s)
- E Cipponeri
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - N Vitturi
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - V Mariano
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - F Boscari
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - S Galasso
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - C Crepaldi
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - G P Fadini
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - S Vigili de Kreutzenberg
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - M C Marescotti
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - E Iori
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | | | - L Sartori
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - A Baritussio
- Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy
| | - A Avogaro
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - D Bruttomesso
- Division of Metabolic Diseases, Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| |
Collapse
|
7
|
Virzì GM, Milan Manani S, Clementi A, Castegnaro S, Brocca A, Riello C, de Cal M, Giuliani A, Battaglia GG, Crepaldi C, Ronco C. Eryptosis Is Altered in Peritoneal Dialysis Patients. Blood Purif 2019; 48:351-357. [PMID: 31291616 DOI: 10.1159/000501541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 06/04/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Red blood cells (RBCs) undergo programmed cell death known as eryptosis. Triggers of eryptosis include increased cytosolic Ca(2+) concentration, oxidative stress, osmotic shock, energy depletion and several uremic toxins. Little is known about the pathogenesis of eryptosis in peritoneal dialysis (PD) patients; furthermore, its relevance in worsening clinical conditions in these patients is still not completely defined. OBJECTIVES We investigated eryptosis levels in PD patients and its association with inflammatory and clinical parameters. MATERIAL AND METHODS A total of 46 PD patients and 17 healthy subjects (CTR) were enrolled. All eryptosis measurements were made in freshly isolated RBCs using the flow cytometer. RESULTS Eryptosis was significantly higher in PD patients than that in CTR (p < 0.001). Eryptosis levels did not differ significantly between PD patients with and without diabetes, with and without hypertension, and with and without cardiovascular disease. Eryptosis showed no significant differences between patients treated with continuous ambulatory PD/automated PD, with Kt/Vurea value ≤1.7 and >1.7, with a negative or positive history of peritonitis. On the contrary, eryptosis showed significantly lower levels in PD patients with weekly creatinine clearance ≥45 L/week/1.73 m2 (2.8%, 1.7-4.9 vs. 5.6%, 5.0-13.5; p= 0.049). Eryptosis showed significantly lower levels in PD patients with residual diuresis (n = 23) than that in patients without (3.7%, 2.6-5.6 vs. 5%, 3.1-16; p = 0.03). In these 23 patients, significant negative correlations between percentage of eryptosis and residual glomerular filtration rate (rGFR; Spearman's rho = -0.51, p = 0.01) and diuresis volume (Spearman's rho = -0.43, p = 0.05) were found. CONCLUSIONS The present study demonstrated higher eryptosis levels in PD patients compared to corresponding levels in CTR. Furthermore, important PD comorbidity and main PD parameters do not influence eryptosis. Importantly, our data have reported an increase in eryptosis levels with progressive residual diuresis and rGFR loss, probably due to decreased uremic toxins clearance.
Collapse
Affiliation(s)
- Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy, .,International Renal Research Institute, IRRIV, Vicenza, Italy,
| | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Anna Clementi
- International Renal Research Institute, IRRIV, Vicenza, Italy.,Department of Nephrology and Dialysis, Santa Marta and Santa Venera Hospital, Acireale, Italy
| | - Silvia Castegnaro
- International Renal Research Institute, IRRIV, Vicenza, Italy.,Hematology Project Foundation, St Bortolo Hospital, Vicenza, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy.,Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
| | - Caterina Riello
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | | | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, St Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute, IRRIV, Vicenza, Italy.,Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
8
|
Milan Manani S, Virzì GM, Crepaldi C, Giuliani A, Ronco C, Proglio M. FP581REMOTE PATIENT MONITORING IN PERITONEAL DIALYSIS IMPROVES CLINCAL OUTCOMES. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz106.fp581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
Van Biesen W, Verger C, Heaf J, Vrtovsnik F, Britto ZML, Do JY, Prieto-Velasco M, Martínez JP, Crepaldi C, De Los Ríos T, Gauly A, Ihle K, Ronco C. Evolution Over Time of Volume Status and PD-Related Practice Patterns in an Incident Peritoneal Dialysis Cohort. Clin J Am Soc Nephrol 2019; 14:882-893. [PMID: 31123180 PMCID: PMC6556715 DOI: 10.2215/cjn.11590918] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 04/10/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Volume overload is frequent in prevalent patients on kidney replacement therapies and is associated with outcome. This study was devised to follow-up volume status of an incident population on peritoneal dialysis (PD) and to relate this to patient-relevant outcomes. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This prospective cohort study was implemented in 135 study centers from 28 countries. Incident participants on PD were enrolled just before the actual PD treatment was started. Volume status was measured using bioimpedance spectroscopy before start of PD and thereafter in 3-month intervals, together with clinical and laboratory parameters, and PD prescription. The association of volume overload with time to death was tested using a competing risk Cox model. RESULTS In this population of 1054 participants incident on PD, volume overload before start of PD amounted to 1.9±2.3 L, and decreased to 1.2±1.8 L during the first year. At all time points, men and participants with diabetes were at higher risk to be volume overloaded. Dropout from PD during 3 years of observation by transfer to hemodialysis or transplantation (23% and 22%) was more prevalent than death (13%). Relative volume overload >17.3% was independently associated with higher risk of death (adjusted hazard ratio, 1.59; 95% confidence interval, 1.08 to 2.33) compared with relative volume overload ≤17.3%. Different practice patterns were observed between regions with respect to proportion of patients on PD versus hemodialysis, selection of PD modality, and prescription of hypertonic solutions. CONCLUSIONS In this large cohort of incident participants on PD, with different treatment practices across centers and regions, we found substantial volume overload already at start of dialysis. Volume overload improved over time, and was associated with survival.
Collapse
Affiliation(s)
- Wim Van Biesen
- Department of Nephrology, Ghent University Hospital, Ghent, Belgium;
| | - Christian Verger
- Registre de dialyse péritonéale de langue Française, Pontoise, France
| | - James Heaf
- Department Medicine, Zealand University Hospital, Roskilde, Denmark
| | | | | | - Jun-Young Do
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | | | - Juan Pérez Martínez
- Servicio de Nefrología, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
| | - Carlo Crepaldi
- Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy; and
| | - Tatiana De Los Ríos
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Adelheid Gauly
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Katharina Ihle
- Clinical and Epidemiological Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Claudio Ronco
- Department of Nephrology Dialysis and Transplantation, International Renal Research Institute, San Bortolo Hospital, Vicenza, Italy; and
| | | |
Collapse
|
10
|
Milan Manani S, Virzì GM, Giuliani A, Crepaldi C, Ronco C. Catheter-related infections in peritoneal dialysis: comparison of a single center results and the literature data. J Nephrol 2019; 32:837-841. [PMID: 30955154 DOI: 10.1007/s40620-019-00604-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Catheter-related infections are important causes of morbidity in patients undergoing peritoneal dialysis (PD). There are different protocols of exit site care for the prevention of catheter-related infections. The aim of this study was to evaluate the incidence of catheter-related infections and their complications in our PD center. METHODS We performed a retrospective, observational study for all patients receiving PD in our center. We observed prevalent patients every year for 5 years. The patients performed the exit-site care three times a week, cleaning the exit site with 10% sodium hypochlorite. From 2017, update of ISPD recommendations suggests the application of antibiotic creams. We recorded the incidence rate of ESI and TI, gentamicin resistance, catheter lost, related post-ESI peritonitis and fungal infections, and we compared our results with the data in the literature. RESULTS Prevalent patients per year were 117.6 ± 5.5. The "time at risk" was 356.46 years. The median values of TESI (tunnel and exit site infections), TI, gentamicin resistance, related post-ESI peritonitis and fungal infection rate were similar in our results and the literature data. The ESI and the catheter lost caused by infection were significantly lower in our patients. No significant adverse effects, such as skin allergy or intolerance, were reported. CONCLUSIONS Our results confirm the utility and the safety of routinely exit site care using 10% sodium hypochlorite. This protocol resulted similar to the data reported in the literature. Our analysis of the literature highlighted the wide variation in the infection rate of ESI and TI.
Collapse
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy. .,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Via Rodolfi, 37, 36100, Vicenza, Italy.,IRRIV, International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy.,Department of Medicine, University of Padua, Padua, Italy
| |
Collapse
|
11
|
Milan Manani S, Rosner MH, Virzì GM, Giuliani A, Berti S, Crepaldi C, Ronco C. Longitudinal Experience with Remote Monitoring for Automated Peritoneal Dialysis Patients. Nephron Clin Pract 2019; 142:1-9. [PMID: 30699410 DOI: 10.1159/000496182] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/11/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is an ideal model for testing remote monitoring (RM). In this study, we evaluated the RM application longitudinally in stable patients undergoing automated PD (APD). METHODS This was an observational study, comparing outcomes in patients with (current patients) and without (historical data) exposure of RM. We analyzed cost-effectiveness of RM-APD measuring the number of night alarms, number of hospital visits, direct and indirect costs. RESULTS Changes in APD prescription were almost double in the case group (RM) compared to the control group (p = 0.0005). The need for in-person visits and nocturnal alarms was significantly less in RM-APD than in traditional APD (p = 0.01 and p = 0.002, respectively). The distance traveled by patients in the case of RM-APD was reduced by 1,134 km with a time saving of 1,554 min for patients. The overall cost reduction for the PD center in terms of time/nurse and time/physician was 2,647 and 3,673 min, respectively. All these advantages were obtained in the presence of an improved technique survival with a significant reduction of dropouts. All patients found that it is easy to use the RM system and were satisfied with the high level of interaction with the care team and with the possibility of timely resolving technical problems. CONCLUSION These data confirm the long-term benefits of RM applied to APD. RM-APD is cost-effective; it allows early detection and resolution of problems, improved treatment compliance, reduction of patient's access to hospital center for technical and clinical complications with consequent savings, and improved patient's quality of life.
Collapse
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy, .,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy,
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Sonia Berti
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,IRRIV-International Renal Research Institute Vicenza, Vicenza, Italy.,Full Professor of Nephrology, Department of Medicine, University of Padua, Padua, Italy
| |
Collapse
|
12
|
Crepaldi C, Rosner M, Ronco C. Preface. Contributions to Nephrology 2019; 197:VII-VIII. [DOI: 10.1159/000496300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
13
|
Ronco C, Heifetz A, Fox K, Curtin C, Brendolan A, Gastaldon F, Crepaldi C, Fortunato A, Pietribasi G, Caberlotto A, Brunello A, Manani SM, Zanella M, La Greca G. Beta 2-microglobulin Removal by Synthetic Dialysis Membranes. Mechanisms and Kinetics of the Molecule. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000303] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Beta 2-microglobulin (ß2-m) accumulation represents a possible complication of long term dialysis. It is therefore important to evaluate the capacity of removal of this molecule from the patient by different dialysis membranes. The present study is aimed at evaluating the mechanisms involved in ß2-m removal by three different synthetic membranes: a) highly asymmetric hydrophobic polysulfone (Biosulfane, NMC), b) moderately asymmetric and hydrophobic polysulfone (PS600, Fresenius), c) Polyacylonitrile (AN69HF, Hospal). The adsorption capacity and sieving coefficients of the three membranes for native and labeled ß2-m were studied in vitro utilizing human blood. The amount adsorbed by the membrane was measured by the elution of the molecule obtained with a detergent solution. Clearances, total removal and membrane adsorption were studied in six patients treated in a randomized sequence with the three membranes. For this purpose, plasma and dialysate measurements as well as total collection of spent dialysate and ß2-m elution from the used dialyzers were carried out. Ex novo generation of ß2-m did not take place during in vitro circulation. The molecule was removed by the studied membranes both by filtration and adsorption. The Biosulfane membrane removed ß2-m mostly by adsorption while the PS600 membrane removed ß2-m almost entirely by filtration. Intermediate behaviour was shown by AN69 membrane. Similar quantities of ß2-m were removed from the patients with the three membranes. Total removal could only be precisely measured by adding the quantity of ß2-m eluted from the membrane to the amount recovered in the spent dialysate. Out of total removal, adsorption was more than 90% with Biosulfane, while only 5% with the PS600. These findings contribute to the understanding of the discrepancy found between the clearance measured from the plasma side and that measured from the dialysate side. In conclusion, clearance and sieving measurements for ß2-m cannot be correctly performed unless the capacity of adsorption of the membrane is taken into account.
Collapse
Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Heifetz
- Washington Research Center, Washington, DC
| | - K. Fox
- National Medical Care, Rockleigh, New Jersey - USA
| | - C. Curtin
- National Medical Care, Rockleigh, New Jersey - USA
| | - A. Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - F. Gastaldon
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Fortunato
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. Pietribasi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Caberlotto
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Brunello
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - S. Milan Manani
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - M. Zanella
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| |
Collapse
|
14
|
Khan S, Giuliani A, Crepaldi C, Ronco C, Rosner MH. Peritoneal Dialysis for Patients with Autosomal Dominant Polycystic Kidney Disease. Perit Dial Int 2018; 37:384-388. [PMID: 28676509 DOI: 10.3747/pdi.2016.00273] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/15/2017] [Indexed: 11/15/2022] Open
Abstract
End-stage renal disease secondary to autosomal dominant polycystic kidney (ADPKD) is a common issue worldwide. Peritoneal dialysis (PD) is a reasonable option for renal replacement therapy for these patients and should not be withheld due to concerns that the patient may not tolerate the fluid volumes in the peritoneal cavity. This review covers the existing data on the outcomes and complications associated with the use of PD in the polycystic kidney disease patient. In general, PD is well tolerated and outcomes in ADPKD patients are equivalent to or better than other patient groups.
Collapse
Affiliation(s)
- Sana Khan
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, San Bortolo Hospital, Vicenza, Italy
| | - Mitchell H Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia, USA
| |
Collapse
|
15
|
Crepaldi C, Virzì GM, Milan Manani S, Giuliani A, Berti S, Ronco C. FP480LIPOPOLYSACCHARIDE (LPS) EVALUATION IN PERITONEAL DIALYSIS PATIENTS WITH PERITONITIS. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
16
|
Milan Manani S, Crepaldi C, Giuliani A, Virzì GM, Garzotto F, Riello C, de Cal M, Rosner MH, Ronco C. Remote Monitoring of Automated Peritoneal Dialysis Improves Personalization of Dialytic Prescription and Patient's Independence. Blood Purif 2018; 46:111-117. [PMID: 29694954 DOI: 10.1159/000487703] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 02/12/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Remote monitoring (RM) supports a healthcare model that enhances patients' self-management. We evaluated the utility of RM in patients undergoing automated peritoneal dialysis (APD). METHODS We observed 37 -RM-APD patients, 16 incidents, and 21 prevalents switched from traditional APD (T-APD). We observed the number of changes for APD prescription, the frequency of visits, and PD adequacy parameters during 1 year of RM utilization in APD. RESULTS The APD prescriptions were modified more frequently in RM-APD vs. T-APD in incident (p = 0.002) and prevalent patients (p = 0.045). Visits were significant less in -RM-APD than in T-APD for incident patient (p = 0.008). No significant difference was found between prevalent populations. PD adequacy was similar in both groups. CONCLUSIONS Our results demonstrate that RM allows an efficient use of healthcare resources, helping to improve personalization of APD prescription and to intervene early with "trouble shooting", thereby reducing the frequency of in-person visits for emergency problems.
Collapse
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Anna Giuliani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Francesco Garzotto
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Caterina Riello
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| | - Mitchell H Rosner
- Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy.,International Renal Research Institute Vicenza (IRRIV), Vicenza, Italy
| |
Collapse
|
17
|
Ronco C, Brendolan A, Crepaldi C, Bettini M, Scabardi M, Cappellari F, Tasinazzo L, Fortunato L, La Greca G. Technical and Clinical Evaluation of a New Asymmetric Polysulfone Membrane (Biosulfane®). Int J Artif Organs 2018. [DOI: 10.1177/039139889301600803] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
First generation asymmetric polysulfone membranes had high hydraulic permeability (kf=40 ml/h/mmHg/sqm) but a low diffusive permeability due to the hydrophobic nature and wall thickness of 75–100 microns. We have tested a new polysulfone membrane with a wall thickness of 40 microns in a series of in vitro and in vivo dialysis session experiments. The new “Biosulfane®” membrane presented a Kf of 45.8 with constant performance up to 240 mins. The koA was 760 and the clearance value at 350 ml/min of Qb in hemodiafiltration was 255 ml/min for urea, 210 for creatinine, 225 for phosphate, 76 for inulin. In high flux dialysis the clearances were similar except for inulin which was 32% lower due to the lower convection amount. Beta-2 microglobulin clearance was 22 ml/min in high flux dialysis and 37 in hemodiafiltration. Solute sieving coefficients were close to 1 for the majority of the studied solutes in a wide range of molecular weights and slight variations were observed for charged solutes due to Donnan's effect. The sieving for Inulin was 0.96 while that for Beta-2 microglobulin was not measurable due to a large molecule adsorption on the inner structure of the fibres. The good performances of this membrane are probably due to reduced wall thickness and a consequent improvement in diffusive permeability to small size solutes.
Collapse
Affiliation(s)
- C. Ronco
- Departments of Nephrology, Vicenza - Italy
| | | | | | - M.C. Bettini
- Departments of Immunohematology, Vicenza - Italy
| | | | | | - L. Tasinazzo
- Departments of Laboratory, St. Bortolo Hospital, Vicenza - Italy
| | - L. Fortunato
- Departments of Laboratory, St. Bortolo Hospital, Vicenza - Italy
| | | |
Collapse
|
18
|
Crepaldi C, Possidoni A, Caputo F, Dell'Aquila R, Galli EG, Costanzo AM, Gualberti G, di Luzio Paparatti U, Russo R. Clinical management of patients on peritoneal dialysis in Italy: results from the ATENA study. Clin Kidney J 2018; 11:275-282. [PMID: 29644071 PMCID: PMC5887992 DOI: 10.1093/ckj/sfx092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 07/17/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In Italy, few studies have examined the clinical management of peritoneal dialysis (PD) patients, resulting in a lack of information and awareness. METHODS A total of 378 PD patients (64.7 ± 14.3 years, 58.9% males) were enrolled across 15 centres in a 12-month retrospective and 6-month prospective study. The primary objective was to evaluate the achievement of Kidney Disease Outcomes Quality Initiative and Kidney Disease Improving Global Outcomes guidelines on recommended target values for anaemia, high blood pressure and mineral metabolism. Comorbidities, hospitalizations, treatment and quality of life were also assessed. RESULTS Frequent comorbidities included hypertension (87.8%) and cardiovascular disease (39.7%). Peritonitis was the leading cause of hospitalization [12 admissions per 100 person-years (95% confidence interval 9.3-15.2)]. At 6 months, anaemia corrected by erythropoiesis-stimulating agents was observed in 30% of patients and 73% received erythropoiesis-stimulating agents. Systolic and diastolic blood pressures were recorded in 50% and 20% of patients, respectively. Sixty-four percent of echocardiograms revealed left ventricular hypertrophy and 30% of patients had vitamin D <10 ng/mL. Medication to treat intact parathyroid hormone (PTH) included calcitriol (36.3%), paricalcitol (29.2%), cholecalciferol (23.6%) and cinacalcet (21.5%). In a subgroup of patients matched for baseline PTH treated for 1 year, a significant reduction in PTH with paricalcitol (-41%; P < 0.001) but not cinacalcet (+2%; P = 0.63) was observed. Comparison of quality of life domains revealed significant differences for symptoms (P = 0.049), cognitive function (P = 0.019) and social support (P = 0.04) (baseline versus 6 months). CONCLUSIONS Hypertension and cardiovascular diseases were frequent comorbidities and peritonitis was the leading cause of hospitalization. Secondary hyperparathyroidism and anaemia were common, thus necessitating frequent monitoring of PTH, calcium, phosphorus and haemoglobin.
Collapse
Affiliation(s)
- Carlo Crepaldi
- Dialisi e Trapianto Renale, ULSS6 di Vicenza Ospedale San Bortolo U.O.C. Nefrologia, Vicenza, Italy
| | | | - Flavia Caputo
- Dialisi e Trapianto, A.R.N.A.S Osp. Civico di Cristina Benfratelli U.O. di Nefrologia 2°, Palermo, Italy
| | - Roberto Dell'Aquila
- Azienda ULSS 7 “PEDEMONTANA” Struttura Complessa di Nefrologia e Dialisi, Bassano del Grappa, Vicenza, Italy
| | | | | | | | | | - Roberto Russo
- A.O.U. Policlinico di Bari U.O.C. di Nefrologia, Bari, Italy
| | | |
Collapse
|
19
|
Ronco C, Brendolan A, Crepaldi C, Rodighiero M, Everard P, Ballestri M, Cappelli G, Spittle M, La Greca G. Dialysate Flow Distribution in Hollow Fiber Hemodialyzers with Different Dialysate Pathway Configurations. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300902] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The efficiency of a hemodialyzer is largely dependent on its ability to facilitate diffusion, since this is the main mechanism by which small solutes are removed. The diffusion process can be impaired if there is a mismatch between blood and dialysate flow distribution in the dialyzer. The objective of the paper was to study the impact of different dialysate compartment designs on dialysate flow distribution and urea clearances. Eighteen hollow fiber 1.3 m2 hemodialyzers were studied, 6 each of 3 designs: Type A- standard fiber bundle (PAN 65DX Asahi Medical, Tokyo, Japan); Type B - spacing filaments external to the fibers (PAN 65SF Asahi Medical, Tokyo, Japan); Type C - fibers waved to give Moiré structure (FB130 Nissho-Nipro, Osaka, Japan). In vitro studies: 3 dialyzers of each type were studied following dye injection into the dialysate compartment. Dynamic sequential imaging of longitudinal sections of the dialyzer were undertaken, using a new generation helical CT scanner (X-Press/HS1 Toshiba Corporation, Tokyo, Japan). In vivo studies: 3 dialyzers of each type were studied, in randomized sequence, in 3 different patients under standardized dialysis conditions. Blood- and dialysate-side urea clearances were measured at 30 and 150 minutes of treatment. Macroscopic and densitometrical analysis revealed that flow distribution was most homogeneous in the dialyzer with Moiré structure (Type C) and least homogeneous in the standard dialyzer (Type A). Space yarns (Type B) gave an intermediate dialysate flow distribution. Significantly increased urea clearances (p<0.001) were seen with Types B and C, compared to the standard dialyzer. Type C (Moiré) had the highest clearances although these were not significantly greater than Type B (space yarns). In conclusion, more homogeneous dialysate flow distribution and improved small solute clearances can be achieved by use of spacing yarns or waved (Moiré structure) patterns of fiber packing in the dialyzer. These effects are achieved probably as a result of reduced dialysate channeling resulting in a lower degree of mismatch between blood and dialysate flows. The new radiological technique using the helical CT scanner allows detailed flow distribution analysis and has the potential for testing future modifications to dialyzer design.
Collapse
Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - A. Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - M. Rodighiero
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - P. Everard
- Medical and Research Department, Nissho-Nipro, Europe, Zaventem - Belgium
| | - M. Ballestri
- Department of Nephrology, University of Modena, Modena - Italy
| | - G. Cappelli
- Department of Nephrology, University of Modena, Modena - Italy
| | - M. Spittle
- Beth Israel Medical Center, New York - USA
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| |
Collapse
|
20
|
Ronco C, Lupi A, Brendolan A, Feriani M, Crepaldi C, La Greca G. Ultrafiltration and Pressure Profiles in Continuous Arteriovenous Hemofiltration Studied by Computerized Scintigraphic Imaging. Int J Artif Organs 2018. [DOI: 10.1177/039139889101400802] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C. Ronco
- Departments of Nephrology and, Vicenza - Italy
| | - A. Lupi
- Nuclear Medicine, St. Bortolo Hospital, Vicenza - Italy
| | | | - M. Feriani
- Departments of Nephrology and, Vicenza - Italy
| | - C. Crepaldi
- Departments of Nephrology and, Vicenza - Italy
| | - G. La Greca
- Departments of Nephrology and, Vicenza - Italy
| |
Collapse
|
21
|
Brendolan A, Ronco C, Crepaldi C, Bragantini L, Milan M, Gastaldon F, La Greca G. Double Pass Dialysis: A New Method of Renal Replacement in Patients with Malfunctioning Vascular Access. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Several patients undergoing chronic renal replacement therapy present problems related to their vascular access. Low blood flows and high rates of recirculation are common in such patients in which, for this reason, it becomes difficult to apply highly efficient techniques or techniques where diffusion and convection are combined as in hemodiafiltration. In these patients we studied the possibility of partially recirculating the blood in the extracorporeal circuit in order to increase the flow rate per single hollow fiber; we defined our system “double pass dialysis”. We evaluated the system's efficiency in 12 patients during 24 dialysis sessions: 12 high flux dialysis sessions (without reinfusion) and 12 hemodiafiltration sessions (9 liters reinfusion). Different surfaces of polyacrylonitrile dialyzers were utilized (1.3-1.7-2.1 sqm) at 250 and 350 ml/min of blood flow with or without 100 ml/min of recirculation. During each dialysis session blood and dialysate samples were taken in order to calculate BUN, Creatinine, Phosphate and Inuline clearances from both the blood and dialysate side. The clearances of low molecular weight solutes were not really influenced by the artificial increase of the blood flow, but on the other hand, the clearances of higher molecular weight solutes increased from 10 to 30% during both high flux dialysis and hemodiafiltration with recirculation. This increase was evident mostly in hemodiafiltration suggesting that the cleaning effect on the membrane has a positive impact on the permeability. The good clinical results obtained with the double pass dialysis show that the system is safe and reliable and may become a valid support in critical situations in order to reach adequate dialysis treatment.
Collapse
Affiliation(s)
- A. Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - L. Bragantini
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - M. Milan
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - F. Gastaldon
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza - Italy
| |
Collapse
|
22
|
Ronco C, Cappelli G, Ballestri M, Lusvarghi E, Frisone P, Milan M, Dell'Aquila R, Crepaldi C, Dissegna D, Gastaldon F, La Greca G. On line filtration of dialysate: structural and functional features of an asymmetric polysulfone hollow fiber ultrafilter (Diaclean®). Int J Artif Organs 2018. [DOI: 10.1177/039139889401701002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The endotoxin transfer across dialysis membranes has been investigated using specific in vitro circuits. Backdiffusion and backfiltration have been analyzed and most dialysis membranes have shown to be permeable to LAL positive substances. Synthetic membranes however display the better capacity of retention of these products despite their higher porosity and permeability. For such reason synthetic polysulfone ultrafilters are used as pyrogen filters to obtain ultrapure dialysate. We have investigated the characteristics of a polysulfone ultrafilter named Diaclean and manufactured by Amicon Ireland. The capacity of endotoxin retention has been investigated both in filtration and backfiltration modes on new and used ultrafilters. The capacity of endotoxin adsorption was investigated as well. Used ultrafilters appeared to maintain the retention capacity and the adsorption capacity up to 4 months of use. Only slight differences were noted from the baseline values (p = n.s.). The best adsorption capacity is always displayed by the outer layer of the membrane suggesting its best utilization in back filtration mode with tangential flow. No morphological changes were observed in the used membrane analyzed by scanning electron microscopy.
Collapse
Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - G. Cappelli
- Chair of Nephrology, University of Modena, Modena - Italy
| | - M. Ballestri
- Chair of Nephrology, University of Modena, Modena - Italy
| | - E. Lusvarghi
- Chair of Nephrology, University of Modena, Modena - Italy
| | - P. Frisone
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - M. Milan
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | | | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - D. Dissegna
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - F. Gastaldon
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| |
Collapse
|
23
|
Ronco C, Brendolan A, Crepaldi C, Frisone P, Ghiotto F, Zamboni S, Gastaldon F, La Greca G. On-Line Urea Monitoring: A Further Step towards Adequate Dialysis Prescription and Delivery. Int J Artif Organs 2018. [DOI: 10.1177/039139889501800911] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Aim Of This Study Is To Present A Clinical Experience Carried Out With A New Device Designed To Measure On-Line Urea Nitrogen Concentration In The Effluent Dialysate. The Biostat 1000® Urea Monitor (Baxter Healthcare, Dirfield, Iii, Usa) Was Utilized In The Present Study. The Monitor Is Based On The Principle That Multiple Urea Measurements In The Dialysate Effluent From The Dialyzer, Permit To Built A Double Exponential Regression Leading To The Urea Kinetic Parameters Of The Dialysis Session. Data Obtained With The Urea Monitor Were, In The Present Study, Compared With Those Obtained By Direct Measurements Carried Out In Blood And Dialysate And By The Collection Of The Whole Amount Of Spent Dialysate. The Monitor Provided An Accurate Value Of Predialysis Bun Without Any Blood Drawing. Urea Kinetics Were Established From Multiple Dialysate Measurements And No Blood Drawing Was Necessary. The Double Pool Kinetics Were Taken Into Account And Kt/V, Pcr And Sri° Obtained Were Comparable To Those Obtained From Direct Measurement. Since A Projected Value Of Kt/V Can Be Obtained, The Monitor Could Represent A Potential Source Of Information To Detect Possible Filter And Machine Dysfunction, As Well As High Rate Of Recirculation.
Collapse
Affiliation(s)
- C. Ronco
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - A. Brendolan
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - C. Crepaldi
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - P. Frisone
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - F. Ghiotto
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - S. Zamboni
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - F. Gastaldon
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| | - G. La Greca
- Department Of Nephrology, Ospedale San Bortolo, Vicenza - Italy
| |
Collapse
|
24
|
Ronco C, Fecondini L, Gavioli L, Conz P, Milan M, Dell'Aquila R, Bragantini L, Chiaramonte S, Brendolan A, Crepaldi C, Feriani M, La Greca G. A New Blood Module for Continuous Renal Replacement Therapies. Int J Artif Organs 2018. [DOI: 10.1177/039139889401700103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A new blood module for continuous renal replacement therapies has been utilized to perform CVVH in critically ill patients. The features of the new module named (HP300 and manifactured by Medica srl (Medolla, Modena) are the easy installation and transportability to the bedside, the simple and safe management and the continuous measurement of the pre and post filter pressure with automatic calculation of the end-to-end pressure drop inside the filter. The last feature permits to detect early malfunctions of the filter due to fibers clotting or due to the internal coating of the hollow fibers by plasma proteins. In both cases the efficiency of the treatment can be reduced because of a significant reduction of the ultrafiltration rates or a remarkable decay of the membrane permeability and solute sieving coefficients. In many cases this reduction is only detected when important effects on solute removal have already occurred. In our experience, the new module permitted the substitution of the filters when early malfunctions were detected and maximal treatment efficiency was therefore guaranteed over extended periods of time.
Collapse
Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | | | | | - P. Conz
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - M. Milan
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | | | - L. Bragantini
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | | | - A. Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - M. Feriani
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| |
Collapse
|
25
|
Ronco C, Scabardi M, Goldoni M, Brendolan A, Crepaldi C, La Greca G. Impact of Spacing Filaments External to Hollow Fibers on Dialysate flow Distribution and Dialyzer Performance. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000505] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A new type of dialyzer (PAN 650 SF Asahi) is analyzed in terms of hydraulic properties, solute clearances and dialysate flow distribution. The new type of dialyzer is a polyacrylonitrile hollow fiber filter, equipped with spacing filaments placed externally to the fibers to facilitate dialysate distribution and avoid channeling. The new filter is compared with a similar filter without spacing filaments. For this purpose, blood and dialysate side clearances have been measured in sequential dialysis session carried out randomly in the same patients. Furthermore, a last generation helical scanner (X-Press / HS1, Toshiba) has been utilized to analyze in vitro the flow distribution of dialysate inside the dialyzer. A contrast medium was injected and a sequence of images has been achieved on a longitudinal section of the dialyzer. This new method permits to avoid any bias due to the cylindrical shape of the dialyzer, since a 10 mm thick rectangular section is analyzed and not the entire body of the filter. The dialyzers equipped with spacing filaments displayed a significant improvement of the dialysate distribution as demonstrated by the radiological pattern. In detail, despite a channeling phenomenon in the peripherical region of the bundle is still present, this is remarkably reduced in comparison with the channelling phenomenon observed in the standard dialyzers. This improved distribution is confirmed by a significant improvement of the solute clearances.
Collapse
Affiliation(s)
- C. Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - M. Scabardi
- Department of Radiology, Casa di Cura Eretenia, Vicenza
| | - M. Goldoni
- Department of Engineering, SIFRA, Isola Della Scala, Verona - Italy
| | - A. Brendolan
- Department of Radiology, Casa di Cura Eretenia, Vicenza
| | - C. Crepaldi
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| | - G. La Greca
- Department of Nephrology, St. Bortolo Hospital, Vicenza
| |
Collapse
|
26
|
Brendolan A, Nalesso F, Fortunato A, Crepaldi C, De Cal M, Cazzavillan S, Cruz D, Techawathanawanna N, Ronco C. Dialytic Performance Evaluation of Rexeed™: a New Polysulfone-based Dialyzer with Improved Flow Distributions. Int J Artif Organs 2018; 28:966-75. [PMID: 16288434 DOI: 10.1177/039139880502801003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
New dialyzers are designed to optimize the convective and diffusive components of solute transport. Asahi Kasei Medical Co., Ltd. has developed a new high flux dialyzer series called Rexeed™ with improved flow distributions. We evaluated the in vivo dialytic performance of two dialyzers of the Rexeed™ series: Rexeed-18A and Rexeed-25A (1.8 m2 and 2.5 m2). We calculated the clearance for urea, creatinine, phosphate and b2-microglobulin both in high flux dialysis (HFD) and in 15 liter postidiluitional on-line hemodiafiltration (HDF) mode. With n=3 patients in high flux HD at blood flow 450, 400, 350 and 250 ml/min we found remarkably high clearance for urea (347±4%,305±0%,288±5%,230±3%, for Rexeed-18A and 361±3%,329±0%,313±1%,234±3% for Rexeed-25A), creatinine (282±10%,234±0%, 221±8%, 174±8%, for Rexeed-18A and 276±6%,245±0%,226±9%,172±13% for Rexeed-25A), phosphate (347±0%,316±0%,275±4%,202±16%, for Rexeed-18A and 364±3%,365±0%,286±3%,224±2% for Rexeed-25A) and b2-microglobulin (133±21%,124±0%,118±12%,98±11%, for Rexeed-18A and 159±8%,169±0%,157±8%,129±7% for Rexeed-25A) With n=2 patients in HDF at blood flow 300 ml/min we found remarkably high clearance for urea (268±2%, for Rexeed-18A and 283±2% for Rexeed-25A), creatinine (183±6% for Rexeed-18A and 205±9% for Rexeed-25A), phosphate (245±3%, for Rexeed-18A and 270±2% for Rexeed-25A) and b2-microglobulin (166±12%, for Rexeed-18A and 192±4% for Rexeed-25A). Our preliminary evaluation describes the characteristics and the performances of a new polysulfone-based hemodialyzer series called Rexeed™. Several innovative features have been implemented by the manufacturer. These constructive approaches seem to have produced a positive effect on the dialyzer performance at the bedside.
Collapse
Affiliation(s)
- A Brendolan
- Department of Nephrology, St. Bortolo Hospital, Vicenza--Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Bonello M, House A, Cruz D, Asuman Y, Andrikos E, Petras D, Strazzabosco M, Ronco F, Brendolan A, Crepaldi C, Nalesso F, Ronco C. Integration of Blood Volume, Blood Pressure, Heart Rate and Bioimpedance Monitoring for the Achievement of Optimal Dry Body Weight during Chronic Hemodialysis. Int J Artif Organs 2018; 30:1098-108. [DOI: 10.1177/039139880703001210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Achieving optimal dry body weight in hemodialysis is challenging. Clinical assessment alone is inadequate, and methods such as bioimpedance monitoring may be impractical for every patient treatment. Continuous blood volume monitoring, blood pressure and heart rate variability inform clinical decision-making, but integrated use of multiple methodologies to achieve dry weight and understand patient factors has not yet been described. Methods Nineteen chronic hemodialysis patients underwent thrice-weekly treatments for two weeks. Baseline hydration status and target weight were determined by bioimpedance. During subsequent treatments, ultrafiltration was adjusted and relative blood volume, blood pressure and pulse were recorded non-invasively Bioimpedance was repeated to assess hydration. Response of variables to progressive change in weight was assessed and selected patients underwent additional autonomic function testing. Results Four distinct hemodynamic patterns emerged. Profile A: 4 patients demonstrated overhydration at baseline. With decreasing target, pulse and blood pressure remained stable while blood volume and bioimpedance demonstrated achievement of dry weight. Profile B: 8 patients demonstrated overhydration at baseline. With decreasing target, blood pressure remained stable while pulse increased. Profile C: 5 patients were overhydrated, but as weight decreased, blood pressure became unstable and heart rate failed to compensate. Further testing confirmed autonomic dysfunction. Profile D: 2 patients were dehydrated, and with increasing target demonstrated stable pulse and pressure, while blood volume and bioimpedance revealed achievement of dry weight. Conclusions Integrating existing non-invasive, continuous monitoring during hemodialysis enabled achievement of dry weight and identified distinct profiles of the patients, some with autonomic dysfunction. This strategy may contribute to achieving optimum dry weight while improving cardiovascular tolerability of hemodialysis.
Collapse
Affiliation(s)
- M. Bonello
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - A.A. House
- Department of Medicine, Division of Nephrology, University of Western Ontario, London - Canada
| | - D. Cruz
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - Y. Asuman
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - E. Andrikos
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - D. Petras
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - M. Strazzabosco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - F. Ronco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - A. Brendolan
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. Crepaldi
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - F. Nalesso
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| | - C. Ronco
- Department of Nephrology Dialysis and Transplantation, St. Bortolo Hospital - International Renal Research Institute Vicenza (IRRIV), Vicenza - Italy
| |
Collapse
|
28
|
Lu R, Estremadoyro C, Chen X, Zhu M, Ribeiro LC, Yan Y, Brendolan A, Fang W, Crepaldi C, Ni Z, Gu L, Ronco C. Hemodialysis versus peritoneal dialysis: an observational study in two international centers. Int J Artif Organs 2017; 41:0. [PMID: 29148022 DOI: 10.5301/ijao.5000656] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Given that it is difficult to randomize end-stage renal disease (ESRD) patients to either hemodialysis (HD) or peritoneal dialysis (PD), differences between these renal replacement therapy (RRT) modalities are of major interest and remain controversial. METHODS All data on maintenance dialysis patients during 2009 to 2013 in the Renji Hospital in Shanghai, China and in the San Bortolo Hospital in Vicenza, Italy were selected. Patients who changed their therapy from HD to PD or PD to HD during this study were excluded. RESULTS 919 maintenance dialysis patients were included in the present study, including 509 patients on HD and 410 on PD. During the 5-year follow-up, mean arterial pressure (MAP) was higher in HD patients. The level of serum HCO3- was significantly better in PD patients than in HD patients. Phosphate was significantly higher in HD patients than in PD patients. With respect to lipid metabolism, triglyceride, total cholesterol and LDL were significantly higher in PD patients. Serum protein and albumin were higher in HD patients than in PD patients. Overall, 236 patients died (25.7%); 150 (16.3%) on HD and 86 (9.4%) on PD. The main cause of death in HD and PD patients was cerebral vascular disease and infection, respectively. After adjusting for dialysis vintage, the Kaplan-Meier patient survival was similar between HD and PD patients. CONCLUSIONS Based on 5 years of data, we demonstrate that lipid metabolism and nutritional status were better in HD patients. However, blood pressure control, acid-base balance, phosphate (P) control were better in PD patients. The main cause of death in HD and PD was cerebral vascular disease and infection, respectively. Considering the dialysis vintage, the Kaplan-Meier patient survival was similar between HD and PD patients.
Collapse
Affiliation(s)
- Renhua Lu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai - China
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, the International Renal Research Institute of Vicenza (IRRIV), Vicenza - Italy
- Department of Nephrology, Kashgar Prefecture Second People's Hospital, Kashgar, Sinkiang - China
| | - Carla Estremadoyro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, the International Renal Research Institute of Vicenza (IRRIV), Vicenza - Italy
| | - Xiaohuan Chen
- Department of Nephrology, Kashgar Prefecture Second People's Hospital, Kashgar, Sinkiang - China
| | - Mingli Zhu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai - China
| | - Leonardo C Ribeiro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, the International Renal Research Institute of Vicenza (IRRIV), Vicenza - Italy
| | - Yucheng Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai - China
| | - Alessandra Brendolan
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, the International Renal Research Institute of Vicenza (IRRIV), Vicenza - Italy
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai - China
| | - Carlo Crepaldi
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, the International Renal Research Institute of Vicenza (IRRIV), Vicenza - Italy
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai - China
| | - Leyi Gu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai - China
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, the International Renal Research Institute of Vicenza (IRRIV), Vicenza - Italy
| |
Collapse
|
29
|
Giuliani A, Karopadi AN, Prieto-Velasco M, Manani SM, Crepaldi C, Ronco C. Worldwide Experiences with Assisted Peritoneal Dialysis. Perit Dial Int 2017; 37:503-508. [DOI: 10.3747/pdi.2016.00214] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 03/19/2017] [Indexed: 11/15/2022] Open
Abstract
End-stage renal disease (ESRD) is common in the elderly population, and renal replacement therapy (RRT) is often required. However, in this particular subgroup of patients, the choice between hemodialysis (HD) and peritoneal dialysis (PD) is often not an easy decision to make. Published literature has adequately demonstrated that PD prevalence is significantly less than HD across all patient age groups despite several advantages. We also know that elderly patients are less likely to complete a PD assessment, due to both medical and social barriers. Additionally, elderly patients are often reluctant to go ahead with PD despite being eligible PD candidates, mainly due to the fear of performing self-therapy. Recently, many new assisted PD (asPD) programs have cropped up in several countries. The main aim of these programs is to overcome barriers to PD and to promote PD utilization among elderly and non-self-sufficient patients. Although asPD has proven to be associated with good clinical results, there still remain concerns about its greater use. In this review, we will first describe an ideal asPD model and then enumerate examples of strategies and outcomes associated with successful asPD programs worldwide.
Collapse
Affiliation(s)
- Anna Giuliani
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Akash Nayak Karopadi
- Dr. Nayak Dialysis Centres Private Limited, Somajiguda, Hyderabad, Telangana, India
| | | | - Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
30
|
Gambero O, Corradi V, Romero G, Meligrana L, Mettifogo M, de Cal M, Brendolan A, Crepaldi C, Marcon M, Perini F, Ferrari F, Ronco C. MP756EVALUATION OF THE ONE YEAR FOLLOW UP OF DIALYSIS PTS BY RAPID NEUROPSYCHOLOGICAL SCREENING BATTERY. Nephrol Dial Transplant 2017. [DOI: 10.1093/ndt/gfx181.mp756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
31
|
Tona F, Silvestre C, Rigato M, Famoso G, Marchini F, Bonfante L, Neri F, Furian L, Crepaldi C, Iliceto S, Rigotti P. Coronary Microvascular Dysfunction Predicts Long-Term Outcome in Simultaneous Pancreas-Kidney Transplantation. Transplant Proc 2017; 48:344-8. [PMID: 27109952 DOI: 10.1016/j.transproceed.2015.12.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with diabetes are at increased cardiovascular risk. Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice in patients with type 1 diabetes mellitus and diabetic nephropathy. We assessed coronary flow reserve (CFR) by transthoracic echocardiography as a marker of major adverse cardiac events (MACE) in SPKT patients. METHODS We studied 48 consecutive SPKT patients (28 male, age at SPKT 54 ± 8 years). Time from transplantation was 8.5 ± 3 years. Follow-up was 4.6 ± 1.8 years. Coronary flow velocity in the left anterior descending coronary artery was detected by Doppler echocardiography at rest and during adenosine infusion. CFR was the ratio of hyperemic diastolic flow velocity (DFV) to resting DFV. A CFR ≤ 2 was considered abnormal and a sign of coronary microvascular dysfunction. MACE were cardiac death, myocardial infarction, and heart failure. RESULTS CFR was 2.55 ± 0.8. CFR was ≤2 in 13 (27%) patients. CFR was lower in SPKT patients with MACE (2.1 ± 0.7 vs 2.7 ± 0.8, P = .03) and patients with MACE had a higher incidence of CFR ≤ 2 (P = .03). Time from transplantation was shorter in patients with MACE (P < .0001). Patients with CFR ≤ 2 had a lower MACE-free survival (P = .03). CFR ≤ 2 predicted the risk of MACE (P = .007) independently from coronary artery disease and metabolic control. However, this predicted role is lost when adjusted for the time from transplantation, which plays a protective role (P = .001). CONCLUSIONS In SPKT, CFR ≤ 2 may be a reliable marker for MACE, independent of coronary artery disease diagnosis. However, this role seems to be reduced over time. This finding suggests a gradual reduction of cardiovascular risk in SPKT patients.
Collapse
Affiliation(s)
- F Tona
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - C Silvestre
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| | - M Rigato
- Nephrology Unit, University of Padua, Padua, Italy
| | - G Famoso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - F Marchini
- Nephrology Unit, University of Padua, Padua, Italy
| | - L Bonfante
- Nephrology Unit, University of Padua, Padua, Italy
| | - F Neri
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| | - L Furian
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| | - C Crepaldi
- Division of Metabolic Diseases, University of Padua, Padua, Italy
| | - S Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - P Rigotti
- Kidney and Pancreas Transplantation Unit, University of Padua, Padua, Italy
| |
Collapse
|
32
|
Virzì GM, Milan Manani S, Brocca A, de Cal M, Tantillo I, Crepaldi C, Ronco C. MP508NEW ROLE OF PERITONEAL CELL-FREE DNA FOR MANAGMENT IN PD-RELATED PERITONITIS. Nephrol Dial Transplant 2016. [DOI: 10.1093/ndt/gfw195.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
33
|
Virzì GM, Manani SM, Cantaluppi V, Brocca A, de Cal M, Tantillo I, Mason G, Ramponi F, Berti S, Crepaldi C, Clementi M, Ronco C. The Role of Cell-Free Plasma DNA in Peritoneal Dialysis Patients with Peritonitis. Perit Dial Int 2015; 35:755-8. [PMID: 26703846 DOI: 10.3747/pdi.2014.00245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Grazia Maria Virzì
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Sabrina Milan Manani
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Vincenzo Cantaluppi
- Nephrology, Dialysis and Kidney Transplantation Unit, University of Torino, Azienda Ospedaliera Città della Salute e della Scienza di Torino-"Molinette", Turin, Italy
| | - Alessandra Brocca
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy Department of Medicine DIMED, University of Padova Medical School, Padua, Italy
| | - Massimo de Cal
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Ilaria Tantillo
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Giacomo Mason
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Ramponi
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Sonia Berti
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Crepaldi
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| | - Maurizio Clementi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Claudio Ronco
- IRRIV - International Renal Research Institute Vicenza and Department of Nephrology Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
34
|
Milan Manani S, Virzì GM, Clementi A, Brocca A, de Cal M, Tantillo I, Ferrando L, Crepaldi C, Ronco C. Pro-inflammatory cytokines: a possible relationship with dialytic adequacy and serum albumin in peritoneal dialysis patients. Clin Kidney J 2015; 9:153-7. [PMID: 26798477 PMCID: PMC4720213 DOI: 10.1093/ckj/sfv137] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/29/2015] [Indexed: 11/23/2022] Open
Abstract
Background Inflammation and serum albumin concentration are both important predictors of survival in patients treated with peritoneal dialysis (PD). Furthermore, systemic and local inflammatory mediators may induce structural and functional alterations in the peritoneal membrane, thus interfering with dialysis adequacy. PD adequacy is monitored primarily by indices of small solute clearance, such as Kt/V urea and weekly creatinine clearance (wCc). The aim of this study was to investigate the possible relationship between pro-inflammatory cytokines, such as interleukin-6 (IL-6) and interleukin-1β (IL-1β), and serum albumin and C-reactive protein (CRP). Moreover, the relationship between IL-6 and IL-1β and PD adequacy has been analysed. Methods We enrolled 46 stable PD patients undergoing maintenance PD for a minimum of 3 months. Plasma levels of serum albumin, high-sensitivity (hs)-CRP, IL-6 and IL-1β were measured in all patients. We used weekly Kt/V urea and wCc to monitor PD adequacy. Daily urine volume was measured in all patients. Results The median values of serum albumin, hs-CRP, IL-6 and IL-1β showed no significant differences between continuous ambulatory PD and automated PD patients. IL-6 levels showed a positive correlation with hs-CRP levels (P < 0.001) and a negative correlation with serum albumin concentration (P = 0.01). There was no statistically significant relationship between IL-1β and hs-CRP or serum albumin concentrations. Subsequently, PD patients were divided into two groups based on Kt/V urea value. PD patients with Kt/V ≤1.7 had significantly higher IL-6 levels compared with PD patients with Kt/V >1.7 (P = 0.015). No statistically significant relationship between IL-6 and wCc was observed. There was no significant difference in IL-1β levels between PD patients with Kt/V ≤1.7 and with Kt/V >1.7 [median (interquartile range) 0.82 (0.88–5.2) versus 1.82 (0.95–2.7)]. There was no significant difference in IL-6 and IL-1β levels in PD patients with and without residual diuresis (P = 0.32 and P = 0.77, respectively). Conclusion Our data suggest a possible relationship between serum IL-6 levels and serum albumin and hs-CRP in PD patients. Furthermore, IL-6 seems to be higher in patients with lower Kt/V, thus suggesting a possible use of this inflammatory biomarker in PD adequacy monitoring.
Collapse
Affiliation(s)
- Sabrina Milan Manani
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Anna Clementi
- IRRIV-International Renal Research Institute, Vicenza, Italy; Department of Nephrology and Dialysis, San Giovanni Di Dio Hospital, Cagliari, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy; Department of Medicine DIMED, University of Padova Medical School, Padova, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Ilaria Tantillo
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Lorena Ferrando
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Carlo Crepaldi
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza, Italy; IRRIV-International Renal Research Institute, Vicenza, Italy
| |
Collapse
|
35
|
Isnard Bagnis C, Crepaldi C, Dean J, Goovaerts T, Melander S, Nilsson EL, Prieto-Velasco M, Trujillo C, Zambon R, Mooney A. Quality standards for predialysis education: results from a consensus conference. Nephrol Dial Transplant 2015; 30:1058-66. [PMID: 24957808 PMCID: PMC4479667 DOI: 10.1093/ndt/gfu225] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 05/27/2014] [Indexed: 11/14/2022] Open
Abstract
This position statement was compiled following an expert meeting in March 2013, Zurich, Switzerland. Attendees were invited from a spread of European renal units with established and respected renal replacement therapy option education programmes. Discussions centred around optimal ways of creating an education team, setting realistic and meaningful objectives for patient education, and assessing the quality of education delivered.
Collapse
Affiliation(s)
- Corinne Isnard Bagnis
- Service de Néphrologie, Groupe Hospitalier Pitié-Salpêtrière et Chaire de Recherche en Education Thérapeutique, Université Pierre et Marie Curie, Paris, France
| | - Carlo Crepaldi
- Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italy
| | - Jessica Dean
- Department of Clinical Health Psychology, Salford Royal Hospital, Salford, UK
| | - Tony Goovaerts
- Cliniques Universitaires St. Luc, Service de Néphrologie, Brussels, Belgium
| | - Stefan Melander
- Department of Nephrology, University Hospital of Linköping, Linköping, Sweden
| | - Eva-Lena Nilsson
- Department of Nephrology, Skånes University Hospital, Malmö, Sweden
| | | | - Carmen Trujillo
- Unidad clínica de Gestión de Nefrología, Hospital Regional Carlos Haya, Malaga, Spain
| | - Roberto Zambon
- Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, Vicenza, Italy
| | - Andrew Mooney
- Renal Unit, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| |
Collapse
|
36
|
Virzì GM, Milan Manani S, Brocca A, Cantaluppi V, de Cal M, Pastori S, Tantillo I, Zambon R, Crepaldi C, Ronco C. Peritoneal Cell-free DNA: an innovative method for determining acute cell damage in peritoneal membrane and for monitoring the recovery process after peritonitis. J Nephrol 2015; 29:111-8. [DOI: 10.1007/s40620-015-0212-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 05/18/2015] [Indexed: 02/07/2023]
|
37
|
Mooney A, Crepaldi C, Goovaerts T, Isnard Bagnis C, Melander S, Nilsson EL, Prieto-Velasco M, Rutherford P, Trujillo C, Zambon R, Dean J. FP735EUROPEAN SURVEY ON RENAL REPLACEMENT THERAPY OPTION EDUCATION. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv183.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
38
|
Virzì GM, Milan S, Brocca A, de Cal M, Tantillo I, Crepaldi C, Ronco C. FP584PERITONEAL CELL-FREE DNA: AN INNOVATIVE METHOD FOR DETERMINING ACUTE CELL DAMAGE IN PERITONEAL MEMBRANE AND FOR MONITORING THE RECOVERY PROCESS AFTER PERITONITIS. Nephrol Dial Transplant 2015. [DOI: 10.1093/ndt/gfv180.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
39
|
Ronco C, Brendolan A, Bragantini L, Crepaldi C, Dell'Aquila R, Milan M, Feriani M, Chiaramonte S, Conz P, La Greca G. High-performance continuous arteriovenous hemofiltration in infants with the new Minifilter plus. Contrib Nephrol 2015; 93:254-6. [PMID: 1802592 DOI: 10.1159/000420231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Ronco C, Brendolan A, Crepaldi C, Dell'Aquila R, Milan M, La Greca G. Importance of hollow-fiber geometry in continuous arteriovenous hemofiltration. Contrib Nephrol 2015; 93:175-8. [PMID: 1802575 DOI: 10.1159/000420213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C Ronco
- Department of Nephrology, St. Bortolo Hospital, Vicenza, Italy
| | | | | | | | | | | |
Collapse
|
41
|
Lu R, Muciño-Bermejo MJ, Ribeiro LC, Tonini E, Estremadoyro C, Samoni S, Sharma A, Zaragoza Galván JDJ, Crepaldi C, Brendolan A, Ni Z, Rosner MH, Ronco C. Peritoneal dialysis in patients with refractory congestive heart failure: a systematic review. Cardiorenal Med 2015; 5:145-56. [PMID: 25999963 PMCID: PMC4427136 DOI: 10.1159/000380915] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Refractory congestive heart failure (RCHF) is associated with a high mortality rate and is a major contributor to hospital admissions. Peritoneal dialysis (PD) is an option to control volume overload and perhaps improve outcomes in this challenging patient population. The aim of this systematic review is to describe the relative risk-benefit ratio based on data reported regarding the use of PD in RCHF. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. An electronic search of PubMed, Embase, and the Cochrane Library was performed to identify relevant studies published from January 1951 to February 2014. Eligible studies selected were prospective or retrospective adult population studies on PD in the setting of RCHF. The following clinical outcomes were used to assess PD therapy: (1) hospitalization rates; (2) heart function; (3) renal function; (4) fluid overload, and (5) adverse clinical outcomes. SUMMARY Of 864 citations, we excluded 843 citations and included 21 studies (n = 673 patients). After PD, hospitalization days declined significantly (p = 0.0001), and heart function improved significantly (left ventricular ejection fraction: p = 0.0013; New York Heart Association classification: p = 0.0000). There were no statistically significant differences in glomerular filtration rate after PD treatment in non-chronic kidney disease stage 5D patients (p = 0.1065). Among patients treated with PD, body weight decreased significantly (p = 0.0006). The yearly average peritonitis rate was 14.5%, and the average yearly mortality was 20.3%. KEY MESSAGES This systematic review suggests that PD may be an effective and safe therapeutic tool for patients with RCHF.
Collapse
Affiliation(s)
- Renhua Lu
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - María-Jimena Muciño-Bermejo
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Leonardo Claudino Ribeiro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Enrico Tonini
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Carla Estremadoyro
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Sara Samoni
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Aashish Sharma
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - José de Jesús Zaragoza Galván
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Carlo Crepaldi
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Alessandra Brendolan
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| | - Zhaohui Ni
- Department of Nephrology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Va., USA
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation of the San Bortolo Hospital, International Renal Research Institute of Vicenza, Vicenza, Italy
| |
Collapse
|
42
|
Ronco C, Verger C, Crepaldi C, Pham J, De Los Ríos T, Gauly A, Wabel P, Van Biesen W. Baseline hydration status in incident peritoneal dialysis patients: the initiative of patient outcomes in dialysis (IPOD-PD study)†. Nephrol Dial Transplant 2015; 30:849-58. [PMID: 25762355 PMCID: PMC4425480 DOI: 10.1093/ndt/gfv013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 01/07/2015] [Indexed: 12/30/2022] Open
Abstract
Background Non-euvolaemia in peritoneal dialysis (PD) patients is associated with elevated mortality risk. There is an urgent need to collect data to help us understand the association between clinical practices and hydration and nutritional status, and their effects on patient outcome. Methods The aim of this prospective international, longitudinal observational cohort study is to follow up the hydration and nutritional status, as measured by bioimpedance spectroscopy using the body composition monitor (BCM) of incident PD patients for up to 5 years. Measures of hydration and nutritional status and of clinical, biochemical and therapy-related data are collected directly before start of PD treatment, at 1 and 3 months, and then every 3 months. This paper presents the protocol and a pre-specified analysis of baseline data of the cohort. Results A total of 1092 patients (58.1% male, 58.0 ± 15.3 years) from 135 centres in 32 countries were included. Median fluid overload (FO) was 2.0 L (males) and 0.9 L (females). Less than half of the patients were normohydrated (38.7%), whereas FO > 1.1 L was seen in 56.5%. Systolic and diastolic blood pressure were 139.5 ± 21.8 and 80.0 ± 12.8 mmHg, respectively, and 25.1% of patients had congestive heart failure [New York Heart Association (NYHA) 1 or higher]. A substantial number of patients judged to be not overhydrated on clinical judgement appeared to be overhydrated by BCM measurement. Overhydration at baseline was independently associated with male gender and diabetic status. Conclusions The majority of patients starting on PD are overhydrated already at start of PD. This may have important consequences on clinical outcomes and preservation of residual renal function. Substantial reclassification of hydration status by BCM versus on a clinical basis was necessary, especially in patients who were not overtly overhydrated. Both clinical appreciation and bioimpedance should be combined in clinical decision-making on hydration status.
Collapse
Affiliation(s)
- Claudio Ronco
- Department of Nephrology, Ospedale S. Bortolo, Vicenza, Italy
| | | | - Carlo Crepaldi
- Department of Nephrology, Ospedale S. Bortolo, Vicenza, Italy
| | - Jenny Pham
- Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Tatiana De Los Ríos
- Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Adelheid Gauly
- Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Peter Wabel
- Clinical Research, Fresenius Medical Care Deutschland GmbH, Bad Homburg, Germany
| | - Wim Van Biesen
- Renal Division, Ghent University Hospital, Ghent, Belgium
| | | |
Collapse
|
43
|
Goovaerts T, Bagnis Isnard C, Crepaldi C, Dean J, Melander S, Mooney A, Prieto‐Velasco M, Trujillo C, Zambon R, Nilsson E. Continuing education: preparing patients to choose a renal replacement therapy. J Ren Care 2015; 41:62-75. [PMID: 25597792 PMCID: PMC7328707 DOI: 10.1111/jorc.12106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with progressive chronic kidney disease face a series of treatment decisions that will impact the quality of life of themselves and their family. Renal replacement therapy option education (RRTOE), generally provided by nurses, is recommended by international guidelines OBJECTIVES To provide nurses with advice and guidance on running RRTOE. DESIGN A consensus conference. PARTICIPANTS Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 European countries) from units that had extensive experience in RRTOE or were performing research in this field. APPROACH Experts brainstormed and discussed quality standards for the education team, processes, content/topics, media/material/funding and quality measurements for RRTOE. RESULTS Conclusions and recommendations from these discussions that are particularly pertinent to nurses are presented in this paper. CONCLUSIONS Through careful planning and smooth interdisciplinary cooperation, it is possible to implement an education and support programme that helps patients choose a form of RRT that is most suited to their needs. This may result in benefits in quality of life and clinical outcomes. APPLICATION TO PRACTICE There are large differences between renal units in terms of resources available and the demographics of the catchment area. Therefore, nurses should carefully consider how best to adapt the advice offered here to their own situation. Throughout this process, it is crucial to keep in mind the ultimate goal - providing patients with the knowledge and skill to make a modality choice that will enhance their quality of life to the greatest degree.
Collapse
Affiliation(s)
- Tony Goovaerts
- Cliniques Universitaires St LucService de NéphrologieBrusselsBelgium
| | - Corinne Bagnis Isnard
- Service de Néphrologie, Groupe Hospitalier Pitié‐Salpêtrière et Chaire de Recherche en Education ThérapeutiqueUniversité Pierre et Marie CurieParisFrance
| | - Carlo Crepaldi
- Unità Operativa di NefrologiaDialisi e TrapiantoOspedale San BortoloVicenzaItaly
| | - Jessica Dean
- Department of Clinical Health PsychologySalford Royal HospitalSalfordUK
| | - Stefan Melander
- Department of NephrologyUniversity Hospital of LinköpingLinköpingSweden
| | - Andrew Mooney
- Renal UnitSt James's University Hospital, Leeds Teaching Hospitals NHS TrustLeedsUK
| | | | - Carmen Trujillo
- Unidad clínica de Gestión de NefrologíaHospital Regional Carlos HayaMalagaSpain
| | - Roberto Zambon
- Unità Operativa di NefrologiaDialisi e TrapiantoOspedale San BortoloVicenzaItaly
| | | |
Collapse
|
44
|
Martino F, Scalzotto E, Giavarina D, Rodighiero MP, Crepaldi C, Day S, Ronco C. The Role of NGAL in Peritoneal Dialysis Effluent in Early Diagnosis of Peritonitis: Case-Control Study in Peritoneal Dialysis Patients. Perit Dial Int 2014; 35:559-65. [PMID: 25395499 DOI: 10.3747/pdi.2013.00300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is frequently complicated by high rates of peritonitis, which result in hospitalization, technique failure, transfer to hemodialysis, and increased mortality. Early diagnosis, and identification of contributing factors are essential components to increasing effectiveness of care. In previous reports, neutrophil gelatinase-associated lipocalin (NGAL), a lipocalin which is a key player in innate immunity and rapidly detectable in peritoneal dialysis effluent (PDE), has been demonstrated to be a useful tool in the early diagnosis of peritonitis. This study investigates predictive value of PDE NGAL concentration as a prognostic indicator for PD-related peritonitis. METHODS A case-control study with 182 PD patients was conducted. Plasma and PDE were analyzed for the following biomarkers: C-reactive protein (CRP), blood procalcitonin (PCT), leucocytes and NGAL in PDE. The cases consisted of patients with suspected peritonitis, while controls were the patients who came to our ambulatory clinic for routine visits without any sign of peritonitis. The episodes of peritonitis were defined in agreement with International Society for Peritoneal Dialysis guidelines. Continuous variables were presented as the median values and interquartile range (IQR). Mann-Whitney U test was used to compare continuous variables. Univariate and multivariate logistic regression were used to evaluate the association of biomarkers with peritonitis. Receiver operating characteristic (ROC) curve analysis was used to calculate area under curve (AUC) for biomarkers. Finally we evaluated sensitivity, and specificity for each biomarker. All statistical analyses were performed with SPSS version 17.0 (SPSS Inc., Chicago, IL, USA). RESULTS During the 19-month study, of the 182 patients, 80 had a clinical diagnosis of peritonitis. C-reactive protein levels (p < 0.001), PCT (p < 0.001), NGAL in PDE (p < 0.001), and white blood cells (WBC) in PDE (p < 0.001) were all significantly different in patients with and without peritonitis. In univariate analysis, CRP (odds ratio [OR] 1,339; p = 0.001), PCT (OR 2,473; p < 0,001), WBC in PDE (OR 3,986; p < 0,001), and NGAL in PDE (OR 36.75 p < 0.001) were significantly associated with episodes of peritonitis. In multivariate regression analysis, only WBC (OR 24.84; p = 0,012), and peritoneal NGAL levels (OR 136.6; p = 0,01) were independent predictors of peritonitis events. Moreover, AUC for NGAL in peritoneal effluent was 0,936 (p < 0.001) while AUC for CRP, PCT, and WBC count in peritoneal effluent were 0,704 (p = 0.001), 0.762 (p = 0.039), 0,975 (p < 0.001), respectively. Finally, combined WBC and peritoneal NGAL test increased the specificity (= 96%) of the single test. CONCLUSIONS These results identify NGAL in peritoneal effluent as a reliable marker of peritonitis episodes in PD patients. Collectively, our findings demonstrate that the use of peritoneal NGAL cooperatively with current clinical diagnostic tools as a prognostic indicator, presents a valuable diagnostic tool in PD-associated peritonitis.
Collapse
Affiliation(s)
- Francesca Martino
- Dept. of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Elisa Scalzotto
- International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Davide Giavarina
- Clinical Chemistry and Haematology Laboratory, San Bortolo Hospital, Vicenza, Italy
| | - Maria Pia Rodighiero
- Dept. of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Carlo Crepaldi
- Dept. of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Sonya Day
- International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- Dept. of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy
| |
Collapse
|
45
|
Prieto-Velasco M, Isnard Bagnis C, Dean J, Goovaerts T, Melander S, Mooney A, Nilsson EL, Rutherford P, Trujillo C, Zambon R, Crepaldi C. Predialysis education in practice: a questionnaire survey of centres with established programmes. BMC Res Notes 2014; 7:730. [PMID: 25326141 PMCID: PMC4210595 DOI: 10.1186/1756-0500-7-730] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing evidence that renal replacement therapy option education (RRTOE) can result in enhanced quality of life, improved clinical outcomes, and reduced health care costs. However, there is still no detailed guidance on the optimal way to run such programmes. To help address this knowledge gap, an expert meeting was held in March 2013 to formulate a position statement on optimal ways to run RRTOE. Experts were selected from units that had extensive experience in RRTOE or were performing research in this field. Before the meeting, experts completed a pilot questionnaire on RRTOE in their own units. They also prepared feedback on how to modify this questionnaire for a large-scale study. METHODS A pilot, web-based questionnaire was used to obtain information on: the renal unit and patients, the education team, RRTOE processes and content, how quality is assessed, and funding. RESULTS Four nurses, 5 nephrologists and 1 clinical psychologist (9 renal units; 6 EU countries) participated. Nurses were almost always responsible for organising RRTOE. Nephrologists spent 7.5% (median) of their time on RRTOE. Education for the patient and family began several months before dialysis or according to disease progression. Key topics such as the 'impact of the disease' were covered by every unit, but only a few units described all dialysis modalities. Visits to the unit were almost always arranged. Materials came in a wide variety of forms and from a wide range of sources. Group education sessions were used in 3/9 centres. Expectations on the timing of patients' decisions on modality and permanent access differed substantially between centres. Common quality assurance measures were: patient satisfaction, course attendance, updated materials. Only 1 unit had a dedicated budget. CONCLUSIONS There were substantial variations in how RRTOE is run between the units. A modified version of this questionnaire will be used to assess RRTOE at a European level.
Collapse
Affiliation(s)
| | - Corinne Isnard Bagnis
- />Service de Néphrology, Groupe Hospitalier Pitié-Salpêtrière et Chaire de Recherche en Education Thérapeutique, Université Pierre et Marie Curie, Paris, France
| | - Jessica Dean
- />Department of Clinical Health Psychology, Salford Royal Hospital, Salford, M6 8HD UK
| | - Tony Goovaerts
- />Cliniques Universitaires St. Luc, Service de Néphrologie, Brussels, Belgium
| | - Stefan Melander
- />Department of Nephrology, University Hospital of Linköping, Linköping, Sweden
| | - Andrew Mooney
- />Renal Unit, St James’s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF UK
| | - Eva-Lena Nilsson
- />Department of Nephrology and Transplantation, Skånes University Hospital, Malmö, Sweden
| | | | - Carmen Trujillo
- />Unidad clínica de Gestión de Nefrología, Hospital Regional Carlos Haya, Malaga, Spain
| | - Roberto Zambon
- />Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, ULSS106 Vicenza, Italy
| | - Carlo Crepaldi
- />Unità Operativa di Nefrologia, Dialisi e Trapianto, Ospedale San Bortolo, ULSS106 Vicenza, Italy
| |
Collapse
|
46
|
Martino F, Adıbelli Z, Mason G, Nayak A, Ariyanon W, Rettore E, Crepaldi C, Rodighiero M, Ronco C. Home visit program improves technique survival in peritoneal dialysis. Blood Purif 2014; 37:286-90. [PMID: 25133487 DOI: 10.1159/000365168] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a home therapy, and technique survival is related to the adherence to PD prescription at home. The presence of a home visit program could improve PD outcomes. We evaluated its effects on clinical outcome during 1 year of follow-up. METHODS This was a case-control study. The case group included all 96 patients who performed PD in our center on January 1, 2013, and who attended a home visit program; the control group included all 92 patients who performed PD on January 1, 2008. The home visit program consisted of several additional visits to reinforce patients' confidence in PD management in their own environment. Outcomes were defined as technique failure, peritonitis episode, and hospitalization. Clinical and dialysis features were evaluated for each patient. RESULTS The case group was significantly older (p = 0.048), with a lower grade of autonomy (p = 0.033), but a better hemoglobin level (p = 0.02) than the control group. During the observational period, we had 11 episodes of technique failure. We found a significant reduction in the rate of technique failure in the case group (p = 0.004). Furthermore, survival analysis showed a significant extension of PD treatment in the patients supported by the home visit program (52 vs. 48.8 weeks, p = 0.018). We did not find any difference between the two groups in terms of peritonitis and hospitalization rate; however, trends toward a reduction of Gram-positive peritonitis rates as well as prevalence and duration of hospitalization related to PD problems were identified in the case group. The retrospective nature of the analysis was a limitation of this study. CONCLUSION The home visit program improves the survival of PD patients and could reduce the rate of Gram-positive peritonitis and hospitalization. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=365168.
Collapse
Affiliation(s)
- Francesca Martino
- Department of Nephrology, Dialysis, and Kidney Transplant, San Bortolo Hospital, Vicenza, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Crepaldi C, Rosner M, Teixeira C, Martos LB, Martino FK, Rodighiero MP, Ronco C. Is Brain Natriuretic Peptide a Reliable Biomarker of Hydration Status in All Peritoneal Dialysis Patients? Blood Purif 2014; 37:238-42. [DOI: 10.1159/000362155] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 03/11/2014] [Indexed: 11/19/2022]
|
48
|
Fotheringham J, Campbell MJ, Wilkie M, Lopes Barreto D, Sampimon DE, Struijk DG, Krediet RT, Portoles J, Janeiro D, Tato AM, Lopez P, Castellano I, Del Peso G, Rivera M, Fernandez-Reyes MJ, Ortega M, Martinez De Miguel P, Caparros G, Selgas R, Sarmento-Dias M, Santos-Araujo C, Poinhos R, Soares Silva I, Simoes Silva L, Sousa MJ, Correia F, Pestana M, Kang SH, Cho KH, Park JW, Yoon KW, Do JY, Ponce D, Banin V, Bueloni T, Caramori J, Balbi A, Barretti P, Virzi GM, Na HY, Kim YB, Jo YI, Griva K, Yu Z, Foo M, Chang KY, Kim YK, Kim YO, Song HC, Yang CW, Kim SH, Kim YL, Kim YS, Kang SW, Kim NH, Kim HW, Waniewski J, Poleszczuk J, Antosiewicz S, Baczy ski D, Pietribiasi M, Wankowicz Z, Alhwiesh A, Nasreldin MA, Saeed I, Braide M, Milan Manani S, I{middle dot}Nal S, Okyay GU, Ulu MS, Kidir V, Altuntas A, Ahsen A, Unverdi S, Yuksel S, Duranay M, Sezer MT, Mushahar L, Lim WM, Mohd Yusuf WS, Sivathasan S, Ancarani P, Parodi D, Terrile O, Scofferi S, Lenzora G, Martins AR, Vizinho R, Branco PQ, Gaspar MA, Barata JD, Dimkovic N, Lazarevic T, Zdenka M, Pljesa S, Marinkovic J, Djukanovic L, Ahbap E, Kara E, Sahutoglu T, Basturk T, Koc Y, Sakaci T, Sevinc M, Akgol C, Unsal A, Vlahu CA, De Graaff M, Vink H, Struijk DG, Krediet RT, Zeiler M, Marani M, Agostinelli RM, Monteburini T, Marinelli R, Di Luca M, Santarelli S, Moreiras-Plaza M, Blanco-Garcia R, Martin-Baez I, Fernandez-Fleming F, Beato-Coo L, Chang JH, Ro H, Jung JY, Lee HH, Moon SJ, Chung W, Hassan K, Hassan D, Shturman A, Hassan F, Rubinchik I, Hassan S, Atar S, Witoon R, Matsuda A, Tayama Y, Ogawa T, Kogure Y, Okazaki S, Hatano M, Kiba T, Iwashita T, Shimizu T, Hasegawa H, Mitarai T, Rroji ( Molla) M, Seferi S, Burazeri G, Thereska N, Theodoridis M, Gioka T, Bounta T, Kriki P, Mourvati E, Thodis E, Roumeliotis A, Passadakis P, Vargemezis V, Bek S, Eren N, Eraldemir FC, Batman A, Derviso lu E. PERITONEAL DIALYSIS 1. Nephrol Dial Transplant 2014. [DOI: 10.1093/ndt/gfu154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
49
|
Ito M, Emami-Naini A, Keyvandarian N, Moeinzadeh F, Mortazavi M, Taheri S, Io K, Nishino T, Obata Y, Kitamura M, Abe S, Koji T, Kohno S, Wakabayashi K, Hamada C, Nakano T, Kanda R, Io H, Horikoshi S, Tomino Y, Korte MR, Braun N, Habib SM, Goffin E, Summers A, Heuveling L, Betjes MGH, Lambie M, Bankart J, Johnson D, Mactier R, Phillips-Darby L, Topley N, Davies S, Liu FX, Leipold R, Arici M, Farooqui U, Cho KH, Do JY, Kang SH, Park JW, Yoon KW, Jung SY, Sise C, Rutherford P, Kovacs L, Konings S, Pestana M, Zimmermann J, Cramp H, Stein D, Bang K, Shin JH, Jeong J, Kim JH, Matsuo N, Maruyama Y, Nakao M, Tanno Y, Ohkido I, Hayakawa H, Yamamoto H, Yokoyama K, Hosoya T, Iannuzzella F, Corradini M, Belloni L, Stefani A, Parmeggiani M, Pasquali S, Svedberg O, Stenvinkel P, Qureshi AR, Barany P, Heimburger O, Leurs P, Anderstam B, Waniewski J, Antosiewicz S, Baczynski D, Galach M, Wankowicz Z, Prabhu M, Subhramanyam SV, Nayak KS, Hwang JC, Jiang MY, Lu YH, Wang CT, Santos C, Rodriguez-Carmona A, Perez Fontan M, Schaefer B, Macher-Goeppinger S, Bayazit A, Sallay P, Testa S, Holland-Cunz S, Querfeld U, Warady BA, Schaefer F, Schmitt CP, Guney I, Turkmen K, Yazici R, Aslan S, Altintepe L, Yeksan M, Kocyigit I, Sipahioglu M, Orscelik O, Unal A, Celik A, Abbas S, Zhu F, Tokgoz B, Dogan A, Oymak O, Kotanko P, Levin N, Sanchez-Gonzalez MC, Gonzalez-Casaus ML, Gonzalez-Parra E, Albalate M, Lorenzo V, Torregrosa V, Fernandez E, de la Piedra C, Rodriguez M, Zeiler M, Monteburini T, Agostinelli RM, Marinelli R, Santarelli S, Bermond F, Bagnis C, Marcuccio C, Soragna G, Bruno M, Vitale C, Marangella M, Martino F, Scalzotto E, Rodighiero MP, Crepaldi C, Ronco C, Seferi S, Rroji M, Likaj E, Barbullushi M, Thereska N, Kim EJ, Han JH, Koo HM, Doh FM, Kim CH, Ko KI, Lee MJ, Oh HJ, Han SH, Yoo TH, Choi KH, Kang SW, Uzun S, Karadag S, Yegen M, Gursu M, Ozturk S, Aydin Z, Sumnu A, Cebeci E, Atalay E, Kazancioglu R, Alscher D, Fritz P, Latus J, Kimmel M, Biegger D, Lindenmeyer M, Cohen CD, Wuthrich RP, Segerer S, Braun N, Kim YK, Kim HW, Song HC, Choi EJ, Yang CW, Matsuda A, Tayama Y, Ogawa T, Iwanaga M, Okazaki S, Hatano M, Kiba T, Shimizu T, Hasegawa H, Mitarai T, Dratwa M, Collart F, Verger C, Tayama Y, Hasegawa H, Takayanagi K, Iwashita T, Shimizu T, Noiri C, Kiba T, Ogawa T, Inamura M, Nakamura S, Matsuda A, Kato H, Mitarai T, Unal A, Sipahioglu MH, Kocyigit I, Elmali F, Tokgoz B, Oymak O, Zhang X, Ma J, Giuliani A, Blanca-Martos L, Nayak Karopadi A, Mason G, Crepaldi C, Ronco C, Santos MT, Fonseca I, Santos O, Rocha MJ, Carvalho MJ, Cabrita A, Rodrigues A, Scabbia L, Domenici A, Apponi F, Tayefeh Jafari M, Sivo F, Falcone C, Punzo G, Mene P, Yildirim T, Yilmaz R, Azak A, Altindal M, Turkmen E, Arici M, Altun B, Duranay M, Erdem Y, Buyukbakkal M, Eser B, Yayar O, Ercan Z, Kali A, Erdogan B, Haspulat A, Merhametsiz O, Yildirim T, Ulusal-Okyay G, Akdag SI, Ayli MD, Pietrzycka A, Miarka P, Chowaniec E, Sulowicz W, Lutwin M, Gaska M, Paciorek A, Karadag S, Gursu M, Ozturk S, Aydin Z, Uzun S, Sumnu A, Cebeci E, Atalay E, Kazancioglu R. Peritoneal dialysis - A. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
50
|
Yayar O, Buyukbakkal M, Eser B, Yildirim T, Ercan Z, Erdogan B, Kali A, Merhametsiz O, Haspulat A, Akdag I, Ayli MD, Quach T, Tregaskis P, Menahem S, Koukounaras J, Mott N, Walker R, Zeiler M, Santarelli S, Degano G, Monteburini T, Agostinelli RM, Marinelli R, Ceraudo E, Grzelak T, Kramkowska M, Walczak M, Czyzewska K, Guney I, Turkmen K, Yazici R, Arslan S, Altintepe L, Yeksan M, Vaduva C, Popa S, Mota M, Mota E, Wan Md Adnan WAH, Zaharan NL, Moreiras-Plaza M, Blanco-Garcia R, Beato-Coo L, Cossio-Aranibar C, Martin-Baez I, Santos MT, Fonseca I, Santos O, Aguiar P, Rocha MJ, Carvalho MJ, Cabrita A, Rodrigues A, Guo Z, Lai X, Theodoridis M, Panagoutsos S, Thodis E, Karanikas M, Mitrakas A, Kriki P, Kantartzi K, Passadakis P, Vargemezis V, Vakilzadeh N, Pruijm M, Burnier M, Halabi G, Azevedo P, Santos O, Carvalho M, Cabrita A, Rodrigues A, Laplante S, Rutherford P, Shutov E, Isachkina A, Gorelova E, Troya MI, Teixido J, Pedreira G, Del Rio M, Romero R, Bonet J, Zhang X, Ma J, Kim Y, Kim JK, Song YR, Kim SG, Kim HJ, Eloot S, Vanholder R, Van Biesen W, Heaf J, Pedersen C, Elgborn A, Arabaci T, Emrem G, Keles M, Kizildag A, Martino F, Amici G, Rodighiero MP, Crepaldi C, Ronco C, Tanaka H, Tsuneyoshi S, Yamasaki K, Daijo Y, Tatsumoto N, Al-Hilali N, Hussain N, Fathy V, Negm H, Alhilali M, Grzegorzewska A, Cieszynski K, Kaczmarek A, Sowinska A, Soleymanian T, Najafi I, Ganji MR, Ahmadi F, Saddadi F, Hakemi M, Amini M, Tong LNMN, Yongcheng HNMN, Qijun WNMN, Shaodong LNMN, Velioglu A, Albaz M, Arikan H, Tuglular S, Ozener C, Bakirdogen S, Eren N, Mehtap O, Bek SG, Cekmen MB, Yilmaz A, Cabana Carcasi MLL, Fernandez Ferreiro A, Fidalgo Diaz M, Becerra Mosquera V, Alonso Valente R, Buttigieg J, Borg Cauchi A, Rogers M, Buhagiar L, Farrugia Agius J, Vella MP, Farrugia E, Han JH, Kim HR, Ko KI, Kim CH, Koo HM, Doh FM, Lee MJ, Oh HJ, Han SH, Yoo TH, Kang SW, Choi KH, Sikorska D, Frankiewicz D, Klysz P, Schwermer K, Hoppe K, Nealis J, Kaczmarek J, Baum E, Wanic-Kossowska M, Pawlaczyk K, Oko A, Hiss M, Gerstein F, Haller H, Gueler F, Fukasawa M, Manabe T, Wan Q, He Y, Zhu D, Li J, Xu H, Yayar O, Eser B, Buyukbakkal M, Ercan Z, Erdogan B, Merhametsiz O, Yildirim T, Kali A, Haspulat A, Oztemel A, Akdag I, Ayli MD, Pilcevic D, Kovacevic Z, Maksic D, Paunic Z, Tadic-Pilcevic J, Mijuskovic M, Petrovic M, Obrencevic K, Rabrenovic V, Ignjatovic L, Terzic B, Jovanovic D, Chang CH, Chang YS, Busuioc M, Guerraoui A, Caillette-Beaudoin A, Bahte SK, Hiss M, Kielstein JT, Polinder-Bos H, Emmelot-Vonk M, Gaillard C. Peritoneal dialysis II. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|