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Proteomics and Extracellular Vesicles as Novel Biomarker Sources in Peritoneal Dialysis in Children.International Journal of Molecular... May 2022Peritoneal dialysis (PD) represents the dialysis modality of choice for pediatric patients with end-stage kidney disease. Indeed, compared with hemodialysis (HD), it... (Review)
Review
Peritoneal dialysis (PD) represents the dialysis modality of choice for pediatric patients with end-stage kidney disease. Indeed, compared with hemodialysis (HD), it offers many advantages, including more flexibility, reduction of the risk of hospital-acquired infections, preservation of residual kidney function, and a better quality of life. However, despite these positive aspects, PD may be associated with several long-term complications that may impair both patient's general health and PD adequacy. In this view, chronic inflammation, caused by different factors, has a detrimental impact on the structure and function of the peritoneal membrane, leading to sclerosis and consequent PD failure both in adults and children. Although several studies investigated the complex pathogenic pathways underlying peritoneal membrane alterations, these processes remain still to explore. Understanding these mechanisms may provide novel approaches to improve the clinical outcome of pediatric PD patients through the identification of subjects at high risk of complications and the implementation of personalized interventions. In this review, we discuss the main experimental and clinical experiences exploring the potentiality of the proteomic analysis of peritoneal fluids and extracellular vesicles as a source of novel biomarkers in pediatric peritoneal dialysis.
Topics: Adult; Biomarkers; Child; Extracellular Vesicles; Humans; Peritoneal Dialysis; Proteomics; Quality of Life; Renal Dialysis
PubMed: 35628461
DOI: 10.3390/ijms23105655 -
Nephrology (Carlton, Vic.) Jul 2016This paper updates a previous 'Call to Action' paper (Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis... (Review)
Review
This paper updates a previous 'Call to Action' paper (Nephrology 2011; 16: 19-29) that reviewed key outcome data for Australian and New Zealand peritoneal dialysis patients and made recommendations to improve care. Since its publication, peritonitis rates have improved significantly, although they have plateaued more recently. Peritoneal dialysis patient and technique survival in Australian and New Zealand have also improved, with a reduction in the proportion of technique failures attributed to 'social reasons'. Despite these improvements, technique survival rates overall remain lower than in many other parts of the world. This update includes additional practical recommendations based on published evidence and emerging initiatives to further improve outcomes.
Topics: Australia; Health Knowledge, Attitudes, Practice; Humans; Kidney Diseases; Nephrology; New Zealand; Patient Education as Topic; Patient Selection; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Practice Guidelines as Topic; Practice Patterns, Physicians'; Process Assessment, Health Care; Quality Improvement; Quality Indicators, Health Care; Risk Factors; Social Support; Time Factors; Treatment Outcome
PubMed: 26807739
DOI: 10.1111/nep.12731 -
BMC Nephrology Apr 2021Considering that current peritoneal dialysis has its own shortcomings, In this study, the Seldinger technique was modified to explore the relationship between different...
BACKGROUND
Considering that current peritoneal dialysis has its own shortcomings, In this study, the Seldinger technique was modified to explore the relationship between different catheter placement methods of peritoneal dialysis and short-term postoperative complications.
METHODS
We retrospectively analyzed the data of 157 patients who received peritoneal dialysis in the Department of Nephrology of our hospital from January 2017 to December 2019. According to different catheter placement methods, the patients were divided into three groups: 111 cases of open surgery technique, 23 cases of Seldinger technique, and 23 cases of modified Seldinger technique (ultrasound-guided Veress needle puncture). The general data, laboratory indexes, and abdominal infection and catheter-related complications within one month postoperatively were collected.
RESULTS
There were 48 (31.0 %) cases of complications in 157 patients within one month postoperatively, which were mainly catheter-related complications (45 cases, 29.0 %). The incidence of catheter tip peritoneal drift (catheter migration) in the three groups was 27.3 %, 39.1 %, and 9.1 %, respectively, with no significant difference between groups (P = 0.069). Univariate logistic regression analysis showed that the systolic blood pressure, history of abdominal and pelvic surgery, creatinine, and modified Seldinger technique were possible impact factors of catheter migration (P < 0.10). After fully adjusting for confounding factors, Compared with the open surgery group, the modified Seldinger method group significantly reduced the risk of catheter migration with an OR of 0.161 (95 % confidence interval: 0.027-0.961, P = 0.045); However, the difference between the Seldinger method group and the open surgery group was not significant, with an OR of 1.061 (95 % confidence interval: 0.308-3.649, P = 0.926). Curve fitting showed that the average incidence of catheter migration in the three groups was 27.3 % (95% CI: 15.9-42.7 %), 28.5 % (95% CI: 10.7-56.9 %), and 5.7 % (95% CI: 1.0-27.0 %); the modified Seldinger method has the lowest average incidence of catheter migration.
CONCLUSIONS
Modified Seldinger technique can significantly reduce catheter-related short-term complications after peritoneal dialysis, and it is especially effective in reducing the incidence of catheter migration. Modified Seldinger technique is a safe and feasible method for the placement of a peritoneal dialysis catheter.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheterization; Equipment Failure; Female; Foreign-Body Migration; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Postoperative Complications; Retrospective Studies; Risk Factors; Ultrasonography; Young Adult
PubMed: 33902497
DOI: 10.1186/s12882-021-02340-y -
Clinical NephrologyArterial stiffness represents an independent risk factor for cardiovascular mortality in dialysis patients and is strongly connected to hypervolemia. The aim of the...
BACKGROUND
Arterial stiffness represents an independent risk factor for cardiovascular mortality in dialysis patients and is strongly connected to hypervolemia. The aim of the study was to evaluate different methods for fluid status assessment and their association with arterial stiffness parameters in peritoneal dialysis patients.
MATERIALS AND METHODS
In 16 peritoneal dialysis patients (53 ± 18 years, 9/16 men) fluid status was determined by clinical examination, lung ultrasound (number of B-lines, normal up to 4), overhydration degree by bioimpedance monitor device, estimation of central venous pressure by ultrasound measurement of vena cava inferior, measurement of serum N-terminal pro b-type natriuretic peptide (NT-proBNP), and albumin level. Pulse wave velocity and augmentation index were measured non-invasively with an oscillometric device to indirectly assess arterial stiffness, blood pressure (BP) was obtained by the same device.
RESULTS
Clinical evaluation (BP 136 ± 15/93 ± 15 mmHg, edema in 2/16 patients) and lung ultrasound (on average 3 ± 6 B-lines) showed mostly normal fluid status of patients. Patients had slightly lower albumin values (37 ± 4 g/L), slightly elevated central venous pressure (10 ± 4 mmHg), and elevated NT-proBNP (11,596 ± 13,635 ng/L). Body composition evaluation showed mild overhydration (1.5 ± 2 L), which significantly correlated with central venous pressure (p = 0.046) and NT-proBNP (p = 0.004). Lung ultrasound significantly negatively correlated with albumin (r = -0.82, p < 0.001) and positively with NT-proBNP (r = 0.62, p = 0.011). Augmentation index (22 ± 11%) and augmentation pressure correlated with lung ultrasound (r = 0.54, p = 0.032 and r = 0.67, p = 0.004, respectively), although pulse wave velocity (8.4 ± 2.5 m/s) showed no significant correlation with fluid status parameters. The multivariate model showed that lung ultrasound B-lines were an independent determinant of augmentation pressure (β = 0.58, p = 0.043).
CONCLUSION
Fluid status evaluated with lung ultrasound showed good correlation with augmentation index and augmentation pressure, which are markers of arterial stiffness. The lung ultrasound B-lines were found to be an independent determinant of augmentation pressure. Overall arterial stiffness evaluated with pulse wave velocity and augmentation index was not markedly elevated in our patients, which could be due to a good euvolemic status. We conclude that different methods for fluid status evaluation are complementary, with lung ultrasound as a beneficial tool in routine clinical practice in peritoneal dialysis patients.
Topics: Blood Pressure; Humans; Male; Peritoneal Dialysis; Pulse Wave Analysis; Renal Dialysis; Vascular Stiffness
PubMed: 34643495
DOI: 10.5414/CNP96S13 -
Peritoneal Dialysis International :... Dec 2018Peritoneal dialysis (PD) was introduced in China later than in most Western countries, and PD research activity was quite limited until the 1990s. However, in the 2000s,... (Review)
Review
Peritoneal dialysis (PD) was introduced in China later than in most Western countries, and PD research activity was quite limited until the 1990s. However, in the 2000s, and even more so during the last decade, there has been an unsurpassed increase in the number of PD patients, paralleled by a substantial increase in PD research activity reflected by an increasing number of PD papers from China. In this brief review, we describe some of the factors that may explain the dramatic developments in PD research in mainland China, such as the focus on basic research using scientific approaches that subsequently could be applied also in clinical studies. Another important factor was the growing interactions with international PD research centers in Hong Kong and in Western countries. Thanks to strong support from Chinese national and regional funding sources, a growing number of young Chinese researchers went to key international PD centers to learn about novel advanced research techniques. This paved the way for long-lasting, productive collaborations with benefits also for the foreign host institutions. Finally, we present some current research projects, including basic research that may contribute to the understanding of mechanisms behind complications such as peritonitis, and clinical projects aiming at improving PD management guidelines and better understanding of the potential of PD in China. Because of the size of the PD population, now the largest in the world, and the increasing number, and quality, of researchers in the PD field, PD research in China is destined to be a major contributor to advancements in PD in the near future.
Topics: China; Cross-Cultural Comparison; Female; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Research Design
PubMed: 30315043
DOI: 10.3747/pdi.2018.00027 -
Renal Failure Dec 2021Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of...
Peritoneal dialysis (PD) was introduced in China more than 60 years ago and has grown continuously since then. Now China leads the first of the world in number of patients on PD. In this manuscript a brief review of the history of peritoneal dialysis in China is presented; this includes a description of pioneers and their important contributions, discussion of peritoneal dialysate, the technique of the use of Tenckhoff catheter, the use of continuous ambulatory peritoneal dialysis (CAPD) and dialysis registration. Current ongoing PD research activities among Chinese PD academicians are also discussed. Finally, we present four areas of future focus: 1) the promotion of PD in rural areas where PD use is still very limited due to the lack of PD awareness and education; 2) PD quality management and continuous quality improvement (CQI) program particularly focusing on PD adequacy and patient rehabilitation; 3) development and enforcement of national standards on PD management; 4) multi-center studies to compare the benefits of PD and hemodialysis (HD) that should include survival, rehabilitation and cost-effectiveness.
Topics: China; History, 20th Century; History, 21st Century; Humans; Nephrology; Peritoneal Dialysis
PubMed: 34865609
DOI: 10.1080/0886022X.2021.2011316 -
Jornal Brasileiro de Nefrologia 2023
Topics: Humans; Brazil; Peritoneal Dialysis; Kidney Failure, Chronic; Renal Dialysis
PubMed: 36917680
DOI: 10.1590/2175-8239-JBN-2023-E002en -
Kidney & Blood Pressure Research 2018Assisted PD (assPD) is an option of home dialysis treatment for dependent end-stage renal patients and worldwide applied in different countries since more than 40 years.... (Review)
Review
Assisted PD (assPD) is an option of home dialysis treatment for dependent end-stage renal patients and worldwide applied in different countries since more than 40 years. China and Germany shares similar trends in demographic development with a growing proportion of elderly referred to dialysis treatment. So far number of patients treated by assPD is low in both countries. We analyze experiences in the implementation process, barriers, and benefits of ass PD in the aging population to provide a model for sustainable home dialysis treatment with PD in both countries. Differences and similarities of different factors (industrial, patient and facility based) which affect utilization of assPD are discussed. AssPD should be promoted in China and Germany to realize the benefits of home dialysis for the aging population by providing a structured model of implementation and quality assurance.
Topics: China; Germany; Hemodialysis, Home; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory
PubMed: 30380542
DOI: 10.1159/000494679 -
Current Opinion in Nephrology and... Sep 2015We review the molecular mechanisms of peritoneal transport and discuss how a better understanding of these mechanisms is relevant for dialysis therapy. (Review)
Review
PURPOSE OF REVIEW
We review the molecular mechanisms of peritoneal transport and discuss how a better understanding of these mechanisms is relevant for dialysis therapy.
RECENT FINDINGS
Peritoneal dialysis involves diffusion and osmosis through the highly vascularized peritoneal membrane. Computer simulations, expression studies and functional analyses in Aqp1 knockout mice demonstrated the critical role of the water channel aquaporin-1 (AQP1) in water removal during peritoneal dialysis. Pharmacologic regulation of AQP1, either through increased expression or gating, is associated with increased water transport in rodent models of peritoneal dialysis. Water transport is impaired during acute peritonitis, despite unchanged expression of AQP1, resulting from the increased microvascular area that dissipates the osmotic gradient across the membrane. In long-term peritoneal dialysis patients, the fibrotic interstitium also impairs water transport, resulting in ultrafiltration failure. Recent data suggest that stroke and drug intoxications might benefit from peritoneal dialysis and could represent novel applications of peritoneal transport in the future.
SUMMARY
A better understanding of the regulation of osmotic water transport across the peritoneum offers novel insights into the role of water channels in microvascular endothelia, the functional importance of structural changes in the peritoneal interstitium and the transport of water and solutes across biological membranes in general.
Topics: Animals; Aquaporin 1; Biological Transport; Body Water; Cell Membrane; Humans; Peritoneal Dialysis; Peritoneum
PubMed: 26197201
DOI: 10.1097/MNH.0000000000000151 -
Renal Failure Dec 2023Gut dysbiosis in peritoneal dialysis (PD) patients causes chronic inflammation and metabolic disorders which result in a series of complications, probably playing an...
BACKGROUND
Gut dysbiosis in peritoneal dialysis (PD) patients causes chronic inflammation and metabolic disorders which result in a series of complications, probably playing an important role in PD technique failure. The reduction in gut microbial diversity was a common feature of gut dysbiosis. The objective was to explore the relationship between gut microbial diversity and technique failure in PD patients.
METHODS
The gut microbiota was analyzed by 16s ribosomal RNA gene amplicon sequencing. Cox proportional hazards models were used to identify association between gut microbial diversity and technique failure in PD patients.
RESULTS
In this study, a total of 101 PD patients were enrolled. During a median follow-up of 38 months, we found that lower diversity was independently associated with a higher risk of technique failure (hazard ratio [HR], 2.682; 95% confidence interval [CI], 1.319-5.456; = 0.006). In addition, older age (HR, 1.034; 95% CI, 1.005-1.063; = 0.020) and the history of diabetes (HR, 5.547; 95% CI, 2.218-13.876; < 0.001) were also independent predictors for technique failure of PD patients. The prediction model constructed on the basis of three independent risk factors above performed well in predicting technique failure at 36 and 48 months (36 months: area under the curve [AUC] = 0.861; 95% CI, 0.836-0.886; 48 months: AUC = 0.815; 95% CI, 0.774-0.857).
CONCLUSION
Gut microbial diversity was independently correlated with technique failure in PD patients, and some specific microbial taxa may serve as a potential therapeutic target for decreasing PD technique failure.
Topics: Humans; Gastrointestinal Microbiome; Dysbiosis; Peritoneal Dialysis; Proportional Hazards Models; Risk Factors; Kidney Failure, Chronic
PubMed: 37009921
DOI: 10.1080/0886022X.2023.2195014