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Peritoneal Dialysis International :... Jan 2021Preservation of peritoneal function is crucial for the continuation of peritoneal dialysis (PD). A previous study suggested that blood cholesterol is involved in the...
BACKGROUND
Preservation of peritoneal function is crucial for the continuation of peritoneal dialysis (PD). A previous study suggested that blood cholesterol is involved in the preservation of peritoneal function; therefore, we determined whether adipocytokines can predict peritoneal function preservation.
METHODS
Eighty patients were enrolled. Serum adiponectin, leptin, apelin, various blood components, and estimated glomerular filtration rate (eGFR) (mL/min/m) were measured. In addition, the duration of PD, presence or absence of peritonitis and diabetes mellitus, body mass index, urine output, peritoneal /, renal /, weekly /, peritoneal creatinine clearance rate (CCr), renal CCr, weekly CCr, use or nonuse of statin products, dialysate volume, glucose exposure, and use or nonuse of icodextrin dialysate were assessed. Peritoneal equilibration tests were performed at 6-month intervals, and dialysate-to-plasma [D/P] ratio and glucose uptake ratio [D/D] were measured. Associations of the baseline values and their percent changes with various adipocytokines and test items were evaluated.
RESULTS
Multiple regression analyses identified adiponectin ( = 0.0392, = 0.0348) as a significant predictive factor of D/P and D/D ratios. eGFR was identified as a significant predictive factor ( = 0.015) of percent change in the D/P ratio. Apelin ( = 0.0484), high-density lipoprotein cholesterol ( = 0.0066), dialysate volume ( = 0.0223), and urine output ( = 0.0020) were identified as factors affecting the duration of PD.
CONCLUSIONS
Adipocytokines are a predictive factor of peritoneal function and the duration of PD in patients undergoing PD.
Topics: Adipokines; Creatinine; Dialysis Solutions; Humans; Icodextrin; Peritoneal Dialysis; Peritoneum
PubMed: 32063216
DOI: 10.1177/0896860819896133 -
Radiographics : a Review Publication of... Oct 2020Interventional radiology (IR) is an underutilized resource for the placement and management of tunneled peritoneal dialysis (PD) catheters, as only about 5% of PD... (Review)
Review
Interventional radiology (IR) is an underutilized resource for the placement and management of tunneled peritoneal dialysis (PD) catheters, as only about 5% of PD catheters are placed by using IR. PD is a cost-effective and physiologically beneficial alternative to hemodialysis (HD) with an increased survival benefit and lower complication rate than HD. As a home dialysis therapy, patients who undergo PD experience many advantages over patients who undergo HD, including a greater sense of well-being and quality of life. The author explains the history, need, rationale, benefits, complications, patient selection, preprocedure patient evaluation and preparation, catheter selection, procedural directives, and management strategies of IR involvement in tunneled PD catheter placement. Surgical and non-image-guided placement techniques and pitfalls are also discussed, and their benefits and limitations are compared with the cost-effective percutaneous image-guided IR technique. Specific attention to image-documented placement of the PD catheter coil into the retrovesical or retrouterine space is emphasized for optimal PD catheter function, as the retrovesical or retrouterine space is the most dependent portion of the peritoneal space and is void of omentum and small bowel. These features increase the functional ability of the PD catheter to effectively exchange the dialysate fluid and avoid complications such as omental wrap. IR, as an image-based specialty, is well positioned to evaluate for other complications of tunneled PD catheters such as migration, catheter kink and obstruction, and catheter leak. The demand for PD is predicted to increase in the future, and IR is strategically situated to become a leader in tunneled PD catheter placement and management. Published under a CC BY 4.0 license.
Topics: Catheters, Indwelling; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Radiography, Interventional
PubMed: 33001792
DOI: 10.1148/rg.2020200063 -
Journal of Nephrology Sep 2023
Topics: Humans; Peritoneum; Peritoneal Dialysis; Radionuclide Imaging; Fistula; Peritoneal Diseases
PubMed: 37535296
DOI: 10.1007/s40620-023-01729-2 -
Renal Failure Dec 2023Excessive daytime sleepiness (EDS) is associated with quality of life and all-cause mortality in the end-stage renal disease population. This study aims to identify...
Excessive daytime sleepiness (EDS) is associated with quality of life and all-cause mortality in the end-stage renal disease population. This study aims to identify biomarkers and reveal the underlying mechanisms of EDS in peritoneal dialysis (PD) patients. A total of 48 nondiabetic continuous ambulatory peritoneal dialysis patients were assigned to the EDS group and the non-EDS group according to the Epworth Sleepiness Scale (ESS). Ultra-high-performance liquid chromatography coupled with quadrupole-time-of-flight mass spectrometry (UHPLC-Q-TOF/MS) was used to identify the differential metabolites. Twenty-seven (male/female, 15/12; age, 60.1 ± 16.2 years) PD patients with ESS ≥ 10 were assigned to the EDS group, while twenty-one (male/female, 13/8; age, 57.9 ± 10.1 years) PD patients with ESS < 10 were defined as the non-EDS group. With UHPLC-Q-TOF/MS, 39 metabolites with significant differences between the two groups were found, 9 of which had good correlations with disease severity and were further classified into amino acid, lipid and organic acid metabolism. A total of 103 overlapping target proteins of the differential metabolites and EDS were found. Then, the EDS-metabolite-target network and the protein-protein interaction network were constructed. The metabolomics approach integrated with network pharmacology provides new insights into the early diagnosis and mechanisms of EDS in PD patients.
Topics: Humans; Male; Female; Adult; Middle Aged; Aged; Quality of Life; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Kidney Failure, Chronic; Disorders of Excessive Somnolence
PubMed: 37051665
DOI: 10.1080/0886022X.2023.2190815 -
BMC Nephrology Jan 2024Patients taking SGLT-2 inhibitors may experience delayed peritoneal fibrosis, better ultrafiltration of water and toxins, and higher survival rates. We aimed to evaluate...
BACKGROUND
Patients taking SGLT-2 inhibitors may experience delayed peritoneal fibrosis, better ultrafiltration of water and toxins, and higher survival rates. We aimed to evaluate the possible effects of Dapagliflozin in changing the peritoneal solute transfer rate, reducing peritoneal glucose absorption, and, hence, increasing ultrafiltration.
METHODOLOGY
A pilot pre-post interventional study was used to evaluate 20 patients on continuous ambulatory peritoneal dialysis (CAPD) enrolled in a one-month self-controlled study [Trial#: NCT04923295]. Inclusion criteria included being over 18, and having a Peritoneal Dialysis (PD) vintage of at least six months. All participants were classified as having high or average high transport status based on their Peritoneal Equilibrium Test with a D0/D4 > 0.39. and using at least two exchanges with 2.35% dextrose over the previous three months before enrollment.
RESULTS
Following the treatment, 13 patients had an increase in median D4/D0 from 0.26 [0.17-0.38] to 0.31 [0.23-0.40], while seven patients had a decline from 0.28 [0.17-0.38] to 0.23 [0.14-0.33]. Additionally, nine patients had a decrease in median D/P from 0.88 [0.67-0.92] to 0.81 [0.54-0.85], while 11 patients had an increase from 0.70 [0.6-0.83] to 0.76 [0.63-0.91].
CONCLUSION
According to the findings of this study, Dapagliflozin usage in peritoneal dialysis patients did not result in a reduction in glucose absorption across the peritoneal membrane. Additionally, Dapagliflozin was also associated with a small increase in sodium dip, a decrease in peritoneal VEGF, and a decrease in systemic IL-6 levels all of which were not statistically significant. Further large-scale studies are required to corroborate these conclusions.
Topics: Humans; Pilot Projects; Peritoneum; Peritoneal Dialysis; Ultrafiltration; Glucose; Dialysis Solutions; Benzhydryl Compounds; Glucosides
PubMed: 38279109
DOI: 10.1186/s12882-023-03429-2 -
Nephrologie & Therapeutique Apr 2021Peritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including...
BACKGROUND
Peritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.
METHODS
We retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.
RESULTS
Of the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249-0.868; P=0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184-5.315; P=0.016) exhibited significant differences.
CONCLUSIONS
The results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.
Topics: Dialysis Solutions; Humans; Peritoneal Dialysis; Peritonitis; Retrospective Studies; Risk Factors
PubMed: 33495136
DOI: 10.1016/j.nephro.2020.10.007 -
Peritoneal Dialysis International :... Mar 2023We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous... (Meta-Analysis)
Meta-Analysis
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77-0.99], = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63-0.90], = 0.00), published in Asia (HR 0.76 [95% CI, 0.67-0.86], < 0.001) or Europe (HR 0.81 [95% CI, 0.74-0.89], < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68-0.99], = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
Topics: Humans; Automation; China; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Proportional Hazards Models
PubMed: 36476184
DOI: 10.1177/08968608221140788 -
Blood Purification 2022A well-functioning peritoneal catheter is key to success of peritoneal dialysis (PD). The Vicenza "short" catheter is a modified Tenckhoff catheter with a shorter...
INTRODUCTION
A well-functioning peritoneal catheter is key to success of peritoneal dialysis (PD). The Vicenza "short" catheter is a modified Tenckhoff catheter with a shorter intraperitoneal segment. The aim of this study was to evaluate the incidence of catheter-related complications and catheter survival rate using the Vicenza "short" catheter, according to the goals suggested by the International Society for Peritoneal Dialysis (ISPD) guidelines. Second, we compared insertion techniques used in our center.
METHODS
This is a retrospective cohort, single-center study analyzing incident PD patients undergoing Vicenza "short" peritoneal catheter placement between January 1, 2015, and December 31, 2019. As clinical outcomes, we evaluated catheter patency at 12 months, exit-site/tunnel infection and peritonitis within 30 days of catheter insertion, visceral injury, or significant hemorrhage during the procedure, in accordance with ISPD guidelines.
RESULTS
The percentage of patency at 12 months for all catheter insertion methods was 88.91%, and the percentage for laparoscopic placement was 93.75%. The exit-site/tunnel infection and peritonitis occurring within 30 days of catheter insertion were, respectively, 0.75% and 2.2%; the visceral injury leading to intervention was 0.75%. We did not have any case of significant hemorrhage. All results were in line with ISPD guidelines.
CONCLUSION
We conclude that the Vicenza "short" catheter is a suitable device for peritoneal access. The implantation procedure is safe and easy to perform, and both nephrologists and surgeons can do it. A confident use and a proper implantation of the Vicenza "short" catheter help achieve the clinical ISPD goals for the PD access procedure in terms of catheter survival and complication rates.
Topics: Catheterization; Catheters, Indwelling; Humans; Peritoneal Dialysis; Peritonitis; Postoperative Complications; Retrospective Studies
PubMed: 34883486
DOI: 10.1159/000519316 -
Renal Failure 2023Residual kidney function (RKF) impacts patients' survival rate and quality of life when undergoing peritoneal dialysis (PD). This meta-analysis was conducted to... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Residual kidney function (RKF) impacts patients' survival rate and quality of life when undergoing peritoneal dialysis (PD). This meta-analysis was conducted to systematically identify risk and protective factors associated with RKF decline and loss.
METHODS
We searched three English and one Chinese databases from inception to January 31, 2023, for cohort and cross-sectional studies exploring factors associated with RKF decline or loss. The random effects model was employed to aggregate risk estimates and 95% confidence intervals (CIs) from multivariate analysis. Sensitivity and subgroup analyses were performed to explore the heterogeneity among the studies.
RESULTS
Twenty-seven studies comprising 13549 individuals and 14 factors were included in the meta-analysis. Based on the meta-analysis results, risk factors involving male gender (hazard ratio (HR) 1.689, 95%CI 1.385-2.061), greater body mass index (BMI) (odds ratio (OR) 1.081, 95% confidence interval (CI) 1.029-1.135), higher systolic blood pressure (SBP) (HR 1.014, 95%CI 1.005-1.024), diabetes mellitus (DM) (HR 1.873, 95%CI 1.475-2.378), DM (OR 1.906, 95%CI 1.262-2.879), peritonitis (relative ratio (RR) 2.291, 95%CI 1.633-3.213), proteinuria (OR 1.223, 95%CI 1.117-1.338), and elevated serum phosphorus (RR 2.655, 95%CI 1.679-4.201) significantly contributed to the risk of RKF decline and loss in PD patients. Conversely, older age (HR 0.968, 95%CI 0.956-0.981), higher serum albumin (OR 0.834, 95%CI 0.720-0.966), weekly Kt/V urea (HR 0.414, 95%CI 0.248-0.690), baseline urine volume (UV) (HR 0.791, 95%CI 0.639-0.979), baseline RKF (HR 0.795, 95%CI 0.739-0.857) exhibited protective effects. However, diuretics use, automatic peritoneal dialysis (APD) modality and baseline RKF did not significantly impact RKF decline.
CONCLUSIONS
Patients with male gender, greater BMI, higher SBP, DM, peritonitis, proteinuria, and elevated serum phosphorus might have a higher risk of RKF decline and loss. In contrast, older age, higher serum albumin, weekly Kt/V urea, baseline UV, and baseline RKF might protect against RKF deterioration.
Topics: Humans; Male; Cross-Sectional Studies; Kidney; Kidney Failure, Chronic; Peritoneal Dialysis; Peritonitis; Phosphorus; Proteinuria; Quality of Life; Serum Albumin; Urea; Female
PubMed: 38036948
DOI: 10.1080/0886022X.2023.2286328 -
Peritoneal Dialysis International :... May 2021
Topics: Humans; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory
PubMed: 33823707
DOI: 10.1177/08968608211001262