Peritoneal Dialysis International最新文献

In acute kidney injury, no dialytic method has been shown to be superior in terms of mortality or recovery of kidney function. Peritoneal dialysis is an excellent treatment option, since it is continuous and can be adapted to clinical needs, it offers hemodynamic stability, adequate solute clearance, correction of electrolyte and acidosis disorders, appropriate ultrafiltration in volume overload, it is cheaper, does not require anticoagulation, provides calories, can be performed at the patient's bedside, its prescription is simple and does not require such sophisticated machinery. And when compared with other modalities, it has been shown to be equally efficient and safe, although its use is limited, partly due to the lack of knowledge and experience with this modality. Existing clinical evidence has consistently shown that this modality has very similar results in terms of the most relevant objectives evaluated in AKI. This modality offers certain advantages in specific contexts of acute kidney injury, such as cardiorenal syndrome, hepatorenal syndrome, in unstable patients on vasopressors, and in neurocritical patients. For all these reasons, we believe that peritoneal dialysis in acute kidney injury has sufficient arguments to be implemented more frequently and receive the value it deserves.

Icodextrin (ICO) is widely used in peritoneal dialysis (PD). Hyperosmolar hyponatremia (hypoNa) has been reported as an adverse event of ICO, but it is unknown whether there is a dose effect relationship between the two. We present a case demonstrating this relationship. A 61-year-old woman with end-stage kidney disease (ESKD) and no history of diabetes, began PD with a single daily dwell of 1L of ICO. Her serum Na during the previous 6 months (n = 16) was 138.9 (mmol/L) ± 2.2 (SD). Within days of starting PD, the Na fell to 132 and over the ensuing 9 months (n = 27) it averaged 133.6 ± 2.1. As her PD prescription (Rx) was changed throughout two hospital admissions and subsequent outpatient management, she maintained normonatremia when using dextrose exchanges and became hyponatremic with ICO exchanges. With increasing daily doses of ICO, her hyponatremia became more severe (nadir of Na 121 with 3L of daily ICO use). She ultimately returned to exclusively dextrose cycles for two years and remained normonatremic. Years later a single 2L ICO dwell was started, and she developed hypoNa again (Na 131). ICO was stopped and Na normalized. We plotted serum Na vs total daily ICO dose and showed a strong correlation (R² = 0.737). HypoNa is a risk factor for ESKD patients that lead to increased morbidity and mortality. This report demonstrates that the severity of ICO-induced hyponatremia is directly proportional to the amount of ICO used. For patients developing hyponatremia, instead of discontinuing ICO, practitioners might consider reducing the dose.

BackgroundSex-based differences may influence the clinical management, complication risks, and healthcare resource utilization of hospitalized end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Understanding these disparities is essential for optimizing patient care and informing healthcare policy.MethodsThis study was conducted using the National Inpatient Sample to identify hospitalized adult ESKD patients receiving PD from the year 2003 to 2018. The outcomes included 1) PD-related outcomes, defined as a composite of peritonitis, mechanical complications, catheter removal or revision, and adequacy issues, 2) non-PD-related outcomes, defined as a composite of sepsis, cardiac arrest, and need for mechanical ventilation 3) transfer to hemodialysis, and 4) in-hospital mortality. The associations between sex and in-hospital outcomes were analyzed using multivariable logistic regression and were adjusted for demographic factors, comorbidities, primary diagnoses, admission types, and hospital characteristics. Discharge weights were applied to generate nationally representative estimates.ResultsOf 97,036 hospitalized ESKD patients receiving PD analyzed, 48,906 (50.4%) were females. In adjusted analyses, there were no overall sex differences in PD-related outcomes, non-PD-related outcomes, or in-hospital mortality. However, age- and comorbidity-based variations were observed in PD-related outcomes. Female sex was associated with lower odds of transfer to hemodialysis, particularly among younger patients and those without heart failure or peripheral vascular disease. Notably, sex differences in in-hospital mortality were observed only among patients with elective admissions.ConclusionThere were sex-based disparities in the outcomes and healthcare utilization of hospitalized ESKD patients receiving PD. These findings underscore the need for sex-specific, individualized strategies to improve PD care and inform clinical and policy decisions.

IntroductionGastrointestinal (GI) symptoms are common and can be debilitating for patients receiving peritoneal dialysis (PD). However, they are rarely reported and there is no widely accepted or validated tool for measuring GI health in these patients to facilitate shared decision making.MethodsAn online consensus workshop was conducted to describe the experiences and perspectives about the impacts of GI symptoms in patients receiving PD and their caregivers and suggestions for measuring GI symptoms in clinical practice and research. A diverse range of patients currently receiving PD or who received PD within the past 5 years and their caregivers from different regions were recruited. After the initial presentation, small-group facilitated discussions were conducted similarly to focus groups, followed by a large-group summarisation of the workshop findings. Transcripts were thematically analysed using an inductive approach informed by grounded theory.Summary of the workshopThirty-five participants attended the online workshop, including 32 patients and 3 caregivers from 7 countries. Four themes were identified: restricting the ability to live freely (inability to predict and prepare, suffering from severe and disruptive symptoms), persistent anguish and struggle (living in fear, isolated by burden), uncertainty about healthcare management (inadequate education and information, lack of individualised care, experimenting to find solutions), measuring GI health in a relevant and robust manner (enabling comprehensive symptom monitoring, individualising frequency of symptom recording, recommending user-friendly and innovative tools).ConclusionThis study demonstrated a high burden of GI symptoms in patients receiving PD. These symptoms were unpredictable in their onset, threatening patients' wellbeing and quality of life. A feasible measure of GI symptoms needs to be developed and implemented to inform treatment decisions and aid in consistent reporting in PD trials.

Patients with dialysis have a high risk of osteoporosis and fractures. However, the optimal treatment strategies for osteoporosis in dialysis patients remain unclear due to the complexity of chronic kidney disease (CKD)-mineral and bone disorder. This case report describes severe symptomatic hypocalcemia and prolonged heart failure following denosumab treatment in a peritoneal dialysis (PD) patient with secondary hyperparathyroidism and osteoporosis. A 70-year-old woman on PD for dialysis caused by diabetic nephropathy was diagnosed with osteoporosis (T score -2.5) during a routine checkup. Denosumab, a receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitor, was administered following an increase in active vitamin D analog levels. One month later, she developed tetany, making it difficult to perform PD. Two days later, she was hospitalized with breathing difficulties and diagnosed with severe hypocalcemia and heart failure. Heart failure was attributed to mild fluid overload and reduced cardiac contractility due to hypocalcemia. Treatment with calcium supplementation and hemodialysis alleviated her symptoms and improved cardiac function. Denosumab is a promising option for osteoporosis in dialysis patients, but it poses a significant risk of severe hypocalcemia, especially in those with secondary hyperparathyroidism. Reports of such complications in PD patients are rare. Clinicians should carefully monitor serum calcium levels, implement preventive strategies, and promptly address complications when using denosumab in this population. In this case, cardiac function remained impaired for at least 6 months, suggesting prolonged heart failure following denosumab-associated hypocalcemia.

BackgroundThere are inequalities in resource allocation and services across peritoneal dialysis (PD) centers in China. This study aimed to explore the association between hospital type (university-affiliated vs. non-university-affiliated hospitals) and clinical outcomes in PD patients.MethodsData from the Peritoneal Dialysis Telemedicine-assisted Platform cohort was analyzed. The primary outcome was all-cause mortality, while secondary outcomes included hemodialysis transfer and first-episode PD-related peritonitis. Univariable and multivariable Fine-Gray models were used to calculate subdistribution hazard ratios (SHRs). Propensity-score matched analyses and sensitivity analyses restricted to incident patients were also performed.ResultsA total of 7416 PD patients were enrolled (June 2016 to April 2019), with a median follow-up of 29.0 months. University-affiliated hospitals' patients (n = 4806) were younger, had better nutritional status, and higher socio-economic status than those in non-university-affiliated hospitals (n = 2610). University-affiliated hospitals exhibited a lower risk for all-cause mortality (SHR: 0.72, 95% confidence interval (CI): 0.61-0.85, p < 0.001), higher hemodialysis transfer (SHR: 1.31, 95% CI: 1.08-1.60, p < 0.01), but no association with first-episode peritonitis in multivariable analyses. After propensity-score matching, university-affiliated hospitals were still associated with lower all-cause mortality (SHR: 0.74, 95% CI: 0.61-0.91, p < 0.01) and a higher risk of hemodialysis transfer (SHR: 1.52, 95% CI: 1.19-1.94, p < 0.01). Comparable results for all-cause mortality and first-episode peritonitis also found in incident patients.ConclusionIn China, PD patients in university-affiliated hospitals had lower mortality but a higher risk of hemodialysis transfer. Further studies are needed to understand these findings and inform future practices and resource allocations.

BackgroundKidney impairment (KI) is a frequent complication of multiple myeloma (MM), with chronic kidney disease (CKD) often necessitating dialysis. Peritoneal dialysis (PD) offers quality-of-life advantages over haemodialysis (HD), yet its use in patients with CKD secondary to MM (CKD-MM) remains understudied. This study investigates the characteristics and outcomes of PD in CKD-MM patients compared to those with other kidney diseases.MethodsThis retrospective observational study analysed data from the French Language PD Registry (RDPLF) for patients initiating PD between 2010 and 2020. A 4:1 ratio random sampling was drawn from patients with other kidney diseases to create a control group. Outcomes included death, transfer to HD and kidney transplantation. Cox regression models assessed the impact of CKD-MM on these outcomes, adjusting for baseline variables and treatment era.ResultsOf 12,861 PD patients, 96 (<1%) had CKD-MM. These patients exhibited higher comorbidities and were less likely to be listed for kidney transplantation compared to controls. Among the 96 patients with CKD-MM, 51 (53%) died, 29 (30%) transferred to HD, and 5 (5%) underwent kidney transplant. CKD-MM was not associated with increased risks of death (cause-specific hazard ratio [cs-HR] 1.18, 95% CI 0.83-1.67) nor transfer to HD (cs-HR 0.73, 95% CI 0.45-1.18). However, CKD-MM patients had a significantly lower chance of transplantation (cs-HR 0.22, 95% CI 0.08-0.59).ConclusionPD is a viable modality for CKD-MM, with outcomes comparable to other kidney diseases. Increased attention to PD initiation and transplant access may further optimise care for these patients.