Cardiovascular disease is the major cause of morbidity and mortality in chronic kidney disease patients. Because of a higher occurrence of asymptomatic coronary artery disease and increased perioperative cardiovascular mortality in kidney transplant patients, screening for coronary artery disease before transplant surgery is essential. Various studies have shown that cardiac stress testing is an unreliable screening method in these patients because of significant variability in sensitivity and negative predictive value. We suggest that high-risk candidates such as those with diabetes or a prior history of myocardial infarction, stroke, peripheral vascular disease, or coronary artery disease should perhaps be considered for coronary angiography rather than stress testing as cardiac screening before kidney transplantation.
{"title":"Preoperative Cardiac Evaluation in Kidney Transplant Patients: Is Coronary Angiography Superior? A Focused Review.","authors":"Natraj Katta, Sudarshan Balla, Poonam Velagapudi, Mayank Mittal, Harsh Agrawal, Arun Kumar, Kul Aggarwal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Cardiovascular disease is the major cause of morbidity and mortality in chronic kidney disease patients. Because of a higher occurrence of asymptomatic coronary artery disease and increased perioperative cardiovascular mortality in kidney transplant patients, screening for coronary artery disease before transplant surgery is essential. Various studies have shown that cardiac stress testing is an unreliable screening method in these patients because of significant variability in sensitivity and negative predictive value. We suggest that high-risk candidates such as those with diabetes or a prior history of myocardial infarction, stroke, peripheral vascular disease, or coronary artery disease should perhaps be considered for coronary angiography rather than stress testing as cardiac screening before kidney transplantation.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"32 ","pages":"32-38"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35581375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael M Strauss, Anupkumar Shetty, Daniel Witheiler
Bullous lesions in patients with end-stage renal disease are uncommon and can pose diagnostic and therapeutic challenges. We present a female patient with end-stage renal disease, bullous skin lesions affecting mainly sun-exposed areas, and high ferritin levels. She also had hepatitis C. Her serum porphyrin panel was suggestive of porphyria cutanea tarda. Skin biopsy excluded inflammatory pathologies. Phlebotomy during each hemodialysis, continuation of darbepoetin, and avoidance of any further doses of intravenous iron, with close monitoring of hemoglobin, resulted in a gradual drop in ferritin level and improvement of the skin lesions.
{"title":"Bullous Skin Lesions in a Patient with End-Stage Renal Disease and Hepatitis C.","authors":"Michael M Strauss, Anupkumar Shetty, Daniel Witheiler","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Bullous lesions in patients with end-stage renal disease are uncommon and can pose diagnostic and therapeutic challenges. We present a female patient with end-stage renal disease, bullous skin lesions affecting mainly sun-exposed areas, and high ferritin levels. She also had hepatitis C. Her serum porphyrin panel was suggestive of porphyria cutanea tarda. Skin biopsy excluded inflammatory pathologies. Phlebotomy during each hemodialysis, continuation of darbepoetin, and avoidance of any further doses of intravenous iron, with close monitoring of hemoglobin, resulted in a gradual drop in ferritin level and improvement of the skin lesions.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"32 ","pages":"56-60"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35477996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Radhames Ramos De Oleo, Hugo Villanueva, Lin Lwin, Madhavi Katikaneni, Jinil Yoo
Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication that is observed mostly in patients on long-term peritoneal dialysis (PD). However it can occur after short-term PD, in association with "second hit" risk factors such as peritonitis, acute cessation of PD, or kidney transplantation with the use of calcineurin inhibitors.In our case, a young woman with second-hit risk factors presented with clinical and abdominal computed tomography findings consistent with EPS after short-term PD. She was treated conservatively with nutritional support and was discharged in improved and stable clinical status.In general, the diagnosis of EPS requires clinical findings of bowel obstruction combined with typical computed tomography imaging features. However, the clinical manifestations can be very vague, and the diagnosis is often unclear. A recent study categorized EPS into 4 clinical stages, from pre-EPS to chronic ileus, with associated management from conservative treatment to surgical intervention.In association with second-hit risk factors, EPS can occur after short-term PD. Severity is variable, and the outcome is often devastating. Timely recognition and expert management of EPS can change the outcome very favorably.
{"title":"Time Is Not Always the Matter: An Instance of Encapsulating Peritoneal Sclerosis Developing in a Patient on Peritoneal Dialysis for a Short Term.","authors":"Radhames Ramos De Oleo, Hugo Villanueva, Lin Lwin, Madhavi Katikaneni, Jinil Yoo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication that is observed mostly in patients on long-term peritoneal dialysis (PD). However it can occur after short-term PD, in association with \"second hit\" risk factors such as peritonitis, acute cessation of PD, or kidney transplantation with the use of calcineurin inhibitors.In our case, a young woman with second-hit risk factors presented with clinical and abdominal computed tomography findings consistent with EPS after short-term PD. She was treated conservatively with nutritional support and was discharged in improved and stable clinical status.In general, the diagnosis of EPS requires clinical findings of bowel obstruction combined with typical computed tomography imaging features. However, the clinical manifestations can be very vague, and the diagnosis is often unclear. A recent study categorized EPS into 4 clinical stages, from pre-EPS to chronic ileus, with associated management from conservative treatment to surgical intervention.In association with second-hit risk factors, EPS can occur after short-term PD. Severity is variable, and the outcome is often devastating. Timely recognition and expert management of EPS can change the outcome very favorably.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"32 ","pages":"19-21"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35581372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ashwin Jaikishen, Adam Lick, Jonathan G Owen, Mihran V Naljayan
Urgent-start peritoneal dialysis (PD) refers to the initiation of PD in new-start end-stage renal disease patients who present either emergently in the hospital or urgently in clinic. These patients are called "late-referred patients." Our academic practice group, like many private practice and academic groups, currently functions within 4 hospitals and 4 clinics. The patient base consists of a large indigent population with limited access to health care and also of insured patients. An urgent-start PD program was initiated to provide all patients with a choice of dialysis modality.Our faculty understood that, for their urgent-start PD program to be successful, they had to have the support of the house staff, hospitalists, surgeons, and the PD nurse. The education began with grand rounds on urgent-start PD in the medicine department. We also educated the hospitalists at the other private hospitals on our urgent-start program. Once the primary care services were comfortable with urgent-start PD, our nephrology group then educated the surgeons about best-practice guidelines for PD catheter placement. At that time, a direct feedback communication loop was created between the PD nurse, surgeon, and nephrologist about the placement and functionality of the catheter. Here, we present our success in the creation of an urgent-start PD program.
{"title":"Louisiana State University Nephrology: Initiation of a Multicenter Urgent-Start Peritoneal Dialysis Program.","authors":"Ashwin Jaikishen, Adam Lick, Jonathan G Owen, Mihran V Naljayan","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Urgent-start peritoneal dialysis (PD) refers to the initiation of PD in new-start end-stage renal disease patients who present either emergently in the hospital or urgently in clinic. These patients are called \"late-referred patients.\" Our academic practice group, like many private practice and academic groups, currently functions within 4 hospitals and 4 clinics. The patient base consists of a large indigent population with limited access to health care and also of insured patients. An urgent-start PD program was initiated to provide all patients with a choice of dialysis modality.Our faculty understood that, for their urgent-start PD program to be successful, they had to have the support of the house staff, hospitalists, surgeons, and the PD nurse. The education began with grand rounds on urgent-start PD in the medicine department. We also educated the hospitalists at the other private hospitals on our urgent-start program. Once the primary care services were comfortable with urgent-start PD, our nephrology group then educated the surgeons about best-practice guidelines for PD catheter placement. At that time, a direct feedback communication loop was created between the PD nurse, surgeon, and nephrologist about the placement and functionality of the catheter. Here, we present our success in the creation of an urgent-start PD program.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"32 ","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35581373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hany Refaat, Dawlat Sany, Amr Mohab, Haitham Ezzat
Patients undergoing dialysis are at high risk for cardiovascular disease (CVD). Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. The question of whether dialysis modality affects the risk for CVD remains to be addressed.In the present study, we evaluated the influence of hemodialysis (HD) and peritoneal dialysis (PD) on survival and the risk of developing de novo CVD. Our observational prospective study enrolled 157 end-stage renal disease patients on HD or PD for 12 months. Patients with a history of malignancy, chronic rheumatic heart disease, congenital heart disease, previous cardiac surgery, or previous transplantation, and patients started on dialysis less than 3 months earlier were excluded from the study. Detailed medical history, demographic data, and routine laboratory investigations were obtained, and patients were follow every 3 months for 12 months. Cardiac echography was performed at baseline and at 6 months. Nutrition status was scored using the standardized 7-point subjective global assessment (SGA). Baseline comorbidities included the presence or absence of coronary artery disease (angina, myocardial infarction, and coronary artery bypass surgery), peripheral vascular disease, hypertension, diabetes mellitus, and cerebrovascular disease.Of the 157 patients, 121 were on HD (60 men, 61 women; mean age: 59.3 years), and 36 were on PD (14 men, 22 women; mean age: 50.8 years, p = 0.13). The dialysis duration was significantly different in the two groups (HD: 52.96 ± 38.3; PD: 30.89 ± 26.3; p = 0.02). Of the HD patients, 95.04% were hypertensive, and 61.98% were diabetic; of the PD patients, 91.66% were hypertensive, and 50% were diabetic. Body mass index and SGA score were not significantly different between the two groups. Patients on PD had a higher residual urine volume (383.66 ± 548.393 mL vs. 12.40 ± 96.238 mL in the HD patients, p < 0.001).In comparing traditional cardiovascular risk factors at the start of the study, PD patients had higher levels of total cholesterol (4.5 ± 1.33 mmol/L vs. 3.85 ± 1.34 mmol/L in HD patients, p < 0.05), low-density lipoprotein cholesterol (2.84 ± 1.31 mmol/L vs. 2.06 ± 0.89 mmol/L, p < 0.001), high-density lipoprotein cholesterol (1.10 ± 0.26 mmol/L vs. 0.91 ± 0.32 mmol/L, p < 0.005). Cardiovascular morbidity affected 17 HD patients and 2 PD patients. A Cox proportional hazards model for cardiovascular events showed a trend suggesting that PD was safer, but the data did not reach statistical significance. Kaplan-Meir survival analysis revealed 12 death events in HD patients compared with 4 events in PD patients-a difference that was not statistically significant.Cardiovascular morbidity during chronic dialysis was prevalent among the older patients (>57 years) and those who used more than 1 antihypertensive medication; an ejection fraction exceeding 53% was found to be cardioprotective. For all-cause mortality, dialysis modality was a nonsigni
接受透析的患者患心血管疾病(CVD)的风险很高。腹膜透析(PD)和血液透析(HD)的死亡率差异存在广泛争议。透析方式是否影响心血管疾病风险的问题仍有待解决。在本研究中,我们评估了血液透析(HD)和腹膜透析(PD)对生存和发展为新生心血管疾病风险的影响。我们的观察性前瞻性研究招募了157名患有HD或PD的终末期肾病患者,为期12个月。有恶性肿瘤史、慢性风湿性心脏病、先天性心脏病、既往心脏手术或既往移植史以及透析开始时间少于3个月的患者被排除在研究之外。获得详细的病史、人口统计资料和常规实验室检查,每3个月随访一次,随访12个月。在基线和6个月时进行心脏超声检查。采用标准化的7分主观整体评估(SGA)对营养状况进行评分。基线合并症包括是否存在冠状动脉疾病(心绞痛、心肌梗死和冠状动脉搭桥手术)、周围血管疾病、高血压、糖尿病和脑血管疾病。157例患者中,121例患有HD(60例男性,61例女性;平均年龄:59.3岁),36人接受PD治疗(男性14人,女性22人;平均年龄:50.8岁,p = 0.13)。两组患者透析时间差异有统计学意义(HD: 52.96±38.3;Pd: 30.89±26.3;P = 0.02)。高血压患者占95.04%,糖尿病患者占61.98%;PD患者中高血压占91.66%,糖尿病占50%。两组间体重指数和SGA评分差异无统计学意义。PD组残尿量高于HD组(383.66±548.393 mL vs 12.40±96.238 mL, p < 0.001)。在比较研究开始时的传统心血管危险因素时,PD患者的总胆固醇(4.5±1.33 mmol/L比HD患者的3.85±1.34 mmol/L, p < 0.05)、低密度脂蛋白胆固醇(2.84±1.31 mmol/L比2.06±0.89 mmol/L, p < 0.001)、高密度脂蛋白胆固醇(1.10±0.26 mmol/L比0.91±0.32 mmol/L, p < 0.005)水平较高。17例HD患者发生心血管疾病,2例PD患者发生心血管疾病。心血管事件的Cox比例风险模型显示出PD更安全的趋势,但数据没有达到统计学意义。Kaplan-Meir生存分析显示,HD患者有12例死亡事件,PD患者有4例死亡事件,差异无统计学意义。慢性透析期间心血管疾病发病率在年龄较大(>57岁)和使用1种以上降压药的患者中普遍存在;射血分数超过53%被认为具有心脏保护作用。对于全因死亡率,透析方式是不显著的危险因素;年龄和Kt/V有显著性差异。
{"title":"Comparing Dialysis Modality and Cardiovascular Mortality in Patients on Hemodialysis and Peritoneal Dialysis.","authors":"Hany Refaat, Dawlat Sany, Amr Mohab, Haitham Ezzat","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Patients undergoing dialysis are at high risk for cardiovascular disease (CVD). Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. The question of whether dialysis modality affects the risk for CVD remains to be addressed.In the present study, we evaluated the influence of hemodialysis (HD) and peritoneal dialysis (PD) on survival and the risk of developing de novo CVD. Our observational prospective study enrolled 157 end-stage renal disease patients on HD or PD for 12 months. Patients with a history of malignancy, chronic rheumatic heart disease, congenital heart disease, previous cardiac surgery, or previous transplantation, and patients started on dialysis less than 3 months earlier were excluded from the study. Detailed medical history, demographic data, and routine laboratory investigations were obtained, and patients were follow every 3 months for 12 months. Cardiac echography was performed at baseline and at 6 months. Nutrition status was scored using the standardized 7-point subjective global assessment (SGA). Baseline comorbidities included the presence or absence of coronary artery disease (angina, myocardial infarction, and coronary artery bypass surgery), peripheral vascular disease, hypertension, diabetes mellitus, and cerebrovascular disease.Of the 157 patients, 121 were on HD (60 men, 61 women; mean age: 59.3 years), and 36 were on PD (14 men, 22 women; mean age: 50.8 years, p = 0.13). The dialysis duration was significantly different in the two groups (HD: 52.96 ± 38.3; PD: 30.89 ± 26.3; p = 0.02). Of the HD patients, 95.04% were hypertensive, and 61.98% were diabetic; of the PD patients, 91.66% were hypertensive, and 50% were diabetic. Body mass index and SGA score were not significantly different between the two groups. Patients on PD had a higher residual urine volume (383.66 ± 548.393 mL vs. 12.40 ± 96.238 mL in the HD patients, p < 0.001).In comparing traditional cardiovascular risk factors at the start of the study, PD patients had higher levels of total cholesterol (4.5 ± 1.33 mmol/L vs. 3.85 ± 1.34 mmol/L in HD patients, p < 0.05), low-density lipoprotein cholesterol (2.84 ± 1.31 mmol/L vs. 2.06 ± 0.89 mmol/L, p < 0.001), high-density lipoprotein cholesterol (1.10 ± 0.26 mmol/L vs. 0.91 ± 0.32 mmol/L, p < 0.005). Cardiovascular morbidity affected 17 HD patients and 2 PD patients. A Cox proportional hazards model for cardiovascular events showed a trend suggesting that PD was safer, but the data did not reach statistical significance. Kaplan-Meir survival analysis revealed 12 death events in HD patients compared with 4 events in PD patients-a difference that was not statistically significant.Cardiovascular morbidity during chronic dialysis was prevalent among the older patients (>57 years) and those who used more than 1 antihypertensive medication; an ejection fraction exceeding 53% was found to be cardioprotective. For all-cause mortality, dialysis modality was a nonsigni","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"32 ","pages":"22-31"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35581374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peritoneal dialysis (PD) catheter-related infection is still is the most troublesome problem for continuation of PD without the need to switch to hemodialysis. We have been performing subcutaneous pathway diversion (SPD) as a surgical treatment for refractory exit-site and tunnel infection (ESTI). To clarify the efficacy and safety of SPD, we conducted a retrospective study. From August 2008 to August 2013, 30 SPDs were performed in 26 patients (16 men, 10 women; mean age: 58 +/- 13 years; 54% with diabetes; mean body mass index: 23.9 +/- 3.5 kg/ m2). The reasons for the SPDs were ESTI in 25 patients, and outer cuff extrusion in 1 patient. All patients resumed PD immediately after SPD, and the duration of hospitalization was 11.7 +/- 10.1 days. After SPD, one patient experienced a dialysate leak, and another patient experienced a mild subcutaneous hematoma. Another 4 patients developed exit-site infection (ESI) and underwent a second SPD. Of those 4 patients, 3 presented with another ESI unrelated to the first episode, and all developed an ESI after 6 months or more. The remaining 20 patients experienced no such complications. Furthermore, catheter survival after SPD was 17.4 +/- 13.4 months. To eradicate ESTTI we suggest that SPD, which does not require catheter removal or interruption of PD, is useful compared with the unroofing technique or catheter removal.
{"title":"Subcutaneous pathway diversion for peritoneal dialysis catheter salvage.","authors":"Tsutomu Sakurada, Takeshi Okamoto, Daisuke Oishi, Kenichiro Koitabashi, Shina Sueki, Nagayuki Kaneshiro, Katsuomi Matsui, Ryuto Nakazawa, Maki Yoshioka, Yusuke Konno, Yuichi Sato, Yugo Shibagaki, Tatsuya Chikaraishi, Kenjiro Kimura","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Peritoneal dialysis (PD) catheter-related infection is still is the most troublesome problem for continuation of PD without the need to switch to hemodialysis. We have been performing subcutaneous pathway diversion (SPD) as a surgical treatment for refractory exit-site and tunnel infection (ESTI). To clarify the efficacy and safety of SPD, we conducted a retrospective study. From August 2008 to August 2013, 30 SPDs were performed in 26 patients (16 men, 10 women; mean age: 58 +/- 13 years; 54% with diabetes; mean body mass index: 23.9 +/- 3.5 kg/ m2). The reasons for the SPDs were ESTI in 25 patients, and outer cuff extrusion in 1 patient. All patients resumed PD immediately after SPD, and the duration of hospitalization was 11.7 +/- 10.1 days. After SPD, one patient experienced a dialysate leak, and another patient experienced a mild subcutaneous hematoma. Another 4 patients developed exit-site infection (ESI) and underwent a second SPD. Of those 4 patients, 3 presented with another ESI unrelated to the first episode, and all developed an ESI after 6 months or more. The remaining 20 patients experienced no such complications. Furthermore, catheter survival after SPD was 17.4 +/- 13.4 months. To eradicate ESTTI we suggest that SPD, which does not require catheter removal or interruption of PD, is useful compared with the unroofing technique or catheter removal.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"30 ","pages":"11-4"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32765255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recently, it was reported that concomitant hemodialysis (HD) in peritoneal dialysis (PD) patients facilitated continuation of PD treatment and mitigated the deterioration of peritoneal function in patients with uremic symptoms and excess body fluid associated with loss of residual renal function. To determine the effect of combined HD and PD on patient and technique survival, we undertook a retrospective cohort study of patients who underwent PD at Saitama Medical University Hospital between 1995 and 2010. We compared patients who started PD during 1995 2002 with those who started during 2003- 2010. Because our center started a new strategy of supplementing PD with once-weekly HD in 2000, the effects of combination therapy could be determined by comparing the data obtained during the two periods. The 440 patients (274 men, 166 women) who started PD during the study period had a mean age of 60.2 +/- 73 years. The mean age was significantly higher in the 2003 - 2010 group than in the 1995 - 2002 group. Using a Kaplan-Meier plot, we observed a significant difference in technique survival (p < 0.001). The technique survival rate at 3 and 5 years was, respectively, 89% and 74% in the 2003-2010 group and 68% and 35% in the 1995 - 2002 group (p < 0.05). Cumulative patient survival at 3 and 5 years was, respectively, 87% and 72% in the 2003 - 2010 group and 69% and 51% in the 1995 - 2003 group (p < 0.01). Patient and technique survival were significantly improved in PD patients receiving the combination of HD and PD.
{"title":"Long-term survival benefits of combined hemodialysis and peritoneal dialysis.","authors":"Hiromichi Suzuki, Hitosi Hoshi, Tsutomu Inoue, Tomohiro Kikuta, Hiroshi Takane, Tsuneo Takenaka, Yusuke Watanabe, Hirokazu Okada, Yumi Kimura","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Recently, it was reported that concomitant hemodialysis (HD) in peritoneal dialysis (PD) patients facilitated continuation of PD treatment and mitigated the deterioration of peritoneal function in patients with uremic symptoms and excess body fluid associated with loss of residual renal function. To determine the effect of combined HD and PD on patient and technique survival, we undertook a retrospective cohort study of patients who underwent PD at Saitama Medical University Hospital between 1995 and 2010. We compared patients who started PD during 1995 2002 with those who started during 2003- 2010. Because our center started a new strategy of supplementing PD with once-weekly HD in 2000, the effects of combination therapy could be determined by comparing the data obtained during the two periods. The 440 patients (274 men, 166 women) who started PD during the study period had a mean age of 60.2 +/- 73 years. The mean age was significantly higher in the 2003 - 2010 group than in the 1995 - 2002 group. Using a Kaplan-Meier plot, we observed a significant difference in technique survival (p < 0.001). The technique survival rate at 3 and 5 years was, respectively, 89% and 74% in the 2003-2010 group and 68% and 35% in the 1995 - 2002 group (p < 0.05). Cumulative patient survival at 3 and 5 years was, respectively, 87% and 72% in the 2003 - 2010 group and 69% and 51% in the 1995 - 2003 group (p < 0.01). Patient and technique survival were significantly improved in PD patients receiving the combination of HD and PD.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"30 ","pages":"31-5"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32765259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years, icodextrin 7.5% has been used in PD as an alternative to glucose to achieve sustained reliable ultrafiltration (UF) and clearance without adversely increasing glucose absorption. Icodextrin is generally well tolerated. The most commonly reported adverse events are cutaneous reactions. We report a rare form of hypersensitivity to icodextrin 7.5% that was accompanied by dyspnea and symptomatic hypotension, without increased UF to account for the observed hypotension. Icodextrin produces symptomatic hypotension in up to 40% of patients by a known mechanism of increased UF and corresponding weight loss. However, it can also produce symptomatic hypotension accompanied by several other systemic symptoms in a hypersensitivity reaction. Discontinuation of the icodextrin results in prompt resolution of those symptoms. Treating nephrologists must be aware of this rare form of icodextrin hypersensitivity.
{"title":"Unexplained hypotension and exertional dyspnea in a night-cycled peritoneal dialysis patient--a rare form of icodextrin hypersensitivity.","authors":"Macaulay A C Onuigbo","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In recent years, icodextrin 7.5% has been used in PD as an alternative to glucose to achieve sustained reliable ultrafiltration (UF) and clearance without adversely increasing glucose absorption. Icodextrin is generally well tolerated. The most commonly reported adverse events are cutaneous reactions. We report a rare form of hypersensitivity to icodextrin 7.5% that was accompanied by dyspnea and symptomatic hypotension, without increased UF to account for the observed hypotension. Icodextrin produces symptomatic hypotension in up to 40% of patients by a known mechanism of increased UF and corresponding weight loss. However, it can also produce symptomatic hypotension accompanied by several other systemic symptoms in a hypersensitivity reaction. Discontinuation of the icodextrin results in prompt resolution of those symptoms. Treating nephrologists must be aware of this rare form of icodextrin hypersensitivity.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"30 ","pages":"87-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32765673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Paula Fein, Stacey Weiss, Francis Ramos, Priyanka Singh, Jyotiprakas Chattopadhyay, Morrell M Avram
We previously reported that lower serum magnesium is associated with poorer nutrition status, impaired cellular health, and increased inflammation in peritoneal dialysis (PD) patients. The present study was designed to investigate the prognostic value of serum magnesium for mortality in PD patients. From November 2000 to July 2008, the study enrolled 62 patients, recording their demographic, clinical, and biochemical data. Patients were followed to September 2011. Mean age of the patients was 55 +/- 16 years, and in this cohort, 55% were women, 63% were African American, and 25% had diabetes. Mean serum magnesium was 1.597 +/- 0.28 mEq/L. Maximum follow-up was 10.8 years. During the follow-up period, 27 patients died (43.5%). Serum magnesium was significantly higher in the patients who survived than in those who did not (1.757 mEq/L vs. 1.515 mEq/L, p = 0.04). Patients were then stratified by enrollment magnesium. After 10.8 years of observation, cumulative survival was significantly better in patients with an enrollment serum magnesium greater than 1.6 mEq/L than in patients with an enrollment serum magnesium of 1.6 mEq/L or less (p = 0.04). Multivariate Cox regression analysis revealed that serum magnesium is a significant predictor of mortality (relative risk: 0.984; p = 0.048) after adjusting for age, race, sex, diabetes, and months on dialysis at enrollment. In conclusion, lower serum magnesium is a significant predictor of higher mortality in PD patients. Factors affecting the serum magnesium concentration in PD patients should be investigated in more detail.
我们之前报道过,低血清镁与腹膜透析(PD)患者营养状况较差、细胞健康受损和炎症增加有关。本研究旨在探讨血清镁对帕金森病患者死亡率的预后价值。从2000年11月到2008年7月,该研究招募了62名患者,记录了他们的人口统计、临床和生化数据。随访至2011年9月。患者的平均年龄为55±16岁,在该队列中,55%为女性,63%为非洲裔美国人,25%患有糖尿病。平均血清镁为1.597±0.28 mEq/L。最长随访时间为10.8年。随访期间死亡27例(43.5%)。存活患者血清镁含量显著高于未存活患者(1.757 mEq/L vs 1.515 mEq/L, p = 0.04)。然后根据入组镁对患者进行分层。经过10.8年的观察,入组血清镁≥1.6 mEq/L的患者的累积生存期明显优于入组血清镁≤1.6 mEq/L的患者(p = 0.04)。多因素Cox回归分析显示,血清镁是死亡率的显著预测因子(相对危险度:0.984;P = 0.048),校正了年龄、种族、性别、糖尿病和入组时透析时间。综上所述,低血清镁是帕金森病患者高死亡率的重要预测因子。PD患者血清镁浓度的影响因素有待进一步研究。
{"title":"Serum magnesium concentration is a significant predictor of mortality in peritoneal dialysis patients.","authors":"Paula Fein, Stacey Weiss, Francis Ramos, Priyanka Singh, Jyotiprakas Chattopadhyay, Morrell M Avram","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>We previously reported that lower serum magnesium is associated with poorer nutrition status, impaired cellular health, and increased inflammation in peritoneal dialysis (PD) patients. The present study was designed to investigate the prognostic value of serum magnesium for mortality in PD patients. From November 2000 to July 2008, the study enrolled 62 patients, recording their demographic, clinical, and biochemical data. Patients were followed to September 2011. Mean age of the patients was 55 +/- 16 years, and in this cohort, 55% were women, 63% were African American, and 25% had diabetes. Mean serum magnesium was 1.597 +/- 0.28 mEq/L. Maximum follow-up was 10.8 years. During the follow-up period, 27 patients died (43.5%). Serum magnesium was significantly higher in the patients who survived than in those who did not (1.757 mEq/L vs. 1.515 mEq/L, p = 0.04). Patients were then stratified by enrollment magnesium. After 10.8 years of observation, cumulative survival was significantly better in patients with an enrollment serum magnesium greater than 1.6 mEq/L than in patients with an enrollment serum magnesium of 1.6 mEq/L or less (p = 0.04). Multivariate Cox regression analysis revealed that serum magnesium is a significant predictor of mortality (relative risk: 0.984; p = 0.048) after adjusting for age, race, sex, diabetes, and months on dialysis at enrollment. In conclusion, lower serum magnesium is a significant predictor of higher mortality in PD patients. Factors affecting the serum magnesium concentration in PD patients should be investigated in more detail.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"30 ","pages":"90-3"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32765674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diuretics are commonly prescribed to manage various conditions in the general population. They can continue to play a role in dialysis patients to manage extracellular fluid volume and hypertension and to reduce the tendency to hyperkalemia. Nevertheless, diuretics are often stopped when patients commence dialysis. Several studies have shown that preserved residual renal function in dialysis patients is associated with improved patient survival. Although the association between diuretic use and preserved residual renal function is still controversial, the numerous clinical benefits offered by diuretics render those agents valuable in dialysis patients with urine output. Loop diuretics are generally the agents of choice in end-stage renal disease. They need to be used at higher doses because of pharmacokinetic changes in the context of diminishing renal clearance. Other classes of diuretics can still be used in end-stage renal disease, but usually in conjunction with loop diuretics or for benefits independent of diuresis. Complications can occur with the use of diuretics, but are avoidable with appropriate use. Dose-related ototoxicity, especially with concomitant use of other ototoxic medications, can occur. Hyperkalemia is possible with the use of potassium-sparing diuretics, but studies suggest that these agents can be safely administered with close monitoring.
{"title":"A review of diuretic use in dialysis patients.","authors":"Ruchi Kumra, Joanne M Bargman","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Diuretics are commonly prescribed to manage various conditions in the general population. They can continue to play a role in dialysis patients to manage extracellular fluid volume and hypertension and to reduce the tendency to hyperkalemia. Nevertheless, diuretics are often stopped when patients commence dialysis. Several studies have shown that preserved residual renal function in dialysis patients is associated with improved patient survival. Although the association between diuretic use and preserved residual renal function is still controversial, the numerous clinical benefits offered by diuretics render those agents valuable in dialysis patients with urine output. Loop diuretics are generally the agents of choice in end-stage renal disease. They need to be used at higher doses because of pharmacokinetic changes in the context of diminishing renal clearance. Other classes of diuretics can still be used in end-stage renal disease, but usually in conjunction with loop diuretics or for benefits independent of diuresis. Complications can occur with the use of diuretics, but are avoidable with appropriate use. Dose-related ototoxicity, especially with concomitant use of other ototoxic medications, can occur. Hyperkalemia is possible with the use of potassium-sparing diuretics, but studies suggest that these agents can be safely administered with close monitoring.</p>","PeriodicalId":7361,"journal":{"name":"Advances in peritoneal dialysis. Conference on Peritoneal Dialysis","volume":"30 ","pages":"115-9"},"PeriodicalIF":0.0,"publicationDate":"2014-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32766625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}