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Clinical Journal of the American... Nov 2015Although a peritoneal equilibration test yields data on three parameters (4-hour dialysate/plasma creatinine, 4- to 0-hour dialysate glucose, and 4-hour ultrafiltration... (Observational Study)
Observational Study
BACKGROUND AND OBJECTIVES
Although a peritoneal equilibration test yields data on three parameters (4-hour dialysate/plasma creatinine, 4- to 0-hour dialysate glucose, and 4-hour ultrafiltration volume), all studies have focused on the prognostic value of dialysate/plasma creatinine for patients undergoing peritoneal dialysis. Because dialysate 4- to 0-hour glucose and ultrafiltration volume may be superior in predicting daily ultrafiltration, the likely mechanism for the association of peritoneal equilibration test results with outcomes, we hypothesized that they are superior to dialysate/plasma creatinine for risk prediction.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
We examined unadjusted and adjusted associations of three peritoneal equilibration test parameters with all-cause mortality, technique failure, and hospitalization rate in 10,142 patients on peritoneal dialysis treated between January 1, 2007 and December 31, 2011 in 764 dialysis facilities operated by a single large dialysis organization in the United States, with a median follow-up period of 15.8 months; 87% were treated with automated peritoneal dialysis.
RESULTS
Demographic and clinical parameters explained only 8% of the variability in dialysate/plasma creatinine. There was a linear association between dialysate/plasma creatinine and mortality (adjusted hazards ratio per 0.1 unit higher, 1.07; 95% confidence interval, 1.02 to 1.13) and hospitalization rate (adjusted incidence rate ratio per 0.1 unit higher, 1.05; 95% confidence interval, 1.03 to 1.06). Dialysate/plasma creatinine and dialysate glucose were highly correlated (r=-0.84) and yielded similar risk prediction. Ultrafiltration volume was inversely related with hospitalization rate but not with all-cause mortality. None of the parameters were associated with technique failure. Adding 4- to 0-hour dialysate glucose, ultrafiltration volume, or both did not result in any improvement in risk prediction with dialysate/plasma creatinine alone.
CONCLUSIONS
This analysis from a large contemporary cohort treated primarily with automated peritoneal dialysis validates dialysate/plasma creatinine as a robust predictor of outcomes in patients treated with peritoneal dialysis.
Topics: Cohort Studies; Creatinine; Dialysis Solutions; Female; Glucose; Humans; Male; Middle Aged; Peritoneal Dialysis; Peritoneum; Risk Assessment; Treatment Outcome
PubMed: 26463882
DOI: 10.2215/CJN.03470315 -
Peritoneal Dialysis International :... Jun 2014Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We...
OBJECTIVES
Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We investigated relationships of indices of dialysis adequacy (including KT/V, KT, clearance, dialysate over plasma concentration ratio) and anthropometric and body composition parameters (BSA, TBW, body mass index (BMI), weight, height, fat mass (FM), and fat-free mass (FFM)) in male and female patients on continuous ambulatory peritoneal dialysis.
METHODS
Ninety-nine stable patients (56 males) performed four 24-hr collections of drained dialysate for four dialysis schedules with three daily exchanges of glucose 1.36% and one night exchange of either: 1) glucose 1.36%, 2) glucose 2.27%, 3) glucose 3.86% or 4) icodextrin 7.5%.
RESULTS
KT and dialysate over plasma concentration ratio, CD/CP, for urea and creatinine were similar for males and females and, in general, did not depend on body-size parameters including V (= TBW), which means that the overall capacity of the transport system in females and males is similar. However, after normalization of KT to V or 1.73/BSA yielding KT/V and creatinine clearance, Cl(1.73/BSA), respectively, the normalized indices were substantially higher in females than in males and correlated inversely with body-size parameters, especially in males.
CONCLUSIONS
As KT/V depends strongly on body size, treatment target values for KT/V should take body size and therefore also gender into account. As KT is less influenced by body size, body composition and gender, KT should be considered as a potential auxiliary index in PD.
Topics: Adult; Aged; Anthropometry; Biological Transport; Body Composition; Creatinine; Dialysis Solutions; Female; Humans; Kidney Failure, Chronic; Kidney Function Tests; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Sex Factors
PubMed: 24497588
DOI: 10.3747/pdi.2013.00018 -
International Journal of Molecular... Jul 2021Peritoneal dialysis (PD) is an important, if underprescribed, modality for the treatment of patients with end-stage kidney disease. Among the barriers to its wider use... (Review)
Review
Peritoneal dialysis (PD) is an important, if underprescribed, modality for the treatment of patients with end-stage kidney disease. Among the barriers to its wider use are the deleterious effects of currently commercially available glucose-based PD solutions on the morphological integrity and function of the peritoneal membrane due to fibrosis. This is primarily driven by hyperglycaemia due to its effects, through multiple cytokine and transcription factor signalling-and their metabolic sequelae-on the synthesis of collagen and other extracellular membrane components. In this review, we outline these interactions and explore how novel PD solution formulations are aimed at utilizing this knowledge to minimise the complications associated with fibrosis, while maintaining adequate rates of ultrafiltration across the peritoneal membrane and preservation of patient urinary volumes. We discuss the development of a new generation of reduced-glucose PD solutions that employ a variety of osmotically active constituents and highlight the biochemical rationale underlying optimization of oxidative metabolism within the peritoneal membrane. They are aimed at achieving optimal clinical outcomes and improving the whole-body metabolic profile of patients, particularly those who are glucose-intolerant, insulin-resistant, or diabetic, and for whom daily exposure to high doses of glucose is contraindicated.
Topics: Diabetes Mellitus; Dialysis Solutions; Glucose; Glucose Intolerance; Humans; Insulin Resistance; Kidney Failure, Chronic; Peritoneal Dialysis; Peritoneum
PubMed: 34360717
DOI: 10.3390/ijms22157955 -
Blood Purification 2019Intermittent infusion hemodiafiltration -(I-HDF) has been performed for a number of years since this mode of dialysis became available with dialyzers used in Japan. It... (Clinical Trial)
Clinical Trial
BACKGROUND
Intermittent infusion hemodiafiltration -(I-HDF) has been performed for a number of years since this mode of dialysis became available with dialyzers used in Japan. It has been effective in some cases and ineffective in others. In this study, we analyzed and clarified these differences.
SUMMARY
We conducted a retrospective study to determine the factors affecting the effectiveness of I-HDF treatment in some patients and ineffectiveness in others and classified the complex causes associated with volume load that were identified. Key Messages: Bolus dialysate infusion in I-HDF affects the volume load (preload), and repeated bolus dialysate infusion influences both preload and afterload in patients with valvular heart disease. In this study, I-HDF was effective when brain natriuretic peptide levels, cardiothoracic ratio, and ultrafiltration rate were well controlled and cardiac load was low. I-HDF was shown to be effective in patients who are prone to developing hypotension at the end of a dialysis session. There were several factors, including different types of load, involved in inefficiency of I-HDF.
Topics: Aged; Aged, 80 and over; Dialysis Solutions; Female; Hemodiafiltration; Humans; Hypotension; Japan; Male; Retrospective Studies
PubMed: 31752001
DOI: 10.1159/000503876 -
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 -
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 -
Journal of Biomedicine & Biotechnology 2011During peritoneal dialysis (PD), constant exposure of mesothelial cells to bioincompatible PD solutions results in the denudation of the mesothelial monolayer and... (Review)
Review
During peritoneal dialysis (PD), constant exposure of mesothelial cells to bioincompatible PD solutions results in the denudation of the mesothelial monolayer and impairment of mesothelial cell function. Hyaluronan, a major component of extracellular matrices, is synthesized by mesothelial cells and contributes to remesothelialization, maintenance of cell phenotype, and tissue remodeling and provides structural support to the peritoneal membrane. Chronic peritoneal inflammation is observed in long-term PD patients and is associated with increased hyaluronan synthesis. During inflammation, depolymerization of hyaluronan may occur with the generation of hyaluronan fragments. In contrast to native hyaluronan which offers a protective role to the peritoneum, hyaluronan fragments exacerbate inflammatory and fibrotic processes and therefore assist in the destruction of the tissue. This paper will discuss the contribution of mesothelial cells to peritoneal membrane alterations that are induced by PD and the putative role of hyaluronan in these processes.
Topics: Biomarkers; Cell Transdifferentiation; Dialysis Solutions; Epithelial Cells; Humans; Hyaluronic Acid; Inflammation; Molecular Weight; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum
PubMed: 22203782
DOI: 10.1155/2011/180594