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Nagai K, Ueda A. Effect of proactive combination therapy with peritoneal dialysis and hemodialysis on technique survival and mortality. J Artif Organs 2024:10.1007/s10047-024-01437-z. [PMID: 38514529 DOI: 10.1007/s10047-024-01437-z] [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: 08/27/2023] [Accepted: 02/18/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Clinically relevant evidence for the timing of starting combination therapy with peritoneal dialysis and hemodialysis remains scarce. We retrospectively examined whether combination therapy during the induction phase of dialysis prolongs peritoneal dialysis duration. METHODS This retrospective study includes 160 patients who underwent combination therapy from 20 dialysis facilities. Four groups were categorized: combination at peritoneal dialysis induction (n = 12, Proactive combination group), and combination following peritoneal dialysis durations of < 2 years (n = 65), 2-5 years (n = 70), or > 5 years (n = 13). Differences in technique survival of dialysis, mortality, and hospitalization due to cardiovascular events in the groups were observed. RESULTS The Proactive combination group had the longer mean duration of combination therapy (3.18 years) comparing to that of combination therapy following peritoneal dialysis (1.45 years), but total peritoneal dialysis duration was shorter than in control groups (4.02 years). Of the 160 cases in the entire cohort, there were 8 deaths, 18 ischemic heart disease hospitalizations, and 18 stroke hospitalizations. The Proactive group had lower crude mortality rate (0/12 cases, 0.0%) and crude hospitalization rate for ischemic heart disease (1/11, 8.3%) than the other groups. However, this cohort study did not have enough statistical power to adjust for patients' background, and we were unable to fully examine the differences in such clinical outcomes by the timing of initiation of combination therapy. CONCLUSION Use of combination therapy in the induction phase might prolong the duration of combination therapy, but is not necessarily effective for prolonging peritoneal dialysis technique survival.
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Affiliation(s)
- Kei Nagai
- Department of Nephrology, Hitachi General Hospital, 2-1-1 Johnan-Cho, Hitachi, Ibaraki, 317-0077, Japan.
- Department of Nephrology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
| | - Atsushi Ueda
- Department of Nephrology, Hitachi General Hospital, 2-1-1 Johnan-Cho, Hitachi, Ibaraki, 317-0077, Japan
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Altunok M, Çankaya E, Gözübüyük Kaplan H, Çınar E, Uyanık A, Sevinç C. The effect of body mass index on mortality, peritonitis, technique proficiency and residual renal function in peritoneal dialysis patients. Int Urol Nephrol 2024:10.1007/s11255-024-03988-9. [PMID: 38431535 DOI: 10.1007/s11255-024-03988-9] [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: 09/03/2023] [Accepted: 02/12/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND The prevalence of obesity is increasing worldwide. Obesity is also increasing in the chronic kidney disease (CKD) population. There are conflicting data on complications such as mortality, peritonitis, and technique proficiency of peritoneal dialysis (PD) in underweight and obese patients according to body mass index (BMI). We aimed to present the data in our region to the literature by comparing the residual renal function (RRF), peritonitis, technique proficiency, and mortality rates of the patients we grouped according to BMI. METHODS The data of 404 patients who were started and followed up in our clinic between March 2005 and November 2021 were evaluated retrospectively. They were grouped as underweight, normal weight, overweight, and obese according to BMI. RRF, mortality, technique proficiency and peritonitis data of the groups were compared. RESULTS Of the 404 patients, 44 were underweight, 199 were normal weight, 110 were overweight, and 55 were obese. No difference was found between the groups in the technique survey and in the time to first peritonitis with Kaplan-Meier analysis (respectively; p = 0.610, p = 0.445). Multivariate Cox regression analysis showed that BMI did not affect mortality (HR 1.196 [95% CI 0.722-1.981] (p = 0.488)). CONCLUSION In conclusion, we report that BMI has no effect on RRF, peritonitis, technique proficiency, and mortality in patients undergoing PD, and that mortality may depend on additional factors such as mean albumin, time to first peritonitis, and loss of RRF.
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Affiliation(s)
- Murat Altunok
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey.
| | - Erdem Çankaya
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | | | - Enes Çınar
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Abdullah Uyanık
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
| | - Can Sevinç
- Department of Nephrology, Faculty of Medicine, Atatürk University, 25240, Erzurum, Turkey
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Tran E, Karadjian O, Chan CT, Trinh E. Home hemodialysis technique survival: insights and challenges. BMC Nephrol 2023; 24:205. [PMID: 37434110 PMCID: PMC10337160 DOI: 10.1186/s12882-023-03264-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 07/06/2023] [Indexed: 07/13/2023] Open
Abstract
Home hemodialysis (HHD) offers several clinical, quality of life and cost-saving benefits for patients with end-stage kidney disease. While uptake of this modality has increased in recent years, its prevalence remains low and high rates of discontinuation remain a challenge. This comprehensive narrative review aims to better understand what is currently known about technique survival in HHD patients, elucidate the clinical factors that contribute to attrition and expand on possible strategies to prevent discontinuation. With increasing efforts to encourage home modalities, it is imperative to better understand technique survival and find strategies to help maintain patients on the home therapy of their choosing. It is crucial to better target high-risk patients, examine ideal training practices and identify practices that are potentially modifiable to improve technique survival.
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Affiliation(s)
- Estelle Tran
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Oliver Karadjian
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada
| | | | - Emilie Trinh
- Division of Nephrology, Department of Medicine, McGill University Health Center, 1650 Av Cedar, L4-510, Montreal, QC, H3G 1A4, Canada.
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4
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Xu X, Ma T, Tian X, Li S, Pei H, Zhao J, Zhang Y, Xiong Z, Liao Y, Li Y, Lin Q, Hu W, Li Y, Zheng Z, Duan L, Fu G, Guo S, Zhang B, Yu R, Sun F, Ma X, Hao L, Liu G, Zhao Z, Xiao J, Shen Y, Zhang Y, Du X, Ji T, Wang C, Deng L, Yue Y, Chen S, Ma Z, Li Y, Zuo L, Zhao H, Zhang X, Wang X, Liu Y, Gao X, Chen X, Li H, Du S, Zhao C, Xu Z, Zhang L, Chen H, Li L, Wang L, Yan Y, Ma Y, Wei Y, Zhou J, Li Y, Zheng Y, Wang J, Zhao M, Dong J. Telemedicine and Clinical Outcomes in Peritoneal Dialysis: A Propensity-Matched Study. Am J Nephrol 2022; 53:663-674. [PMID: 35977460 DOI: 10.1159/000525917] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/08/2022] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Telemedicine (TM) has shown to provide potential benefits on clinical outcomes in patients with chronic kidney disease but limited evidences published in the peritoneal dialysis (PD) population. This study aimed to explore the long-term effects of TM on the mortality and technique failure. METHODS The Peritoneal Dialysis Telemedicine-assisted Platform Cohort Study (PDTAP Study) was conducted prospectively in 27 hospitals in China since 2016. Patient and practice data were collected through the doctor-end of the TM app (Manburs) for all participants. TM including self-monitoring records, on-line education materials, and real-time physician-patient contact was only performed for the patient-end users of the Manburs. The primary outcome was all-cause mortality. The secondary outcomes were cause-specific mortality and all-cause and cause-specific permanent transfer to hemodialysis. RESULTS A total of 7,539 PD patients were enrolled between June 2016 and April 2019, with follow-up till December 2020. Patients were divided into two cohorts: TM group (39.1%) and non-TM group (60.9%). A propensity score was used to create 2,160 matched pairs in which the baseline covariates were well-balanced. There were significantly lower risks of all-cause mortality (HR 0.59 [0.51, 0.67], p < 0.001), CVD mortality (HR 0.59 [0.49, 0.70], p < 0.001), all-cause transfer to hemodialysis (0.57 [0.48, 0.67], p < 0.001), transfer to hemodialysis from PD-related infection (0.67 [0.51, 0.88], p = 0.003), severe fluid overload (0.40 [0.30, 0.55], p < 0.001), inadequate solute clearance (0.49 [0.26, 0.92], p = 0.026), and catheter-related noninfectious complications (0.41 [0.17, 0.97], p = 0.041) in the TM group compared with the non-TM group. CONCLUSION This study indicated real-world associations between TM usage and reduction in patient survival and technique survival through a multicenter prospective cohort.
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Affiliation(s)
- Xiao Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Tiantian Ma
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Xue Tian
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Shaomei Li
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University, Hebei, China
| | - Huaying Pei
- Renal Division, Department of Medicine, The Second Hospital of Hebei Medical University, Hebei, China
| | - Jinghong Zhao
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ying Zhang
- Department of Nephrology, The Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Chongqing Clinical Research Center of Kidney and Urology Diseases, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Zibo Xiong
- Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Guangdong, China
| | - Yumei Liao
- Renal Division, Department of Medicine, Peking University Shenzhen Hospital, Guangdong, China
| | - Ying Li
- Renal Division, Department of Medicine, The Third Hospital of Hebei Medical University, Hebei, China
| | - Qiongzhen Lin
- Renal Division, Department of Medicine, The Third Hospital of Hebei Medical University, Hebei, China
| | - Wenbo Hu
- Renal Division, Department of Medicine, People's Hospitel of Qinghai Province, Qinghai, China
| | - Yulin Li
- Renal Division, Department of Medicine, People's Hospitel of Qinghai Province, Qinghai, China
| | - Zhaoxia Zheng
- Renal Division, Department of Medicine, Handan Central Hospital, Hebei, China
| | - Liping Duan
- Renal Division, Department of Medicine, Handan Central Hospital, Hebei, China
| | - Gang Fu
- Renal Division, Department of Medicine, Peking Haidian Hospital, Beijing, China
| | - Shanshan Guo
- Renal Division, Department of Medicine, Peking Haidian Hospital, Beijing, China
| | - Beiru Zhang
- Renal Division, Department of Medicine, Shengjing Hospital Affiliated to China Medical University, Jilin, China
| | - Rui Yu
- Renal Division, Department of Medicine, Shengjing Hospital Affiliated to China Medical University, Jilin, China
| | - Fuyun Sun
- Renal Division, Department of Medicine, Cangzhou Central Hospital, Hebei, China
| | - Xiaoying Ma
- Renal Division, Department of Medicine, Cangzhou Central Hospital, Hebei, China
| | - Li Hao
- Renal Division, Department of Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Guiling Liu
- Renal Division, Department of Medicine, The Second Affiliated Hospital of Anhui Medical University, Anhui, China
| | - Zhanzheng Zhao
- Renal Division, Department of Medicine, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Jing Xiao
- Renal Division, Department of Medicine, The First Affiliated Hospital of Zhengzhou University, Henan, China
| | - Yulan Shen
- Renal Division, Department of Medicine, Beijing Miyun District Hospital, Beijing, China
| | - Yong Zhang
- Renal Division, Department of Medicine, Beijing Miyun District Hospital, Beijing, China
| | - Xuanyi Du
- Renal Division, Department of Medicine, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Tianrong Ji
- Renal Division, Department of Medicine, The Second Affiliated Hospital of Harbin Medical University, Heilongjiang, China
| | - Caili Wang
- Renal Division, Department of Medicine, The First Affiliated Hospital of BaoTou Medical College, Neimenggu, China
| | - Lirong Deng
- Renal Division, Department of Medicine, The First Affiliated Hospital of BaoTou Medical College, Neimenggu, China
| | - Yingli Yue
- Renal Division, Department of Medicine, People's Hospital of Langfang, Hebei, China
| | - Shanshan Chen
- Renal Division, Department of Medicine, People's Hospital of Langfang, Hebei, China
| | - Zhigang Ma
- Renal Division, Department of Medicine, People's Hospital of Gansu, Gansu, China
| | - Yingping Li
- Renal Division, Department of Medicine, People's Hospital of Gansu, Gansu, China
| | - Li Zuo
- Renal Division, Department of Medicine, Peking University People's Hospital, Beijing, China
| | - Huiping Zhao
- Renal Division, Department of Medicine, Peking University People's Hospital, Beijing, China
| | - Xianchao Zhang
- Renal Division, Department of Medicine, Pingdingshan First People's Hospital, Henan, China
| | - Xuejian Wang
- Renal Division, Department of Medicine, Pingdingshan First People's Hospital, Henan, China
| | - Yirong Liu
- Renal Division, Department of Medicine, The First People's Hospital of Xining, Qinghai, China
| | - Xinying Gao
- Renal Division, Department of Medicine, The First People's Hospital of Xining, Qinghai, China
| | - Xiaoli Chen
- Renal Division, Department of Medicine, Taiyuan Central Hospital, Shanxi, China
| | - Hongyi Li
- Renal Division, Department of Medicine, Taiyuan Central Hospital, Shanxi, China
| | - Shutong Du
- Renal Division, Department of Medicine, Cangzhou People's Hospital, Hebei, China
| | - Cui Zhao
- Renal Division, Department of Medicine, Cangzhou People's Hospital, Hebei, China
| | - Zhonggao Xu
- Renal Division, Department of Medicine, First Hospital of Jilin University, Jilin, China
| | - Li Zhang
- Renal Division, Department of Medicine, First Hospital of Jilin University, Jilin, China
| | - Hongyu Chen
- Renal Division, Department of Medicine, The People's Hospital of Chuxiong Yi Autonomous Prefecture, Yunnan, China
| | - Li Li
- Renal Division, Department of Medicine, The People's Hospital of Chuxiong Yi Autonomous Prefecture, Yunnan, China
| | - Lihua Wang
- Renal Division, Department of Medicine, The Second Hospital of Shanxi Medical University, Shanxi, China
| | - Yan Yan
- Renal Division, Department of Medicine, The Second Hospital of Shanxi Medical University, Shanxi, China
| | - Yingchun Ma
- Renal Division, Department of Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Yuanyuan Wei
- Renal Division, Department of Medicine, China Rehabilitation Research Center, Beijing Boai Hospital, Beijing, China
| | - Jingwei Zhou
- Renal Division, Department of Medicine, Beijing Dongzhimen Hospital, Beijing, China
| | - Yan Li
- Renal Division, Department of Medicine, Beijing Dongzhimen Hospital, Beijing, China
| | - Yingdong Zheng
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
| | - Jie Dong
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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Wang IK, Yu TM, Yen TH, Yip HT, Lai PC, Li CY, Sun KT, Sung FC. The impact of multidisciplinary pre-dialysis care on the outcomes of incident peritoneal dialysis patients. BMC Nephrol 2022; 23:173. [PMID: 35513793 PMCID: PMC9069744 DOI: 10.1186/s12882-022-02800-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 04/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background This study aims to evaluate the impact of multidisciplinary pre-dialysis care (MDPC) on the risks of peritonitis, technique failure and mortality in peritoneal dialysis (PD) patients. Methods Incident end-stage kidney disease patients who received peritoneal dialysis (PD) for more than 90 days were recruited in this study from 1 January 1, 2007 to December 31, 2018. Patients were classified into two groups, the MDPC group and the control group, that received the usual care by nephrologists. Risks of the first episode of peritonitis, technique failure and mortality were compared between the two groups. Results There were 126 patients under the usual care and 546 patients under the MDPC. Patients in the MDPC group initiated dialysis earlier than those in the non-MDPC group. There was no significant difference between these two groups in time to the first episode of peritonitis. Compared to the non-MDPC group, the MDPC group was at similar risks of technique failure (adjusted HR = 0.85, 95% CI = 0.64–1.15) and mortality (adjusted HR = 0.66, 95% CI = 0.42–1.02). Among patients with diabetes, the risk of mortality was significantly reduced in the MDPC group with an adjusted HR of 0.45 (95% CI = 0.25–0.80). Conclusions There was no significant difference in time to develop the first episode of peritonitis, and risks of technique failure and mortality between these two groups. Diabetic PD patients under MDPC had a lower risk of mortality than those under the usual care.
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Affiliation(s)
- I-Kuan Wang
- Graduate Institute of Biological Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan.,Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Tung-Min Yu
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hei-Tung Yip
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Ping-Chin Lai
- Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Graduate Institute of Biological Sciences, College of Medicine, China Medical University, Taichung, Taiwan.,Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Kuo-Ting Sun
- Department of Dentistry, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan. .,Department of Health Services Administration, China Medical University College of Public Health, Taichung, 404, Taiwan. .,Department of Food Nutrition and Health Biotechnology, Asia University, 500 Lioufeng Rd., Wufeng, Taichung, 413, Taiwan.
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Uchiyama K, Washida N, Kusahana E, Nakayama T, Morimoto K, Itoh H. Eosinophilic Reaction at the Time of Catheter Insertion Predicts Survival in Patients Initiating Peritoneal Dialysis. Blood Purif 2021; 51:355-364. [PMID: 34284388 DOI: 10.1159/000517349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/29/2020] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Despite excellent biocompatibility, insertion of silicone peritoneal dialysis (PD) catheters can induce minor foreign body reaction, affecting long-term patient outcomes. We evaluated the effect of eosinophilic reaction associated with PD catheter insertion on outcomes of patients initiating PD. METHODS Eosinophilic reaction to PD catheter insertion was defined as the ratio of peripheral blood eosinophil count at 1 week after insertion (E1W) to pre-insertion eosinophil count (E0), and the association of E1W/E0 with technique survival, peritonitis-free survival, and heart failure (HF)-related hospitalization-free survival was analyzed. RESULTS This retrospective cohort study included 116 patients (89 male patients) who underwent PD catheter insertion between January 2008 and June 2018 (61.3 ± 12.9 years). The follow-up duration was 46.2 (23.8-75.3) months. E1W was significantly higher than E0 (median, 333 vs. 234/μL, p < 0.001), with a median E1W/E0 of 1.54. The log-rank test showed that technique survival, peritonitis-free survival, and HF-related hospitalization-free survival were significantly better in patients with E1W/E0 < 1.54 than in those with E1W/E0 ≥ 1.54 (p = 0.002, <0.001, and <0.001, respectively). By the Cox regression analysis adjusted for age, sex, the Charlson comorbidity index, the estimated glomerular filtration rate, and the geriatric nutritional risk index, E1W/E0 remained a significant risk factor for technique failure, peritonitis, and hospitalization for HF (hazard ratio (HR) 1.68, p = 0.01; HR 2.19, p < 0.001; HR 2.15, p < 0.001, respectively). CONCLUSION Eosinophilic reaction at the time of PD catheter insertion is a novel marker that may predict outcomes in patients initiating PD.
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Affiliation(s)
- Kiyotaka Uchiyama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Washida
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.,Department of Nephrology, International University of Health and Welfare School of Medicine, Chiba, Japan
| | - Ei Kusahana
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashin Nakayama
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kohkichi Morimoto
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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Boyer A, Lanot A, Lambie M, Verger C, Guillouet S, Lobbedez T, Béchade C. Trends in Peritoneal Dialysis Technique Survival, Death, and Transfer to Hemodialysis: A Decade of Data from the RDPLF. Am J Nephrol 2021; 52:318-327. [PMID: 33906190 DOI: 10.1159/000515472] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/24/2021] [Indexed: 01/29/2023]
Abstract
INTRODUCTION There is limited information on the trends of peritoneal dialysis (PD) technique survival over time. This study aimed to estimate the effect of calendar time on technique survival, transfer to hemodialysis (HD) (and the individual causes of transfer), and patient survival. METHODS This retrospective, multicenter study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 14,673 patients who initiated PD in France between January 1, 2005, and December 31, 2016. Adjusted Cox regressions with robust variance were used to examine the probability of a composite end point of either death or transfer to HD, death, and transfer to HD, accounting for the nonlinear impact of PD start time. RESULTS There were 10,201 (69.5%) cases of PD cessation over the study period: 5,495 (37.4%) deaths and 4,706 (32.1%) transfers to HD. The rate of PD cessation due to death or transfer to HD decreased over time (PR 0.96, 95% CI: 0.95-0.97). Compared to 2009-2010, starting PD between 2005 and 2008 or 2011 and 2016 was strongly associated with a lower rate of transfer to HD (PR 0.88, 95% CI: 0.81-0.96, and PR 0.91, 95% CI: 0.84-0.99, respectively), mostly due to a decline in the rate of infection-related transfers to HD (PR 0.96, 95% CI: 0.94-0.98). CONCLUSIONS Rates of the composite end point of either death or transfer to HD, death, and transfer to HD have decreased in recent decades. The decline in transfers to HD rates, observed since 2011, is mainly the result of a significant decline in infection-related transfers.
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Affiliation(s)
- Annabel Boyer
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
| | - Antoine Lanot
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Mark Lambie
- Renal Unit, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, United Kingdom
- Faculty of Medicine and Health Sciences, Keele University, Newcastle, United Kingdom
| | | | - Sonia Guillouet
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Thierry Lobbedez
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
| | - Clémence Béchade
- Centre Universitaire des Maladies Rénales, CHU de Caen, Caen, France
- U1086 INSERM, ANTICIPE, Centre Régional de Lutte contre le Cancer, François Baclesse, Caen, France
- Normandie Université, Unicaen, UFR de médecine, Caen, France
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Díaz Cuevas M, Limón Ramírez R, Pérez Contreras FJ, Gómez Roldán C. Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study. Nefrologia 2021; 41:53-61. [PMID: 36165362 DOI: 10.1016/j.nefroe.2020.05.005] [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: 10/29/2019] [Accepted: 05/04/2020] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS The study included 2243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, p = .004), and they were on average younger (48 years vs 55 years, p < .001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, p < .001). Patients with PGN also had more transplants (48,9%, p < .001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, p < .001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0-169,9] vs 110,3 months [95% CI: 100,8-119,7], p < .001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (p = .018). Factors with a negative influence on mortality were being older (p < .001) and having any comorbidity, mainly diabetes and liver disease (p < .001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (p = .001). CONCLUSIONS PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.
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Affiliation(s)
- María Díaz Cuevas
- Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, Spain.
| | - Ramón Limón Ramírez
- Subdirección General de Evaluación de la Gestión Asistencial, Dirección General de Asistencia Sanitaria, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
| | | | - Carmen Gómez Roldán
- Servicio de Nefrología, Hospital General Universitario de Albacete, Albacete, Spain
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9
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Phang CC, Foo MWY, Johnson DW, Wu SY, Hao Y, Jayaballa M, Koniman R, Chan CM, Oei EL, Chong TT, Htay H. Comparison of outcomes of urgent-start and conventional-start peritoneal dialysis: a single-centre experience. Int Urol Nephrol 2020; 53:583-590. [PMID: 32895864 DOI: 10.1007/s11255-020-02630-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/22/2020] [Accepted: 08/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND There has been a growing interest in urgent-start peritoneal dialysis (PD) in patients with end-stage kidney disease to avoid central venous catheter use and its complications. This study aimed to compare clinical outcomes between urgent-start PD (defined as PD commencement within 2 weeks of PD catheter insertion) and conventional-start PD. METHODS This was a single-centre retrospective cohort study of all incident PD patients at Singapore General Hospital between January 2017 and February 2018. The primary outcome was dialysate leak. Secondary outcomes included catheter malfunction, catheter readjustment, exit-site infection, peritonitis, technique and patient survival. RESULTS A total of 187 incident PD patients were included. Of these, 66 (35%) initiated urgent-start PD. Dialysate leak was significantly higher in urgent-start PD compared with conventional-start PD groups (7.6% versus 0.8%; p = 0.02) whilst catheter malfunction (4.5% vs. 3.3%; p = 0.70) and catheter readjustment (1.5% vs. 2.5%; p = 1.00) were comparable between the two groups. Exit-site infection was comparable (IRR: 0.66 95% CI 0.25-1.74) whilst peritonitis was significantly higher in urgent-start PD compared with conventional-start PD (incidence risk ratio (IRR) 3.10, 95% confidence interval (CI) 1.29-7.44). Time to first episode of peritonitis, particularly Gram-positive peritonitis was significantly shorter with urgent-start PD. Technique survival (hazards ratio (HR) 1.95, 95% CI 0.89-4.31) and patient survival (HR 1.46, 95% CI 0.44-4.87) were comparable between the two groups. CONCLUSION Urgent-start PD was associated with higher risks of dialysate leak and peritonitis but comparable technique and patient survival compared to conventional-start PD.
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Affiliation(s)
- Chee Chin Phang
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Marjorie Wai Yin Foo
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - David W Johnson
- Princess Alexandra Hospital, Brisbane, Australia.,Centre for Kidney Disease Research, University of Queensland, Brisbane, Australia.,Translational Research Institute, Brisbane, Australia.,Metro South and Ipswich Nephrology and Transplant Services (MINTS), Logan City, Australia
| | - Sin Yan Wu
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Ying Hao
- Health Services Research Centre (HSRC), Singapore Health Services (SingHealth), Singapore, Singapore
| | - Mathini Jayaballa
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Riece Koniman
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Choong Meng Chan
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Elizabeth Ley Oei
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore
| | - Tze Tec Chong
- Department of General Surgery, Singapore General Hospital, Singapore, Singapore
| | - Htay Htay
- Department of Renal Medicine, Singapore General Hospital, Academia, Level 3, 20 College Road, Singapore, 169856, Singapore.
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10
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Díaz Cuevas M, Limón Ramírez R, Pérez Contreras FJ, Gómez Roldán C. Peritoneal dialysis in incident patients with primary glomerulonephritis. Results of a 20-year multicenter registry study. Nefrologia 2020; 41:53-61. [PMID: 32800597 DOI: 10.1016/j.nefro.2020.05.009] [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: 10/29/2019] [Revised: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Glomerulonephritis (GN) is one of the main causes of chronic terminal kidney disease; however, few studies assess its prognosis in dialysis. We analyze the survival and characteristics of patients on peritoneal dialysis (PD) with primary GN (PGN), and compare their results with other kidney patients. METHODS This prospective observational study took place from 1995 to 2014. We included all incident patients who were initiated on the technique in the Levante registry. Data were transferred to an anonymized database in Access. Statistical analysis was performed using SPSS software (version 19.0). RESULTS The study included 2,243 patients, with GN representing the main cause of primary kidney disease (21,5%). IgA nephropathy was the most frequent histologically confirmed form of PGN. Compared with the rest of the sample, patients with PGN were more often men (65% vs 58%, P=.004), and they were on average younger (48 years vs 55 years, P<.001). They also had fewer comorbidities and a higher rate of inclusion on the waitlist for a kidney transplant (87 vs 63%, P<.001). Patients with PGN also had more transplants (48,9%, P<.001), and this was the most frequent reason for stopping PD; beyond that, their peritonitis mean rate was lower (0,34 vs 0,45 episodes/patient-year, P<.001). Technique survival was 90,6% at one year, 71,7% at 3 years, and 59,0% at 5 years (median 76,8 months); there were no differences between groups. Survival was 94,9% at one year, 80,1% at 3 years, and 63,7% at 5 years (median 90,7 months). Patients with PGN showed better mean survival than patients with other kidney pathologies (153,5 months [95% IC: 137,0 to 169,9] vs 110,3 months [95% CI: 100,8 to 119,7], P<.001). In the multivariable analysis, the main negative risk factor influencing technique survival was a higher peritoneal transport (P=.018). Factors with a negative influence on mortality were being older (P <.001) and having any comorbidity, mainly diabetes and liver disease (P <.001). By contrast, protective survival factors were inclusion on the transplant waitlist and a higher baseline residual renal function (P=.001). CONCLUSIONS PD has several advantages as a first dialytic treatment, and our results suggest that it is an excellent technique to manage patients with PGN while they await a kidney transplant.
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Affiliation(s)
- María Díaz Cuevas
- Servicio de Nefrología, Hospital General Universitario de Alicante, Alicante, España.
| | - Ramón Limón Ramírez
- Subdirección General de Evaluación de la Gestión Asistencial, Dirección General de Asistencia Sanitaria, Conselleria de Sanitat Universal i Salut Pública, Valencia, España
| | | | - Carmen Gómez Roldán
- Servicio de Nefrología, Hospital General Universitario de Albacete, Albacete, España
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11
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Rydell H, Ivarsson K, Almquist M, Clyne N, Segelmark M. Fewer hospitalizations and prolonged technique survival with home hemodialysis- a matched cohort study from the Swedish Renal Registry. BMC Nephrol 2019; 20:480. [PMID: 31888674 PMCID: PMC6937632 DOI: 10.1186/s12882-019-1644-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/06/2019] [Accepted: 11/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients on home hemodialysis (HHD) exhibit superior survival compared with patients on institutional hemodialysis (IHD) and peritoneal dialysis (PD). There is a sparsity of reports comparing morbidity between HHD and IHD or PD and none in a European population. The aim of this study is to compare morbidity between modalities in a Swedish population. METHODS The Swedish Renal Registry was used to retrieve patients starting on HHD, IHD or PD. Patients were matched according to sex, age, comorbidity and start date. The Swedish Inpatient Registry was used to determine comorbidity before starting renal replacement therapy (RRT) and hospital admissions during RRT. Dialysis technique survival was compared between HHD and PD. RESULTS RRT was initiated with HHD for 152 patients; these were matched with 608 patients with IHD and 456 with PD. Patients with HHD had significantly lower annual admission rate and number of days in hospital. (median 1.7 admissions; 12 days) compared with IHD (2.2; 14) and PD (2.8; 20). The annual admission rate was significantly lower for patients with HHD compared with IHD for cardiovascular diagnoses and compared with PD for infectious disease diagnoses. Dialysis technique survival was significantly longer with HHD compared with PD. CONCLUSIONS Patients choosing HHD as initial RRT spend less time in hospital compared with patients on IHD and PD and they were more likely than PD patients, to remain on their initial modality. These advantages, in combination with better survival and higher likelihood of renal transplantation, are important incentives for promoting the use of HHD.
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Affiliation(s)
- Helena Rydell
- Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Njurmedicin exp A5:04, 171 76, Stockholm, Sweden.
| | - Kerstin Ivarsson
- Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Njurmedicin exp A5:04, 171 76, Stockholm, Sweden
| | - Martin Almquist
- Department of Clinical Sciences Lund, Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Naomi Clyne
- Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Njurmedicin exp A5:04, 171 76, Stockholm, Sweden
| | - Mårten Segelmark
- Department of Clinical Sciences Lund, Nephrology, Lund University, Skane University Hospital, Njurmedicin exp A5:04, 171 76, Stockholm, Sweden.,Department of Nephrology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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12
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Prasad N, Rangaswamy D, Patel M, Gulati S, Bhadauria D, Kaul A, Gupta A. Long-term outcomes in children on chronic continuous ambulatory peritoneal dialysis: a retrospective cohort study from a developing country. Pediatr Nephrol 2019; 34:2389-2397. [PMID: 31468143 DOI: 10.1007/s00467-019-04311-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease. METHODS To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes. RESULTS A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months). CONCLUSION CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Dharshan Rangaswamy
- Department of Nephrology (Pediatric), Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal (Udupi), 576104, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Sanjeev Gulati
- Pediatric Nephrology, Fortis Group of Hospitals, New Delhi, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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13
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Stepanova N, Burdeyna O. Association between Dyslipidemia and Peritoneal Dialysis Technique Survival. Open Access Maced J Med Sci 2019; 7:2467-2473. [PMID: 31666849 PMCID: PMC6814482 DOI: 10.3889/oamjms.2019.664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/21/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND: A large body of research has investigated the effects of pro-atherogenic lipid profile on cardiovascular diseases (CVD) in peritoneal dialysis (PD) patients. However, there is a general lack of research on the association between atherogenic dyslipidemia and PD technique survival. AIM: The study aimed to define the association between dyslipidemia and PD technique survival. METHODS: It was a prospective single-centre observational study involving 40 outpatients on continuous ambulatory PD treatment for more than 3 months between 2010 and 2016 in a single centre in Ukraine. There were 27 males and 13 females. The mean age of the participants was 49.3 ± 12.2 years. The primary outcome measures were all-cause technique failure. RESULTS: Atherogenic dyslipidemia was identified in 28/40 (70 %) patients and correlated with PD adequacy parameters. During the 36-month- follow-up period technique failure occurred in 2/12 (16.6 %) patients with atherogenic dyslipidemia compared with 12 / 28 (42.9 %) patients without atherogenic dyslipidemia (χ2 = 2.5; p = 0.12). In the univariate Cox regression model, atherogenic dyslipidemia at baseline was significantly associated with a higher risk of all-cause PD technique failure (HR 4.5; 95% CI 1.6 to 12.9; χ2 = 5.5, p = 0.019). CONCLUSION: The presence of atherogenic dyslipidemia was significantly associated with a higher risk of technique failure in PD patients. This is an important issue for future research. Further well-designed clinical trials are needed to determine the impact of dyslipidemia on PD adequacy and technique survival.
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Affiliation(s)
- Natalia Stepanova
- Department of Nephrology and Dialysis, State Institution "Institute of Nephrology of the National Academy of Medical Sciences of Ukraine"Kiev, Ukraine
| | - Olena Burdeyna
- Department of Nephrology and Dialysis, State Institution "Institute of Nephrology of the National Academy of Medical Sciences of Ukraine"Kiev, Ukraine
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14
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Ye H, Yang X, Yi C, Guo Q, Li Y, Yang Q, Chen W, Mao H, Li J, Qiu Y, Zheng X, Zhang D, Lin J, Li Z, Jiang Z, Huang F, Yu X. Urgent-start peritoneal dialysis for patients with end stage renal disease: a 10-year retrospective study. BMC Nephrol 2019; 20:238. [PMID: 31266466 PMCID: PMC6604308 DOI: 10.1186/s12882-019-1408-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [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: 04/26/2018] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
Background Urgent-start peritoneal dialysis (PD) can help patients with end-stage renal diseases (ESRD) that are referred late to dialysis. However, catheter patency and related complications of urgent-start PD have not been thoroughly clarified. We investigated the clinical outcomes of urgent-start PD in a Chinese cohort. Methods We enrolled ESRD patients who received urgent-start PD (starting PD within 14 days after catheter insertion) in our center from January 1, 2006 to December 31, 2014, and followed them up for 10 years. The primary outcome was catheter failure. Secondary outcomes included short-term and long-term complications related to urgent-start PD. Results Totally 2059 patients (58.9% male, mean age 47.6 ± 15.9 years) were enrolled. Few perioperative complications were observed, including significant hemorrhage (n = 3, 0.1%) and bowel perforation (n = 0). Early peritonitis occurred in 24 (1.2%) patients (0.28 episodes per patient-year). Within the first month after catheter insertion, functional catheter malfunction occurred in 85 (4.1%) patients, and abdominal wall complications (including hernia, hydrothorax, hydrocele, and leakage) in 36 (1.7%) patients. During a median 36.5 (17.7–61.4) months of follow-up, 75 (3.6%) patients experienced catheter failure, and 291 (14.1%) had death-censoring technique failure. At the end of 1-month, 1 -year, 3-year, and 5-year, catheter patency rate was 97.6, 96.4, 96.2, 96.2%; and technique survival rate was 99.5, 97.0, 90.3, 82.7%, respectively. After adjusting for confounders, every 5-year increase in age was associated with 19% decrease of risk for catheter failure (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.73–0.89). Male sex (HR: 1.43, 95% CI: 1.00–2.04), diabetic nephropathy (HR: 1.56, 95% CI: 1.08–2.25) and low hemoglobin levels (HR: 0.89, 95% CI: 0.81–0.98) were independent risk factors for abdominal wall complications. Conclusions Urgent-start PD is a safe and efficacious option for unplanned ESRD patients. A well-trained PD team, a standardized catheter insertion procedure by experienced nephrologists, and a carefully designed initial PD prescription as well as comprehensive follow-up care, might be essential for the successful urgent-start PD program. Electronic supplementary material The online version of this article (10.1186/s12882-019-1408-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongjian Ye
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Qunying Guo
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Yafang Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Qiongqiong Yang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Wei Chen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Jianbo Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Xunhua Zheng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Dihua Zhang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Zhijian Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Zongpei Jiang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Fengxian Huang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China.,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, 58th, Zhongshan Road II, Guangzhou, 510080, China. .,Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, 510080, Guangdong, China.
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15
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Sukul N, Zhao J, Fuller DS, Karaboyas A, Bieber B, Sloand JA, Subramanian L, Johnson DW, Oliver MJ, Tungsanga K, Tomo T, Morton RL, Morgenstern H, Robinson BM, Perl J. Patient-reported advantages and disadvantages of peritoneal dialysis: results from the PDOPPS. BMC Nephrol 2019; 20:116. [PMID: 30940103 PMCID: PMC6446371 DOI: 10.1186/s12882-019-1304-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 09/20/2018] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patient-reported measures are increasingly recognized as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand associations between patient-reported perceptions of the advantages and disadvantages of PD and clinical outcomes. METHODS In this cohort study, 2760 PD patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) completed a questionnaire on their PD experience, between 2014 and 2017. In this questionnaire, PDOPPS patients rated 17 aspects of their PD experience on a 5-category ordinal scale, with responses scored from - 2 (major disadvantage) to + 2 (major advantage). An advantage/disadvantage score (ADS) was computed for each patient by averaging their response scores. The ADS, along with each of these 17 aspects, were used as exposures. Outcomes included mortality, transition to hemodialysis (HD), patient-reported quality of life (QOL), and depression. Cox regression was used to estimate associations between ADS and mortality, transition to HD, and a composite of the two. Logistic regression with generalized estimating equations was used to estimate cross-sectional associations of ADS with QOL and depression. RESULTS While 7% of PD patients had an ADS < 0 (negative perception of PD), 59% had an ADS between 0 and < 1 (positive perception), and 34% had an ADS ≥1 (very positive perception). Minimal association was observed between mortality and the ADS. Compared with a very positive perception, patients with a negative perception had a higher transition rate to HD (hazard ratio [HR] = 1.67; 95% confidence interval [CI]: 1.21, 2.30). Among individual items, "space taken up by PD supplies" was commonly rated as a disadvantage and had the strongest association with transition to HD (HR = 1.28; 95% CI 1.07, 1.53). Lower ADS was strongly associated with worse QOL rating and greater depressive symptoms. CONCLUSIONS Although patients reported a generally favorable perception of PD, patient-reported disadvantages were associated with transition to HD, lower QOL, and depression. Strategies addressing these disadvantages, in particular reducing solution storage space, may improve patient outcomes and the experience of PD.
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Affiliation(s)
- Nidhi Sukul
- Michigan Medicine, 1500 E. Medical Center Dr., SPC 5364, Ann Arbor, Michigan, 48109-5364, USA.
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | - David W Johnson
- Centre for Kidney Disease Research, University of Queensland at Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | | | | | - Rachael L Morton
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Hal Morgenstern
- Departments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA
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16
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Guilloteau S, Lobbedez T, Guillouët S, Verger C, Ficheux M, Lanot A, Béchade C. Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry. Am J Nephrol 2018; 48:425-433. [PMID: 30463079 DOI: 10.1159/000494664] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 10/16/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. METHOD This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. RESULTS Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84-1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75-0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. CONCLUSIONS In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.
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Affiliation(s)
- Solène Guilloteau
- Néphrologie, CHU Caen, Avenue de la Côte de Nacre, Caen, France
- U1086 INSERM - ANTICIPE - Center Régional de Lutte contre le Cancer François Baclesse, Caen, France
| | - Thierry Lobbedez
- Néphrologie, CHU Caen, Avenue de la Côte de Nacre, Caen, France
- RDPLF, 30 rue Sere Depoin, Pontoise, France
| | - Sonia Guillouët
- Néphrologie, CHU Caen, Avenue de la Côte de Nacre, Caen, France
| | | | - Maxence Ficheux
- Néphrologie, CHU Caen, Avenue de la Côte de Nacre, Caen, France
| | - Antoine Lanot
- Néphrologie, CHU Caen, Avenue de la Côte de Nacre, Caen, France
| | - Clémence Béchade
- Néphrologie, CHU Caen, Avenue de la Côte de Nacre, Caen, France,
- U1086 INSERM - ANTICIPE - Center Régional de Lutte contre le Cancer François Baclesse, Caen, France,
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17
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Ma TKW, Chow KM, Kwan BCH, Ng JKC, Choy ASM, Kwong VWK, Pang WF, Leung CB, Li PKT, Szeto CC. Peritoneal Dialysis Catheter Revision and Replacement by Nephrologist for Peritoneal Dialysis Catheter Malfunction. Nephron Clin Pract 2017; 138:214-219. [PMID: 29241164 DOI: 10.1159/000485643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Catheter malfunction is an important cause of technique failure for peritoneal dialysis (PD) patients, and is commonly managed by surgeons or intervention radiologists. We reviewed our experience in catheter revision or replacement by nephrologists. METHOD We reviewed the clinical outcome and complication rate of 95 consecutive patients who had PD catheter malfunction, with catheter revision or replacement by nephrologist. RESULT Amongst the 95 patients, 32 had catheter revision, 24 catheter replacement via the original wound, and 39 catheter replacement via a new mini-laparotomy wound. Catheter survival was 71.6% at 1 month and 48.4% at 6 months; technique survival was 88.4% at 1 month and 77.4% at 6 months. When the 3 types of procedure were analyzed separately, technique survival at 1 month was 96.8, 75.0, and 89.7%, respectively, for patients who received catheter revision, catheter replacement via the original wound, and catheter replacement via a new mini-laparotomy wound (p = 0.0002), although their catheter survival rates were not significantly different. Also, 2 patients had bleeding that required urgent surgical exploration, 2 had wound infection, and 8 had peritonitis within 4 weeks after the surgery. CONCLUSION PD catheter revision and replacement by nephrologist has an acceptable catheter survival and a reasonable complication rate. Given that prompt intervention is an important consideration, catheter revision and replacement by nephrologist is a suitable method for the management of catheter malfunction.
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18
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Matsui M, Samejima KI, Takeda Y, Morimoto K, Tagawa M, Onoue K, Okayama S, Kawata H, Kawakami R, Akai Y, Okura H, Saito Y. Angiogenic Factors and Risks of Technique Failure and Cardiovascular Events in Patients Receiving Peritoneal Dialysis. Cardiorenal Med 2016; 6:251-9. [PMID: 27275161 DOI: 10.1159/000444886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Received: 09/28/2015] [Accepted: 02/08/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family that acts as a pleiotropic cytokine capable of stimulating angiogenesis and accelerating atherogenesis. Soluble fms-like tyrosine kinase-1 (sFlt-1) antagonizes PlGF action. Higher levels of PlGF and sFlt-1 have been associated with cardiovascular events in patients with chronic kidney disease, yet little is known about their relationship with adverse outcomes in patients on peritoneal dialysis (PD). The aim of this study was to investigate the association of PlGF and sFlt-1 with technique survival and cardiovascular events. METHODS We measured serum levels of PlGF and plasma levels of sFlt-1 in 40 PD patients at Nara Medical University. RESULTS PlGF and sFlt-1 levels were significantly correlated with the dialysate-to-plasma ratio of creatinine (r = 0.342, p = 0.04 and r = 0.554, p < 0.001) although PlGF and sFlt-1 levels were not correlated with total creatinine clearance and total Kt/V. Additionally, both PlGF and sFlt-1 levels were significantly higher in patients with high transport membranes compared to those without (p = 0.039 and p < 0.001, respectively). Patients with PlGF levels above the median had lower technique survival and higher incidence of cardiovascular events than patients with levels below the median, with hazard ratios of 11.9 and 7.7, respectively, in univariate Cox regression analysis. However, sFlt-1 levels were not associated with technique survival or cardiovascular events (p = 0.11 and p = 0.10, respectively). CONCLUSION Elevated PlGF and sFlt-1 are significantly associated with high transport membrane status. PlGF may be a useful predictor of technique survival and cardiovascular events in PD patients.
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Affiliation(s)
- Masaru Matsui
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Ken-Ichi Samejima
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yukiji Takeda
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Katsuhiko Morimoto
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Miho Tagawa
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Kenji Onoue
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Satoshi Okayama
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Kawata
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Rika Kawakami
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yasuhiro Akai
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Hiroyuki Okura
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan
| | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University, Kashihara, Japan; Department of Regulatory Medicine for Blood Pressure, Nara Medical University, Kashihara, Japan
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