Global incidence and prevalence of autoimmune hepatitis, 1970-2022: a systematic review and meta-analysis

Background

Autoimmune hepatitis (AIH) varies significantly in incidence and prevalence across countries and regions. We aimed to examine global, regional, and national trends in incidence and prevalence of AIH from 1970 to 2022.

Methods

We conducted a thorough search of the PubMed/MEDLINE, Embase, CINAHL, Google Scholar, and Cochrane databases from database inception to August 9, 2023, using the search term "autoimmune hepatitis" in combination with "incidence," "prevalence," or "trend." Only general population-based observational studies with larger samples sizes were considered for inclusion. Studies that recruited convenience samples, and those with fewer than 50 participants were excluded. Summary data were extracted from published reports. A random effects model was used and pooled estimates with 95% CI were used to calculate the incidence and prevalence of AIH. Heterogeneity was evaluated using the I2 statistic. The study protocol was registered with PROSPERO, CRD42023430138.

Findings

A total of 37 eligible studies, encompassing more than 239 million participants and 55,839 patients with AIH from 18 countries across five continents, were included in the analysis. Global pooled incidence and prevalence of AIH were found to be 1.28 cases per 100,000 inhabitant-years (95% CI, 1.01-1.63, I2 = 99·51%; number of studies, 33; sample population, 220,673,674) and 15.65 cases per 100,000 inhabitants (95% CI, 13.42-18.24, I2 = 99·75%; number of studies, 26; sample population, 217,178,684), respectively. The incidence of AIH was greater in countries with high Human Development Index (>0.92), in North America and Oceania (compared with Asia), among females, adults (compared with children), and high latitude (>45°). Similar patterns in AIH prevalence were observed. Pooled AIH prevalence increased gradually from 1970 to 2019 (1970-1999; 9.95 [4.77-15.13], I2 = 95·58% versus 2015-2022; 27.91 [24.86-30.96], I2 = 99·32%; cases per 100,000 inhabitants). The overall incidence and prevalence of AIH, as well as some subgroup analyses of the studies, displayed asymmetry in the funnel plots, suggesting potential evidence of publication bias.

Interpretation

AIH incidence and prevalence have increased significantly and exhibit substantial variation across regions worldwide. Further research is required to assess the incidence and prevalence of AIH, specifically in South America and Africa.

Funding

National Research Foundation of Korea.

Effect of Statin Use on Liver Cancer Mortality Considering Hypercholesterolemia and Obesity in Patients with Non-Cirrhotic Chronic Hepatitis B

Little is known about the benefits of statin use on liver cancer mortality among patients with chronic hepatitis B (CHB) considering hypercholesterolemia and obesity. A nationwide retrospective cohort study was conducted using data from a Health Examination Cohort of the National Health Insurance Service of Korea. Data on CHB patients with no other concurrent liver disease were acquired, and statin use was defined as a cumulative daily dose ≥28. A 3-year landmark analysis was performed to avoid immortal time bias. Patients who started statin therapy within the landmark date were considered statin users. A Cox regression analysis was applied to assess associations between statin use and liver cancer mortality considering hypercholesterolemia and obesity. Among 13063 patients, 193 (1.5%) died of liver cancer during the mean follow-up period of 10.6 years. After adjusting for demographic and metabolic factors, statin use [hazard ratio (HR), 0.17; 95% confidence interval (CI), 0.04-0.70] and hypercholesterolemia (HR, 0.46; 95% CI, 0.24-0.88 for total cholesterol ≥240 mg/dL) were associated with a decreased risk of liver cancer mortality, whereas body mass index (BMI) ≥30 kg/m² was associated with an increased risk of liver cancer mortality (HR, 2.46; 95% CI, 1.20-5.06). This study showed that statin use was associated with decreased liver cancer mortality when adjusting for cholesterol levels and BMI. This study found that hypercholesterolemia was independently associated with decreased liver cancer mortality regardless of statin use.

A Compressed-Sensing Based Blind Deconvolution Method for Image Deblurring in Dental Cone-Beam Computed Tomography

In cone-beam computed tomography (CBCT), reconstructed images are inherently degraded, restricting its image performance, due mainly to imperfections in the imaging process resulting from detector resolution, noise, X-ray tube's focal spot, and reconstruction procedure as well. Thus, the recovery of CBCT images from their degraded version is essential for improving image quality. In this study, we investigated a compressed-sensing (CS)-based blind deconvolution method to solve the blurring problem in CBCT where both the image to be recovered and the blur kernel (or point-spread function) of the imaging system are simultaneously recursively identified. We implemented the proposed algorithm and performed a systematic simulation and experiment to demonstrate the feasibility of using the algorithm for image deblurring in dental CBCT. In the experiment, we used a commercially available dental CBCT system that consisted of an X-ray tube, which was operated at 90 kV_p and 5 mA, and a CMOS flat-panel detector with a 200-μm pixel size. The image characteristics were quantitatively investigated in terms of the image intensity, the root-mean-square error, the contrast-to-noise ratio, and the noise power spectrum. The results indicate that our proposed method effectively reduced the image blur in dental CBCT, excluding repetitious measurement of the system's blur kernel.

Supplementation with spermine during in vitro maturation of porcine oocytes improves early embryonic development after parthenogenetic activation and somatic cell nuclear transfer

Spermine plays an important role in protection from reactive oxygen species (ROS) in bacteria, yeast, and mammalian cells, but there are few studies on the effects of spermine on porcine oocyte maturation and subsequent embryo development. The aim of this study was to determine the effects of spermine on in vitro maturation (IVM) of porcine oocytes and their developmental competence after parthenogenetic activation (PA) and somatic cell nuclear transfer (SCNT). We evaluated nuclear maturation, intracellular glutathione (GSH), and ROS levels in oocytes, and their subsequent embryonic development, as well as gene expression in mature oocytes, cumulus cells, and PA blastocysts. After treatment with various concentrations of spermine in IVM culture medium, there was no significant difference in nuclear maturation rate. However, spermine treatment groups (10- 500 µM) showed significantly increased intracellular GSH levels and decreased ROS levels compared to the control ( < 0.05). Furthermore, 10 µM spermine supported significantly higher blastocyst formation rates after PA than the control group ( < 0.05). According to the optimal condition from the PA results, we investigated the effects of 10 µM spermine on SCNT, and it also significantly improved blastocyst formation rates compared with the control group ( < 0.05). In evaluating the effects of 10 µM spermine on gene expression, there was significantly lower expression of a proapoptotic gene () and higher expression of an antiapoptotic gene () in cumulus cells ( < 0.05). was increased in spermine-treated oocytes. Levels of transcription for and were significantly increased in PA blastocysts. In conclusion, 10 µM spermine supplementation during IVM improved the development of porcine PA and SCNT embryos by increasing intracellular GSH, scavenging ROS levels, and regulating gene expression.

The effects of canthaxanthin on porcine oocyte maturation and embryo development in vitro after parthenogenetic activation and somatic cell nuclear transfer

The objective of this study was to examine the effects of canthaxanthin (Cx) treatment during in vitro maturation (IVM) of porcine oocytes on embryonic development after parthenogenetic activation (PA) and somatic cell nuclear transfer (SCNT), on intracellular glutathione (GSH) and reactive oxygen species (ROS) levels in mature oocytes, and on gene expression in both PA- and SCNT-derived blastocysts. To determine the optimal effective concentration of Cx, porcine oocytes were cultured in IVM medium supplemented with various concentrations (0, 20, 40 and 80 μM) of Cx for 22 hr. Compared to other groups, supplementation with 40 μM Cx significantly improved blastocyst formation rates after PA (p < .05), but no significant differences were observed among groups in total blastocyst cell numbers. Subsequently, oocytes were cultured in IVM medium supplemented with or without 40 μM Cx. Oocytes treated with 40 μM Cx showed significantly increased cleavage and blastocyst formation rates after SCNT compared to the control group (p < .05). Moreover, significantly increased intracellular GSH and reduced ROS levels were observed in the Cx-treated group (p < .05). In addition, both PA- and SCNT-derived blastocysts from the 40 μM Cx-treated group showed significantly increased mRNA expression of Bcl2 and Oct4 and decreased Caspase3 expression level (p < .05), when compared with the control group. PA-derived blastocysts from the 40 μM Cx-treated group also exhibited significantly decreased expression of Bax (p < .05). Our results demonstrated that treatment with 40 μM Cx during IVM improves the developmental competence of PA and SCNT embryos. Improvement of embryo development by Cx is most likely due to increased intracellular GSH synthesis, which reduces ROS levels in oocytes, and it may also positively regulate apoptosis- and development-related genes.

3D reconstruction based on compressed-sensing (CS)-based framework by using a dental panoramic detector

In this work, we propose a practical method that can combine the two functionalities of dental panoramic and cone-beam CT (CBCT) features in one by using a single panoramic detector. We implemented a CS-based reconstruction algorithm for the proposed method and performed a systematic simulation to demonstrate its viability for 3D dental X-ray imaging. We successfully reconstructed volumetric images of considerably high accuracy by using a panoramic detector having an active area of 198.4 mm × 6.4 mm and evaluated the reconstruction quality as a function of the pitch (p) and the angle step (Δθ). Our simulation results indicate that the CS-based reconstruction almost completely recovered the phantom structures, as in CBCT, for p≤2.0 and θ≤6°, indicating that it seems very promising for accurate image reconstruction even for large-pitch and few-view data. We expect the proposed method to be applicable to developing a cost-effective, volumetric dental X-ray imaging system.

Clinicobiochemical prediction of biopsy-proven cases of severe hepatic fibrosis in patients with chronic hepatitis C infection

OBJECTIVE

To evaluate clinicobiochemical factors predicting severe hepatic fibrosis in patients with chronic hepatitis C virus (HCV) infection.

SETTING

Tertiary institution.

PARTICIPANTS

859 treatment-naïve Korean patients with HCV who underwent liver biopsy. Severe fibrosis was defined as fibrosis stage ≥3 based on the METAVIR system.

PRIMARY OUTCOME MEASURES

Clinicobiochemical factors predicting severe hepatic fibrosis.

RESULTS

The median serum alanine aminotransferase (ALT) level was 68 IU/L and body mass index (BMI) was 24.2 kg/m(2). Severe fibrosis was observed in 326 (39.7%) of the 859 patients. The frequencies of severe fibrosis were 0%, 37.8%, 41.9% and 42% in patients with serum ALT concentrations (IU/L) of ≤20, 20-30, 30-40 and >40 (p<0.01), respectively, and 10.7%, 19.8%, 30.5%, 39.2% and 55.6% in patients <30, 30-40, 40-50, 50-60 and ≥60 years old, respectively (p<0.01). Categorised age in years (50-60 (OR 4.26, p=0.03) and ≥60 (OR 7.53, p<0.01) compared with <30), categorised ALT level in IU/L (20-30 (OR 16.76, p<0.01), 30-40 (OR 20.02, p<0.01) and >40 (OR 21.49, p<0.01) compared with ≤20) and BMI >27.5 kg/m(2) (OR 1.65, p=0.03) were independently related to severe fibrosis in patients with chronic HCV. The severe fibrosis rate was 60.6% in patients aged ≥50 years with ALT >20 IU/L and BMI >27.5 kg/m(2).

CONCLUSIONS

More advanced age (≥50 years), obesity and serum ALT>20 IU/L are associated with severe fibrosis in patients with chronic HCV. Anti-HCV therapy may be considered for these patients without histological confirmation, regardless of HCV genotype. A wait-and-see policy may be justified for patients with serum ALT ≤20 IU/L.

[Effect of S-amlodipine nicotinate on the cerebral circulation in rats under conditions of ischemic and hemorrhagic brain injury]

We have performed a comparative study of the effects of S-amlodipine nicotinate and nimodipine on the local cerebral blood flow were studied in intact rats and those with model ischemic and hemorrhagic brain injury. It is established that S-amlodipine nicotinate produces a somewhat more pronounced enhancement of cerebral blood flow in rats with ischemic and hemorrhagic brain injury than in intact animals. In addition, S-amlodipine nicotinate significantly exceed nimodipine with respect to cerebrovascular activity in rats with brain pathology of both ischemic and hemorrhagic nature.

[Comparative study of the effect of S-amlodipine nicotinate and amlodipine benzylate on the arterial pressure of awake rats]

We have performed a comparative study of the effects of two calcium channel blockers, S-amlodipine nicotinate and amnlodipine benzylate, on the arterial pressure (AP) of awake rats measured in the tail artery. The results of experiments showed that both preparations produce a statistically significant long-term decrease in the AP of animals. In respect of both strength and duration of the hypotensive effect, S-amlodipine nicotinate somewhat exceeds amnlodipine benzylate.

Species-specific challenges in dog cloning

Somatic cell nuclear transfer (SCNT) is now an established procedure used in cloning of several species. SCNT in dogs involves multiple steps including the removal of the nuclear material, injection of a donor cell, fusion, activation of the reconstructed oocytes and finally transfer to a synchronized female recipient. There are therefore many factors that contribute to cloning efficiency. By performing a retrospective analysis of 2005-2012 published papers regarding dog cloning, we define the optimum procedure and summarize the specific feature for dog cloning.

A large-sized phytobezoar located on the rare site of the gastrointestinal tract

Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 7×8 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion.

A New Technique Using Ultra-slim Endoscopy for High-Grade Crohn's Stricture

Crohn's disease (CD) is a chronic inflammatory bowel disease of unknown etiology. Most patients with CD will eventually develop a stricturing or penetrating complication. Colonoscopic findings may predict the clinical course in patients with CD. Moreover, since CD patients are at increased risk for developing dysplasia and colorectal cancer, surveillance colonoscopy is necessary for the detection of malignancies. We describe here a CD patient with a high-grade anorectal stricture who successfully underwent a total colon examination with an ultra-slim upper endoscope after an insertion failure with a standard colonoscope and gastroscope.

Effectiveness of slow freezing and vitrification for long-term preservation of mouse ovarian tissue

This study was conducted to evaluate the interaction between cryo-damage and ART outcome after cryopreservation of mouse ovarian tissues with different methods. Either a vitrification or a slow freezing was employed for the cryopreservation of B6CBAF1 mouse ovaries and follicle growth and the preimplantation development of intrafollicular oocytes following parthenogenesis or IVF were monitored. Both cryopreservation protocols caused significant damage to follicle components, including vacuole formation and mitochondrial deformities. Regardless of the cryopreservation protocols employed, a sharp (P < 0.0001) decrease in follicle viability and post-thaw growth was detected. When IVF program was employed, significant (P < 0.05) decrease in cleavage and blastocyst formation was notable in both modes of cryopreservation. However, such retardation was not found when oocytes were parthenogenetically activated. In the IVF oocytes, slow freezing led to better development than vitrification. In conclusion, a close relationship between cryopreservation and ART methods should be considered for the selection of cryopreservation program.

The influence of seasonal factors on the incidence of peritonitis in continuous ambulatory peritoneal dialysis in the temperate zone

Many factors contribute to the development of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. The role of climate in CAPD peritonitis has received relatively little attention. We retrospectively analyzed the incidence of CAPD peritonitis according to temperature and relative humidity. Data from 80 patients were examined. The monthly mean temperature and relative humidity during study period varied between -3.4 degrees C and 25.4 degrees C and between 61% and 81%, respectively. In 1123 patient-months, 53 cases of peritonitis occurred. The occurrence of peritonitis paralleled temperature and relative humidity, being the highest (0.180 episodes/patient-month) in July (mean temperature, 24.6 degrees C; relative humidity, 81%) and lowest (0.013 episodes/patient-month) in November (mean temperature, 6.6 degrees C; relative humidity, 66%). Significant correlations were seen between the monthly frequency of CAPD peritonitis and temperature (r = 0.53, p < 0.05) and relative humidity (r = 0.59, p < 0.05). The incidence was higher in the warm season (months with a mean temperature > or = 15 degrees C, that is, May-September) than in the cold season (months with a mean temperature < 15 degrees C, that is, October-April), at 0.074 episodes/patient-month versus 0.024 episodes/patient-month, p < 0.05. We also found a tendency for gram-negative peritonitis to occur uniformly throughout the year, but for gram-positive peritonitis to increase during hot and humid months, especially the rainy month of July. Gram-positive organisms caused 50% of peritonitis from March to August, but just 17.7% from September to February. Gram-negative organisms caused 7.3% and 29.4% of peritonitis during the same periods (p < 0.05). The results indicate a clear seasonal change in the rate of CAPD peritonitis and in the causative micro-organisms. The observation that CAPD peritonitis increases in the season of high temperature and high humidity suggests the influence of climate on CAPD peritonitis in the temperate zone.

Assessment of total body water from anthropometry-based equations using bioelectrical impedance as reference in Korean adult control and haemodialysis subjects

BACKGROUND

Several indirect prediction equations to estimate total body water (TBW) with simple demographic and anthropometric data are commonly used by researchers and dialysis units. These equations are largely based on observations in subjects of the Western hemisphere. The purpose of this study was to investigate the possible application of anthropometry-based TBW equations to a Korean adult control population and maintenance haemodialysis (HD) patients using multifrequency bioelectrical impedance analysis (BIA) as reference.

METHODS

We performed BIA and anthropometric measurements in 67 healthy adults and 101 HD patients. Four anthropometry-based equations were used: 58% of actual body weight (TBW-58), the Watson formula (TBW-W), the Hume formula (TBW-H), and the Chertow formula (TBW-C). Multifrequency BIA was performed at fasting state in controls and after HD.

RESULTS

TBW-BIA was 34.6+/-6.9 l in control and 29.9+/-5.1 l in HD patients. TBW-58 and TBW-C gave significantly greater TBWs than TBW-BIA in both control and HD subjects. The correlation coefficients of TBW-BIA with calculated TBWs were lowest in TBW-58 (0.754 in control and 0.856 in HD subjects), and highest in TBW-C (0.944 in control and 0.916 in HD subjects). Mean prediction error was greatest in the Chertow formula for control and HD patients. Mean prediction error, limits of agreement, and root mean square error were lowest between TBW-BIA and TBW-H in control and between TBW-BIA and TBW-W in HD subjects. The correlation coefficient in the Bland-Altman plot was closer to zero and parallel with TBW-W than TBW-H in control and HD subjects.

CONCLUSION

Currently available TBW equations overestimate TBW in both Korean normal control subjects and HD patients. Among them, the Watson formula appears to be the closest to TBW and to have the least bias. Based on this analysis, it is reasonable to use the Watson formula for the calculation of TBW in Korean adult control and HD subjects until an Asian-based TBW equation is available.

A case of living-related kidney transplantation in Bartter's syndrome

Bartter's syndrome is a renal tubular disorder characterized by hypokalemia, metabolic alkalosis, increased urinary excretion of potassium and prostaglandins, a relative vascular resistance to the pressor effects of exogenous angiotensin II, and hyperplasia of the juxtaglomerular apparatus. In most patients, the glomerular filtration rate is normal and chronic renal failure does not develop. We report here on a case of living-related kidney transplantation in Bartter's syndrome, in which a non-steroidal anti-inflammatory drug is suspected to be the cause of the end-stage renal disease.

Effect of dialysis modalities on gastric myoelectrical activity in end-stage renal disease patients

Gastric motility is controlled by gastric myoelectrical activity, which propagates from the proximal body to the distal antrum at a frequency of 3 cycles/min. In uremic patients, dyspeptic symptoms are common. To investigate whether dialysis modality affects gastric myoelectrical activity in uremic patients, we performed electrogastrography (EGG) in 41 patients without diabetes with end-stage renal disease (ESRD) undergoing hemodialysis (HD; n = 22) and continuous ambulatory peritoneal dialysis (CAPD; n = 19). EGG was performed noninvasively using abdominal surface electrodes in the fasting state before and 4 hours after HD and at empty and 2 hours after CAPD with 2,000 mL of dialysate. There were no significant differences in age, sex, body weight, duration of dialysis, and percentage of patients with upper gastrointestinal (UGI) symptoms (63.6% versus 42.1%). CAPD patients had significantly lower serum albumin levels (3.4 +/- 0.4 versus 3.9 +/- 0.4 g/dL; P < 0.05), greater serum total-cholesterol levels (189 +/- 33 versus 157 +/- 36 mg/dL; P: < 0.05), and greater percentages of patient with early satiety (42.1% versus 13.6%; P < 0.05) than HD patients. Dominant power significantly increased after HD (251.3 +/- 157.5 versus 512.9 +/- 390.0 dB; P < 0.05) but seemed to decrease after CAPD without statistical significance (416.2 +/- 323.6 versus 283.8 +/- 280.7 dB). There was no difference in the normal slow-wave frequency (NSWF) between HD and CAPD patients (predialysis, 60.7% +/- 29.3% versus 52.2% +/- 36.7%; postdialysis, 56.3% +/- 32.0% versus 50.9% +/- 34.2%). Tachygastria significantly increased after CAPD (pre-CAPD, 2.35% +/- 4.3% versus post-CAPD, 10.0% +/- 14.8%; P < 0.05). There was a significant correlation between changes in tachygastria after CAPD and grade of early satiety in CAPD patients with UGI symptoms (r = 0.74; P: < 0.05). Changes in NSWF after CAPD significantly correlated with age (r = -0.51; P: < 0.05). In conclusion, dialysis modalities seem to have different effects on gastric myoelectrical activity in patients with ESRD.

Effect of peritoneal glucose load on plasma leptin concentration in continuous ambulatory peritoneal dialysis patients

This study was performed to investigate the effect of peritoneal glucose load on plasma leptin concentrations in the continuous ambulatory peritoneal dialysis (CAPD) performed on 13 non-diabetic ESRD patients. Plasma leptin and insulin concentrations were measured for 2 hours during a single 2 liter exchange of 1.5% glucose-based dialysate (SPD, n = 6), for 7 days of daily peritoneal dialysis (DPD, n = 7). In DPD, standard full volume (2,000 ml x 4 times/day) exchange was performed immediately after operation. In SPD, plasma leptin and insulin concentrations remained unchanged during the study. In DPD, the plasma leptin concentration increased significantly after CAPD on the first day (PD1) (11.2 +/- 5.4 to 17.0 +/- 6.0 ng/mL, p < 0.05) and this elevation seemed to persist until 7 days after operation. After CAPD, there was no significant day-to-day variation in peritoneal glucose absorption (391-465 cal). Oral intake seemed to decrease on operation day (PD0) and PD1 and then increased slowly. Plasma insulin and glucose concentrations did not significantly change after CAPD. Changes of leptin concentration were significantly correlated with the changes of peritoneal glucose absorption at PD1. In conclusion, continuous peritoneal glucose load may affect plasma leptin concentrations in CAPD patients.

Clinical outcomes of immediate full-volume exchange one year after peritoneal catheter implantation for CAPD

OBJECTIVE

To evaluate actual risk of complications and 1-year catheter survival of immediate full-volume 2000-mL dialysate exchange after peritoneal catheter implantation.

DESIGN AND SETTING

A prospective randomized comparative study in a university hospital kidney center.

PATIENTS

The study included 59 end-stage renal disease patients entering into a continuous ambulatory peritoneal dialysis program between January 1996 and December 1997.

INTERVENTIONS

In group 1 (n = 21), exchange volume was gradually increased from 500 mL per 3 hours to full-volume exchange over 13 days. In group 2 (n = 38), full-volume exchange per 6 hours was performed from the day of catheter implantation. Bed rest with minimal activity was recommended for the first 3 days in both groups.

MAIN OUTCOME MEASURES

Occurrence of catheter-related complications such as dialysate leakage, drainage failure, malposition, infectious complications, and, ultimately, catheter loss were observed for 1 year.

RESULTS

After straight Tenckhoff catheter implantation, pericatheter dialysate leaks occurred in 9.5% of group 1 and in 10.5% of group 2 patients (no significance, NS). Within 1 month of implantation, the incidences of tunnel or exit-site infection, catheter malposition, and outflow failure were not significantly different between the two groups. Abdominal discomfort was noted in 2 patients from group 2. Peritonitis occurred in 9.5% and 5.3% (NS) within 2 weeks of catheter implantation, and in 14.3% and 10.5% (NS) after more than 2 weeks in group 1 and group 2, respectively. Early catheter loss within 1 month occurred in 4.8% of patients in group 1 and 5.3% in group 2 (NS). The causes of loss were persistent leakage in group 1, and persistent leakage combined with tunnel infection and outflow failure in group 2. The duration of hospitalization from the day of catheter insertion to discharge was definitely shorter in group 2 compared to group 1 (9.9 +/-0.6 days vs 15.0 +/- 0.8 days, p < 0.001). For 1-year follow-up, the frequencies of peritonitis were 0.062 +/- 0.015/patient-month in group 1 and 0.076 +/- 0.018/patient-month in group 2 (NS). The actual 1-year catheter survival was 85.7% in group 1 and 84.2% in group 2 (NS).

CONCLUSIONS

One-year catheter survival after immediate full-volume peritoneal dialysis exchange was 84.2%. This study did not show any evidence that immediate full-volume exchange causes more short- or long-term complications compared to the stepwise volume increment method.

Measurement of fluid shift in CAPD patients using segmental bioelectrical impedance analysis

OBJECTIVE

To determine, using segmental bioelectrical impedance analysis (BIA), the characteristics of fluid shift of each body segment in continuous ambulatory peritoneal dialysis (CAPD) patients during and after peritoneal dialysis (PD) solution exchange.

DESIGN

Observational study with repeated measurements of bioelectrical impedance, which is inversely related to tissue fluid content.

PATIENTS

Thirteen clinically stable CAPD patients.

METHODS

Bioelectrical impedance was measured at frequencies of 5, 50, 250, and 500 kHz in each body segment four times: (1) before and (2) after drainage of dialysate, and (3) at 1 hour and (4) at 2 hours after exchange of new 1.5% dextrose PD solution.

RESULTS

Impedance of both arms was significantly increased at 1 hour post exchange at all frequencies. In the trunk, impedance at all frequencies increased significantly after drainage, decreased significantly at 1 hour post exchange, and then increased again for the next hour without significance. Impedance of both legs showed a decreasing tendency at all frequencies during and after exchange. Net calculated water volume changes between the time before drainage and 2 hours post exchange were -0.5 L in the trunk, -0.25 L in both arms, +0.47 L in both legs, -0.28 L in total. The change in body weight between the time before drainage and 2 hours post exchange was -0.21 kg, on average, and significantly correlated with total net calculated water volume change (p = 0.009).

CONCLUSIONS

Each body segment of the CAPD patient has its own characteristic pattern of fluid shift in response to PD solution exchange or dwell. Segmental BIA may be a useful tool for understanding the physiological changes in fluid shift in CAPD patients.