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Clinical Journal of the American... Jun 2019Almost half of patients on dialysis demonstrate a postdialysis serum potassium ≤3.5 mEq/L. We aimed to examine the relationship between postdialysis potassium levels...
BACKGROUND AND OBJECTIVES
Almost half of patients on dialysis demonstrate a postdialysis serum potassium ≤3.5 mEq/L. We aimed to examine the relationship between postdialysis potassium levels and all-cause mortality.
DESIGN, SETTING, PATIENTS, & MEASUREMENTS
We conducted a cohort study of 3967 participants on maintenance hemodialysis from the Dialysis Outcomes and Practice Patterns Study in Japan (2009-2012 and 2012-2015). Postdialysis serum potassium was measured repeatedly at 4-month intervals and used as a time-varying variable. We estimated the hazard ratio of all-cause mortality rate using Cox hazard regression models, with and without adjusting for time-varying predialysis serum potassium. Models were adjusted for baseline characteristics and time-varying laboratory parameters. We also analyzed associations of combinations of pre- and postdialysis potassium with mortality.
RESULTS
The age of participants at baseline was 65±12 years (mean±SD), 2552 (64%) were men, and 96% were treated with a dialysate potassium level of 2.0 to <2.5 mEq/L. The median follow-up period was 2.6 (interquartile range, 1.3-2.8) years. During the follow-up period, 562 (14%) of 3967 participants died, and the overall mortality rate was 6.7 per 100 person-years. Compared with postdialysis potassium of 3.0 to <3.5 mEq/L, the hazard ratios of postdialysis hypokalemia (<3.0 mEq/L) were 1.84 (95% confidence interval, 1.44 to 2.34) in the unadjusted model, 1.44 (95% confidence interval, 1.14 to 1.82) in the model without adjusting for predialysis serum potassium, and 1.10 (95% confidence interval, 0.84 to 1.44) in the model adjusted for predialysis serum potassium. The combination of pre- and postdialysis hypokalemia was associated with the highest mortality risk (hazard ratio, 1.72; 95% confidence interval, 1.35 to 2.19, reference; pre- and postdialysis nonhypokalemia).
CONCLUSIONS
Postdialysis hypokalemia was associated with mortality, but this association was not independent of predialysis potassium.
Topics: Aged; Dialysis Solutions; Female; Follow-Up Studies; Humans; Hypokalemia; Japan; Male; Middle Aged; Mortality; Potassium; Proportional Hazards Models; Renal Dialysis
PubMed: 31048327
DOI: 10.2215/CJN.07950718 -
Annals of Palliative Medicine Dec 2021Dialysate potassium concentration directly affects the serum potassium level and safety of hemodialysis patients. In most dialysis centers in China, a single dialysate...
BACKGROUND
Dialysate potassium concentration directly affects the serum potassium level and safety of hemodialysis patients. In most dialysis centers in China, a single dialysate potassium concentration is used for dialysis, but there is no data on whether this is reasonable or not.
METHODS
Serum potassium values before and after dialysis in maintenance hemodialysis (MHD) patients between 2019 and 2020 were collected from 5 hemodialysis centers in Shanghai, which uniformly use dialysate with a potassium concentration (KD) of 2.0 mmol/L, and data were collected 3 times per patient for analysis. Serum potassium fluctuation was analyzed after administration of individualized KD dialysate.
RESULTS
In all, 1,296 MHD patients were included in the study. Predialysis serum potassium was lower than 4.5 mmol/L in 38.0% and higher than 5.5 mmol/L in 14.6% of patients. Postdialysis serum potassium was lower than 3 mmol/L in 11.3% and higher than 4 mmol/L in 10.4% of patients. Pre-dialysis serum potassium was below 4.5 mmol/L and post- dialysis serum potassium was below 3 mmol/L in 9.54% of patients. Compared with patients younger than 40 years, patients >80 years more often exhibited predialysis serum potassium below 4.5 mmol/L and Postdialysis serum potassium below 3 mmol/L. A total of 668 patients underwent a trial of hemodialysis with individualized KD dialysate. When receiving individualized KD, compared with uniform KD 2.0 mmol/L, the number of patients with postdialysis serum potassium less than 3 mmol/L significantly decreased, the following predialysis serum potassium level was not significantly different from baseline, and the proportion of patients with predialysis serum potassium less than 4.5 mmol/L and postdialysis serum potassium less than 3 mmol/L significantly decreased.
CONCLUSIONS
Hypokalemia and fluctuations of serum potassium are common in MHD patients. KD 2.0 mmol/L dialysate should not be used for all patients, and individualized KD dialysate for patients with low serum potassium reduces the incidence of hypokalemia.
Topics: China; Dialysis Solutions; Humans; Potassium; Renal Dialysis
PubMed: 35016414
DOI: 10.21037/apm-21-3030 -
International Journal of Molecular... Mar 2023Chronic kidney disease (CKD) incidence is growing worldwide, with a significant percentage of CKD patients reaching end-stage renal disease (ESRD) and requiring kidney... (Review)
Review
Chronic kidney disease (CKD) incidence is growing worldwide, with a significant percentage of CKD patients reaching end-stage renal disease (ESRD) and requiring kidney replacement therapies (KRT). Peritoneal dialysis (PD) is a convenient KRT presenting benefices as home therapy. In PD patients, the peritoneum is chronically exposed to PD fluids containing supraphysiologic concentrations of glucose or other osmotic agents, leading to the activation of cellular and molecular processes of damage, including inflammation and fibrosis. Importantly, peritonitis episodes enhance peritoneum inflammation status and accelerate peritoneal injury. Here, we review the role of immune cells in the damage of the peritoneal membrane (PM) by repeated exposure to PD fluids during KRT as well as by bacterial or viral infections. We also discuss the anti-inflammatory properties of current clinical treatments of CKD patients in KRT and their potential effect on preserving PM integrity. Finally, given the current importance of coronavirus disease 2019 (COVID-19) disease, we also analyze here the implications of this disease in CKD and KRT.
Topics: Humans; Peritoneum; Renal Dialysis; COVID-19; Dialysis Solutions; Peritonitis; Renal Insufficiency, Chronic; Inflammation; Kidney Failure, Chronic; Immunity
PubMed: 36982834
DOI: 10.3390/ijms24065763 -
The Western Journal of Emergency... May 2018Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack... (Review)
Review
Peritoneal dialysis (PD) is a means of renal replacement therapy (RRT) that can be performed in remote settings with limited resources, including regions that lack electrical power. PD is a mainstay of end-stage renal disease (ESRD) therapy worldwide, and the ease of initiation and maintenance has enabled it to flourish in both resource-limited and resource-abundant settings. In natural disaster scenarios, military conflicts, and other austere areas, PD may be the only available life-saving measure for acute kidney injury (AKI) or ESRD. PD in austere environments is not without challenges, including catheter placement, availability of dialysate, and medical complications related to the procedure itself. However, when hemodialysis is unavailable, PD can be performed using generally available medical supplies including sterile tubing and intravenous fluids. Amidst the ever-increasing global burden of ESRD and AKI, the ability to perform PD is essential for many medical facilities.
Topics: Acute Kidney Injury; Armed Conflicts; Dialysis Solutions; Disasters; Humans; Kidney Failure, Chronic; Peritoneal Dialysis
PubMed: 29760854
DOI: 10.5811/westjem.2018.3.36762 -
The Israel Medical Association Journal... Jan 2019
Topics: Dialysis Solutions; Humans; Renal Dialysis; Ultrafiltration; Water; Water Microbiology; Water Purification
PubMed: 30685906
DOI: No ID Found -
Journal of Nephrology Jun 2020At the start of the 2000s, the progressive diffusion of high-flux extracorporeal dialysis and membranes saw an increased use of high infusion volumes injected into the... (Review)
Review
INTRODUCTION
At the start of the 2000s, the progressive diffusion of high-flux extracorporeal dialysis and membranes saw an increased use of high infusion volumes injected into the patient's blood circuit following the advent of on-line water production plants.
METHODOLOGY
Our 15-year experience with on-line extracorporeal methodologies using very high infusion volumes has led to the detection of errors and weaknesses, thus allowing us to correct and provide for the implementation of appropriate technology in dialysis water production plants with the aim of ensuring a higher chemical-physical, bacteriological and endotoxin quality. The initial procedures had already been outlined in the 2005 Italian Guidelines, although still today Health Technicians and Nephrologists operating in the field are unable to take on board specific integrations for on-line methods due to a lack of upgrading of documentation in both European and non-European Guidelines.
RESULTS
After more than 17 years' experience, and in view of the technological implementations developed since 2005, we wish to put forward a series of suggestions in an attempt to improve the safety of on-line water, with uses ranging from drinking water, pre-treatment, osmosis, distribution circuit, hemodialysis monitors up to the most recent update of microbiological cultures.
DISCUSSION
Additional, more stringent measures are required to prevent the occurrence of acute accidents during dialysis sessions and to reduce chronic inflammation-oxidation deriving from the use of not totally ultra-pure/sterile dialysis fluids.
CONCLUSION
Our point of view based on our long-standing experience, the proposals made relate to procedures to be applied in technological maintenance, which the consultant nephrologist and other relevant personnel such as microbiologists, biologists, and technical operators should adhere to rigorously to ensure that the production of dialysis water on-line is viewed on a par with a pharmacological administration.
Topics: Dialysis Solutions; Humans; Italy; Renal Dialysis; Water
PubMed: 31713828
DOI: 10.1007/s40620-019-00667-2 -
Pediatric Nephrology (Berlin, Germany) May 2023Peritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and...
BACKGROUND
Peritonitis is an important complication and cause of morbidity in patients undergoing peritoneal dialysis (PD). Corynebacterium species, often considered skin and mucosal contaminants, are a rare cause of PD-associated peritonitis and have been acknowledged in published guidelines for the diagnosis and treatment of PD peritonitis only over the last decade.
CASE-DIAGNOSIS/TREATMENT
We present two children with difficult-to-treat episodes of PD peritonitis due to Corynebacterium amycolatum. Episodes were associated with fever, abdominal pain and cloudy dialysate, high dialysate polymorphonuclear leukocyte counts, and elevated serum C-reactive protein and procalcitonin concentrations. Symptoms persisted beyond 5 days in 4 of 5 peritonitis episodes, and peritonitis relapsed despite in vitro sensitivity of the bacterial isolates to guideline-recommended antibiotics. C. amycolatum was cultured from the PD catheter tip despite 4 weeks of intraperitoneal glycopeptide therapy and clinical peritonitis resolution suggestive of efficient biofilm formation. Our systematic literature search identified three previous (adult) case descriptions of C. amycolatum peritonitis, all with repeat episodes by the same organism. The incidence of C. amycolatum as a cause of PD peritonitis has not yet been established but is likely underreported due to challenges in species differentiation.
CONCLUSIONS
C. amycolatum is a rarely identified cause of refractory and/or relapsing PD peritonitis. Species differentiation of non-diphtheriae Corynebacterium isolates is critical, and prolonged antibiotic treatment, preferably with a glycopeptide antibiotic, is recommended, with a low threshold for PD catheter change or removal in case of repeat peritonitis.
Topics: Adult; Child; Humans; Peritoneal Dialysis; Corynebacterium; Peritonitis; Anti-Bacterial Agents; Dialysis Solutions; Glycopeptides
PubMed: 36352270
DOI: 10.1007/s00467-022-05801-0 -
Frontiers in Immunology 2023Peritoneal dialysis (PD) is an effective replacement therapy for end-stage renal disease patients. However, long-term exposure to peritoneal dialysate will lead to the...
Histone deacetylase 8 inhibition prevents the progression of peritoneal fibrosis by counteracting the epithelial-mesenchymal transition and blockade of M2 macrophage polarization.
BACKGROUND
Peritoneal dialysis (PD) is an effective replacement therapy for end-stage renal disease patients. However, long-term exposure to peritoneal dialysate will lead to the development of peritoneal fibrosis. Epigenetics has been shown to play an important role in peritoneal fibrosis, but the role of histone deacetylases 8 (HDAC8) in peritoneal fibrosis have not been elucidated. In this research, we focused on the role and mechanisms of HDAC8 in peritoneal fibrosis and discussed the mechanisms involved.
METHODS
We examined the expression of HDAC8 in the peritoneum and dialysis effluent of continuous PD patients. Then we assessed the role and mechanism of HDAC8 in peritoneal fibrosis progression in mouse model of peritoneal fibrosis induced by high glucose peritoneal dialysis fluid by using PCI-34051. In vitro, TGF-β1 or IL-4 were used to stimulate human peritoneal mesothelial cells (HPMCs) or RAW264.7 cells to establish two cell injury models to further explore the role and mechanism of HDAC8 in epithelial-mesenchymal transition (EMT) and macrophage polarization.
RESULTS
We found that HDAC8 expressed highly in the peritoneum from patients with PD-related peritonitis. We further revealed that the level of HDAC8 in the dialysate increased over time, and HDAC8 was positively correlated with TGF-β1 and vascular endothelial growth factor (VEGF), and negatively correlated with cancer antigen 125. In mouse model of peritoneal fibrosis induced by high glucose dialysate, administration of PCI-34051 (a selective HDAC8 inhibitor) significantly prevented the progression of peritoneal fibrosis. Treatment with PCI-34051 blocked the phosphorylation of epidermal growth factor receptor (EGFR) and the activation of its downstream signaling pathways ERK1/2 and STAT3/HIF-1α. Inhibition of HDAC8 also reduced apoptosis. In vitro, HDAC8 silencing with PCI-34051 or siRNA inhibited TGF-β1-induced EMT and apoptosis in HPMCs. In addition, continuous high glucose dialysate or IL-4 stimulation induced M2 macrophage polarization. Blockade of HDAC8 reduced M2 macrophage polarization by inhibiting the activation of STAT6 and PI3K/Akt signaling pathways.
CONCLUSIONS
We demonstrated that HDAC8 promoted the EMT of HPMCs via EGFR/ERK1/2/STAT3/HIF-1α, induced M2 macrophage polarization via STAT6 and PI3K/Akt signaling pathways, and ultimately accelerated the process of peritoneal fibrosis.
Topics: Animals; Humans; Mice; Dialysis Solutions; Epithelial-Mesenchymal Transition; ErbB Receptors; Glucose; Histone Deacetylases; Interleukin-4; Macrophages; Percutaneous Coronary Intervention; Peritoneal Fibrosis; Phosphatidylinositol 3-Kinases; Proto-Oncogene Proteins c-akt; Transforming Growth Factor beta1; Vascular Endothelial Growth Factor A
PubMed: 36911746
DOI: 10.3389/fimmu.2023.1137332 -
Prilozi (Makedonska Akademija Na... Dec 2019Asymptomatic hypoglycaemia has been reported in both diabetic and non-diabetic patients on haemodialysis. Uremic symptoms as inadequate appetite, nausea and vomiting... (Clinical Trial)
Clinical Trial Comparative Study
INTRODUCTION
Asymptomatic hypoglycaemia has been reported in both diabetic and non-diabetic patients on haemodialysis. Uremic symptoms as inadequate appetite, nausea and vomiting worsen the risk of hypoglycaemia at dialysis initiation. As a standard therapeutic approach for decreasing this risk and dis-equilibrium syndrome at our dialysis unit, a continuous venous 5% glucose solution is applied during the glucose-free dialysate (GFD) dialysis. In this interventional study we sought to assess the glycaemic control during standard initiating dialysis protocol versus novel approach with glucose-rich dialysis fluid (GRD).
MATERIAL AND METHODS
Twenty-one dialysis patients with chronic renal failure were dialyzed alternatively using GRD (5.6 mmol/l) and GFD fluid. They were not taking any hypoglycaemic medication prior and food during dialysis session. Blood was sampled at regular intervals during dialysis. The dialysis prescription consisted of ultrafiltration (UF) of up to 1 L, membrane surface (MS) up to 1.4 square meters and duration time of 2-2.5 hours. Intra-patient glycaemic variability was defined by Coefficient of variation (CV). In paired analysis t-test was used to determine the glucose control differences in both therapeutic approaches in each patient. For the whole group t-test was used to assess the glucose variability as CV.
RESULTS
The mean age of study participants was 62.95±11.73 years; 7 (33%) had diabetes. The two dialysis approaches did not differ in respect of initial blood pressure, UF and MS. Only two episodes of hypoglycaemia occurred in both types of dialysis. The mean glucose level was higher during GRD (8.15±1.89 vs. 6.29±1.33, p=0.001), respectively. The glucose CV was lower in GRD dialysis when pared t-test was applied, without significant difference (16.97± 8.86 vs. 21.05±11.99, p=0.151). When only diabetic patients were analysed, there was no significant glucose CV difference as well (p=0.151). For the whole cohort glucose variability was significantly higher in glucose-free dialysate dialysis (p=0.0001).
CONCLUSION
The GRD approach for initiating dialysis sessions is non-inferior to standard GFD care. Dialysate rich in glucose obtains better glucose control during dialysis compared to glucose-free dialysate.
Topics: Biomarkers; Blood Glucose; Blood Pressure; Cross-Over Studies; Dialysis Solutions; Female; Glucose; Humans; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Treatment Outcome
PubMed: 32109218
DOI: 10.2478/prilozi-2020-0003 -
Pediatric Nephrology (Berlin, Germany) Dec 2023About 10% of all home peritoneal dialysis regimens in children with chronic kidney disease stage 5 are reported to involve some form of a tidal peritoneal dialysis (TPD)...
About 10% of all home peritoneal dialysis regimens in children with chronic kidney disease stage 5 are reported to involve some form of a tidal peritoneal dialysis (TPD) prescription. Despite this, there remain several gaps in how pediatric nephrologists approach the use of TPD. This stems from a combination of factors such as the confusing technical terminology pertaining to TPD, seemingly conflicting data on the risks, benefits, and indications for TPD, and lastly, limited published guidelines on the practical aspects of how to write a TPD prescription, based on the indication, in children. Our educational review, using evidence-based data, attempts to bridge this gap and provide an easy-to-use guide on the key practical aspects of TPD in children.
Topics: Humans; Child; Dialysis Solutions; Peritoneal Dialysis; Peritoneum; Kidney Failure, Chronic; Hemodialysis, Home
PubMed: 36780006
DOI: 10.1007/s00467-023-05898-x