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Pediatric Nephrology (Berlin, Germany) Jul 2018Pediatric dialysis patients are at risk of nutritional illness secondary to deficiencies in water-soluble vitamins and trace elements. Unlike 25-OH vitamin D, most other... (Review)
Review
Pediatric dialysis patients are at risk of nutritional illness secondary to deficiencies in water-soluble vitamins and trace elements. Unlike 25-OH vitamin D, most other vitamins and trace elements are not routinely monitored in the blood and, consequently, the detection of any deficiency may not occur until significant complications develop. Causes of vitamin and trace element deficiency in patients on maintenance dialysis patient are multifactorial, ranging from diminished nutritional intake to altered metabolism as well as dialysate-driven losses of water-soluble vitamins and select trace elements. In this review we summarize the nutritional sources of key water-soluble vitamins and trace elements with a focus on the biological roles and clinical manifestations of their respective deficiency to augment awareness of potential nutritional illness in pediatric patients receiving maintenance dialysis. The limited pediatric data on the topic of clearance of water-soluble vitamins and trace elements by individual dialysis modality are reviewed, including a brief discussion on clearance of water-soluble vitamins and trace elements with continuous renal replacement therapy.
Topics: Avitaminosis; Child; Dialysis Solutions; Humans; Kidney Failure, Chronic; Nutritional Requirements; Nutritional Status; Renal Dialysis; Trace Elements; Vitamins
PubMed: 28752387
DOI: 10.1007/s00467-017-3751-z -
JSLS : Journal of the Society of... 2023Peritoneal dialysis (PD) is an accepted renal replacement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in patients with PD is not standardized....
BACKGROUND AND OBJECTIVES
Peritoneal dialysis (PD) is an accepted renal replacement therapy for end-stage renal disease (ESRD). Managing inguinal hernia in patients with PD is not standardized. Thus, this study reported the outcomes of simultaneous laparoscopic peritoneal dialysis catheter (PDC) placement and transabdominal preperitoneal (TAPP) repair of inguinal hernia.
METHODS
Thirteen patients with chronic renal disease and inguinal hernia attending a tertiary hospital between May 1, 2016 and June 30, 2021 were evaluated for laparoscopic PDC placement. Concurrent laparoscopic inguinal herniorrhaphy and laparoscopic PDC placement were performed. Dialysate fluid was measured intraoperatively to the level below the incised peritoneum by 1 inch. The inflow and outflow was smooth without leakage. The amount was increased gradually in the two weeks after regular PD was obtained.
RESULTS
Laparoscopic PDC was inserted for 13 patients. Ten patients had unilateral hernia and two had bilateral inguinal hernia. Associated paraumbilical hernia was discovered in two patients. The median follow-up was 30 months. The measured safe amount of dialysate fluid intraoperatively was 400 - 600 mL. There was no death, intraoperative complication, or dialysate leakage. Three PDCs were removed owing to noncompliance. No hernia recurrence was observed.
CONCLUSION
Simultaneous laparoscopic PDC placement and laparoscopic repair of inguinal hernia with immediate dialysis is a safe and feasible surgical technique. Utilizing minimally invasive surgery affords PDC placement and inguinal hernia repair simultaneously.
Topics: Humans; Peritoneum; Hernia, Inguinal; Renal Dialysis; Laparoscopy; Peritoneal Dialysis; Kidney Failure, Chronic; Dialysis Solutions; Catheters; Herniorrhaphy; Surgical Mesh; Treatment Outcome
PubMed: 36923162
DOI: 10.4293/JSLS.2022.00087 -
Clinical Journal of the American... May 2017Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/V has been broadly applied as a... (Review)
Review
Urea removal has become a key measure of the intensity of dialysis treatment for kidney failure. Small solute removal, exemplified by Kt/V has been broadly applied as a means to quantify the dose of thrice weekly hemodialysis. Yet, the reliance on small solute clearances alone as a measure of dialysis adequacy fails fully to quantify the intended clinical effects of dialysis therapy. This review aims to () understand the strengths and limitations of small solute kinetics as a surrogate marker of dialysis dose, and () present the prospect of a more comprehensive construct for dialysis dose, one that considers more broadly the goals of ESRD care to maximize both quality of life and survival. On behalf of the American Society of Nephrology Dialysis Advisory Group, we propose the need to ascertain the validity and utility of a multidimensional measure that moves beyond small solute kinetics alone to quantify optimal dialysis derived from both patient-reported and comprehensive clinical and dialysis-related measures.
Topics: Biomarkers; Dialysis Solutions; Fluid Therapy; Humans; Kidney Failure, Chronic; Kinetics; Models, Biological; Patient Reported Outcome Measures; Peritoneal Dialysis; Predictive Value of Tests; Quality Control; Quality Indicators, Health Care; Quality of Life; Renal Dialysis; Treatment Outcome; Urea
PubMed: 28314806
DOI: 10.2215/CJN.08460816 -
Kidney360 Apr 2021Metabolic acidosis is a common threat for patients on hemodialysis, managed by alkaline dialysate. The main base is bicarbonate, to which small amounts of acetic,...
BACKGROUND
Metabolic acidosis is a common threat for patients on hemodialysis, managed by alkaline dialysate. The main base is bicarbonate, to which small amounts of acetic, citric, or hydrochloric acid are added. The first two are metabolized to bicarbonate, mostly by the liver. Citric acid-containing dialysate might improve dialysis efficiency, anticoagulation, calcification propensity score, and intradialytic hemodynamic stability. However, a recent report from the French dialysis registry suggested this dialysate increases mortality risk. This prompted us to assess whether citric acid-containing bicarbonate-based dialysate was associated with mortality in the international Dialysis Outcomes and Practice Patterns Study (DOPPS).
METHODS
Detailed patient-based information on dialysate composition was collected in DOPPS phases 5 and 6 (2012-2017). Cox regression was used to model the association between baseline bicarbonate dialysate containing citric acid versus not containing citric acid and mortality among DOPPS countries and phases where citric acid-containing dialysate was used.
RESULTS
Citric acid-containing dialysate was most commonly used in Japan, Italy, and Belgium (25%, 25%, 21% and of patients who were DOPPS phase 6, respectively) and used in <10% of patients in other countries. Among 11,306 patients in DOPPS country and phases with at least 15 patients using citric acid-containing dialysate, patient demographics, comorbidities, and laboratories were similar among patients using (14%) versus not using (86%) citric acid-containing dialysate. After accounting for case mix, we did not observe a directional association between citric acid-containing dialysate use (any versus none) and mortality (HR, 1.14; 95% CI, 0.97 to 1.34), nor did we find evidence of a dose-dependent relationship when parameterizing the citric acid concentration in the dialysate as 1, 2, and 3+ mEq/L.
CONCLUSIONS
The use of citric acid-containing dialysate was not associated with greater risk of all-cause mortality in patients on hemodialysis participating in DOPPS. Clinical indications for the use of citric acid-containing dialysate deserve further investigation.
Topics: Bicarbonates; Citric Acid; Dialysis Solutions; Humans; Renal Dialysis; Survival Rate
PubMed: 35373053
DOI: 10.34067/KID.0006182020 -
Peritoneal Dialysis International :... 2015Outcomes for peritoneal dialysis (PD) patients are affected by the characteristics of the peritoneal membrane, which may be determined by genetic variants. We carried... (Review)
Review
BACKGROUND
Outcomes for peritoneal dialysis (PD) patients are affected by the characteristics of the peritoneal membrane, which may be determined by genetic variants. We carried out a systematic review of the literature to identify studies which assessed the association between genetic polymorphisms, peritoneal membrane solute transport, and clinical outcomes for PD patients.
METHODS
The National Library of Medicine was searched using a variety of strategies. Studies which met our inclusion criteria were reviewed and data abstracted. Our outcomes of interest included: high transport status peritoneal membrane, risk for peritonitis, encapsulating peritoneal sclerosis (EPS), patient and technique survival. We combined data from studies which evaluated the same genetic polymorphism and the same outcome.
RESULTS
We evaluated 18 relevant studies. All studies used a candidate gene approach. Gene polymorphisms in the interleukin (IL)-6 gene were associated with peritoneal membrane solute transport in several studies in different ethnic populations. Associations with solute transport and polymorphisms in endothelial nitric oxide synthase and receptor for advanced glycation end product genes were also identified. There was evidence of a genetic predisposition for peritonitis found in 2 studies, and for EPS in 1 study. Survival was found to be associated with a polymorphism in vascular endothelial growth factor and technique failure was associated with a polymorphism in the IL-1 receptor antagonist.
CONCLUSIONS
There is evidence that characteristics of the peritoneal membrane and clinical outcomes for PD patients have genetic determinants. The most consistent association was between IL-6 gene polymorphisms and peritoneal membrane solute transport.
Topics: Biological Transport; Carrier Proteins; Dialysis Solutions; Humans; Interleukin-6; Peritoneal Dialysis; Peritoneum; Polymorphism, Genetic
PubMed: 25395500
DOI: 10.3747/pdi.2014.00049 -
Blood Purification 2015Retrospective randomized clinical studies have shown that online hemodiafiltration (OL-HDF) is associated with a lower risk reduction of mortality than standard... (Review)
Review
BACKGROUND
Retrospective randomized clinical studies have shown that online hemodiafiltration (OL-HDF) is associated with a lower risk reduction of mortality than standard hemodialysis.
SUMMARY
In all of these large randomized studies, the convective volume seemed to be an important issue, but the optimal OL-HDF dose has not yet been defined. This article, to make a EUDIAL working group position, reviews the association between survival and convective volume, the minimum recommended replacement volume, the importance of the infusion flow rate, and the main limiting factors in achieving a high convective volume. Finally, the article discusses whether the convective dose should be normalized to body size. Key Messages: At present, there is sufficient scientific evidence to indicate that OL-HDF treatment reduces mortality risk and that it should be the first-line option in hemodialysis patients. It seems reasonable to recommend that patients should receive the highest possible convective dose and that the largest possible blood flow should be used to obtain the highest possible infusion flow rate. Based on the results of secondary analyses of the main clinical trials, the current recommendation of the optimal dose of OL-HDF, in the postdilutional mode and on a thrice-weekly treatment schedule, would be a convective volume higher than 23 liters/session. There is insufficient scientific evidence to recommend that the convective dose should be normalized to body size.
Topics: Blood Flow Velocity; Body Size; Dialysis Solutions; Hemodiafiltration; Humans; Kidney Failure, Chronic; Retrospective Studies; Rheology; Survival Analysis
PubMed: 26344509
DOI: 10.1159/000437409 -
Seminars in Dialysis Nov 2022Clinical application of continuous flow peritoneal dialysis (CFPD) has been explored since the 1960s, but despite anticipated clinical benefits, CFPD has failed to gain... (Review)
Review
Clinical application of continuous flow peritoneal dialysis (CFPD) has been explored since the 1960s, but despite anticipated clinical benefits, CFPD has failed to gain a foothold in clinical practice, among others due to the typical use of two catheters (or a dual-lumen catheter) and large dialysate volumes required per treatment. Novel systems applying CFPD via the existing single-lumen catheter using rapid dialysate cycling may solve one of these hurdles. Novel on-demand peritoneal dialysate generation systems and sorbent-based peritoneal dialysate regeneration systems may considerably reduce the storage space for peritoneal dialysate and/or the required dialysate volume. This review provides an overview of current evidence on CFPD in vivo. The available (pre)clinical evidence on CFPD is limited to case reports/series with inherently nonuniform study procedures, or studies with a small sample size, short follow-up, and no hard endpoints. Small solute clearance appears to be higher in CFPD compared to conventional PD, in particular at dialysate flows ≥100 mL/min using two single-lumen catheters or a double-lumen catheter. Results of CFPD using rapid cycling via a single-lumen catheter are too preliminary to draw any conclusions. Continuous addition of glucose to dialysate with CFPD appears to be effective in reducing the maximum intraperitoneal glucose concentration while increasing ultrafiltration efficiency (mL/g absorbed glucose). Patient tolerance may be an issue since abdominal discomfort and sterile peritonitis were reported with continuous circulation of the peritoneal dialysate. Thus, well-designed clinical trials of longer duration and larger sample size, in particular applying CFPD via the existing catheter, are urgently required.
Topics: Humans; Renal Dialysis; Peritoneal Dialysis; Dialysis Solutions; Peritoneum; Glucose
PubMed: 35650168
DOI: 10.1111/sdi.13097 -
Journal of Mathematical Biology Jun 2023Chronic kidney diseases imply an ongoing need to remove toxins, with hemodialysis as the preferred treatment modality. We derive analytical expressions for phosphate...
Chronic kidney diseases imply an ongoing need to remove toxins, with hemodialysis as the preferred treatment modality. We derive analytical expressions for phosphate clearance during dialysis, the single pass (SP) model corresponding to a standard clinical hemodialysis and the multi pass (MP) model, where dialysate is recycled and therefore makes a smaller clinical setting possible such as a transportable dialysis suitcase. For both cases we show that the convective contribution to the dialysate is negligible for the phosphate kinetics and derive simpler expressions. The SP and MP models are calibrated to clinical data of ten patients showing consistency between the models and provide estimates of the kinetic parameters. Immediately after dialysis a rebound effect is observed. We derive a simple formula describing this effect which is valid both posterior to SP or MP dialysis. The analytical formulas provide explanations to observations of previous clinical studies.
Topics: Humans; Phosphates; Kinetics; Renal Dialysis; Dialysis Solutions; Kidney Failure, Chronic
PubMed: 37332042
DOI: 10.1007/s00285-023-01942-4 -
BioMed Research International 2015Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine... (Review)
Review
Hyaluronan (HA) is a ubiquitous extracellular matrix glycosaminoglycan composed of repeated disaccharide units of alternating D-glucuronic acid and D-N-acetylglucosamine residues linked via alternating β-1,4 and β-1,3 glycosidic bonds. HA is synthesized in humans by HA synthase (HAS) enzymes 1, 2, and 3, which are encoded by the corresponding HAS genes. Previous in vitro studies have shown characteristic changes in HAS expression and increased HA synthesis in response to wounding and proinflammatory cytokines in human peritoneal mesothelial cells. In addition, in vivo models and human peritoneal biopsy samples have provided evidence of changes in HA metabolism in the fibrosis that at present accompanies peritoneal dialysis treatment. This review discusses these published observations and how they might contribute to improvement in peritoneal dialysis.
Topics: Dialysis Solutions; Epithelium; Extracellular Matrix; Fibroblasts; Humans; Hyaluronic Acid; Models, Biological; Peritoneal Dialysis; Peritoneum
PubMed: 26550568
DOI: 10.1155/2015/427038 -
Biomolecules May 2020One of the main limitations to successful long-term use of peritoneal dialysis (PD) as a renal replacement therapy is the harmful effects of PD solutions to the... (Review)
Review
One of the main limitations to successful long-term use of peritoneal dialysis (PD) as a renal replacement therapy is the harmful effects of PD solutions to the structure and function of the peritoneal membrane (PM). In PD, the PM serves as a semipermeable membrane that, due to exposure to PD solutions, undergoes structural alterations, including peritoneal fibrosis, vasculopathy, and neoangiogenesis. In recent decades, oxidative stress (OS) has emerged as a novel risk factor for mortality and cardiovascular disease in PD patients. Moreover, it has become evident that OS plays a pivotal role in the pathogenesis and development of the chronic, progressive injury of the PM. In this review, we aimed to present several aspects of OS in PD patients, including the pathophysiologic effects on the PM, clinical implications, and possible therapeutic antioxidant strategies that might protect the integrity of PM during PD therapy.
Topics: Animals; Dialysis Solutions; Epithelial Cells; Glycation End Products, Advanced; Humans; Oxidative Stress; Peritoneal Dialysis; Peritoneum
PubMed: 32423139
DOI: 10.3390/biom10050768