Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis最新文献

{"title":"Feasibility of Urgent-Start Peritoneal Dialysis in Older Patients with End-Stage Renal Disease: A Single-Center Experience.","authors":"Haijiao Jin,&nbsp;Zhaohui Ni,&nbsp;Shan Mou,&nbsp;Renhua Lu,&nbsp;Wei Fang,&nbsp;Jiaying Huang,&nbsp;Chunhua Hu,&nbsp;Haifen Zhang,&nbsp;Hao Yan,&nbsp;Zhenyuan Li,&nbsp;Zanzhe Yu","doi":"10.3747/pdi.2017.00002","DOIUrl":"https://doi.org/10.3747/pdi.2017.00002","url":null,"abstract":"<p><strong>Background: </strong>Patients with end-stage renal disease (ESRD) frequently require urgent-start dialysis. Recent evidence suggests that peritoneal dialysis (PD) might be a feasible alternative to hemodialysis (HD) in these patients, including in older patients.</p><p><strong>Methods: </strong>This retrospective study enrolled patients aged > 65 years with ESRD who underwent urgent dialysis without functional vascular access or PD catheter at a single center, from January 2011 to December 2014. Patients were grouped based on their dialysis modality (PD or HD). Patients unable to tolerate PD catheter insertion or wait for PD were excluded. Each patient was followed for at least 30 days after catheter insertion. Short-term (30-day) dialysis-related complications and patient survival were compared between the 2 groups.</p><p><strong>Results: </strong>A total of 94 patients were enrolled, including 53 (56.4%) who underwent PD. The incidence of dialysis-related complications during the first 30 days was significantly lower in PD compared with HD patients (3 [5.7%] vs 10 [24.4%], <i>p</i> = 0.009). Logistic regression identified urgent-start HD as an independent risk factor for dialysis-related complications compared with urgent-start PD (odds ratio 4.760 [1.183 - 19.147], <i>p</i> = 0.028). The 6-, 12-, 24-, and 36-month survival rates in the PD and HD groups were 92.3% vs 94.6%, 82.4% vs 81.3%, 75.7% vs 74.2%, and 69.5% vs 60.6%, respectively, with no significant differences between the groups (log-rank = 0.011, <i>p</i> = 0.915).</p><p><strong>Conclusion: </strong>Urgent-start PD was associated with fewer short-term dialysis-related complications and similar survival to urgent-start HD in older patients with ESRD. Peritoneal dialysis may thus be a safe and effective dialysis modality for older ESRD patients requiring urgent dialysis.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"125-130"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35574152","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}

{"title":"Single Daily Icodextrin Exchange as Initial and Solitary Therapy.","authors":"Baris U Agar,&nbsp;James A Sloand","doi":"10.3747/pdi.2017.00130","DOIUrl":"https://doi.org/10.3747/pdi.2017.00130","url":null,"abstract":"<p><strong>Background: </strong>Incremental dialysis utilizes gradually increasing dialysis doses in response to declines in residual kidney function, and it is the preferred renal replacement therapy for patients who have just transitioned to end-stage renal disease (ESRD). Incremental peritoneal dialysis (PD) may impose fewer restrictions on patients' lifestyle, help attenuate lifetime peritoneal and systemic exposure to glucose and its degradation products, and minimize connections that could compromise the sterile fluid path. In this study, we utilized a 3-pore kinetic model to assess fluid and solute removal during single daily icodextrin treatments for patients with varying glomerular filtration rates (GFR).</p><p><strong>Methods: </strong>Single icodextrin exchanges of 8 to 16 hours using 2- and 2.5-L bag volumes were simulated for different patient transport types (i.e., high to low) to predict daily peritoneal ultrafiltration (UF), daily peritoneal sodium removal, and weekly total (peritoneal + residual kidney) Kt/V (Kt/V_Total) for patients with residual renal GFRs ranging from 0 to 15 mL/min/1.73 m².</p><p><strong>Results: </strong>Daily peritoneal UF varied from 359 to 607 mL, and daily peritoneal Na removal varied from 52 to 87 mEq depending on length of icodextrin exchange and bag volume. Both were effectively independent of patient transport type. All but very large patients (total body water [TBW] > 60 L) were predicted to achieve adequate dialysis (Kt/V_Total ≥ 1.7) with a GFR of 10 mL/min/1.73 m², and small patients (TBW: 30 L) were predicted to achieve adequate dialysis with a GFR of 6 mL/min/1.73 m².</p><p><strong>Conclusions: </strong>A single daily icodextrin exchange can be tailored to augment urea, UF, and Na removal in patients with sufficient residual kidney function (RKF). A solitary icodextrin exchange may therefore be reasonable initial therapy for some incident ESRD patients.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"119-124"},"PeriodicalIF":2.8,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2017.00130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35781269","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}

{"title":"Comparison of direct medical costs between automated and continuous ambulatory peritoneal dialysis.","authors":"Laura Cortés-Sanabria,&nbsp;Brenda E Rodríguez-Arreola,&nbsp;Victor R Ortiz-Juárez,&nbsp;Herman Soto-Molina,&nbsp;Leonardo Pazarín-Villaseñor,&nbsp;Héctor R Martínez-Ramírez,&nbsp;Alfonso M Cueto-Manzano","doi":"10.3747/pdi.2011.00274","DOIUrl":"https://doi.org/10.3747/pdi.2011.00274","url":null,"abstract":"<p><strong>Objective: </strong>We set out to estimate the direct medical costs (DMCs) of peritoneal dialysis (PD) and to compare the DMCs for continuous ambulatory PD (CAPD) and automated PD (APD). In addition, DMCs according to age, sex, and the presence of peritonitis were evaluated.</p><p><strong>Methods: </strong>Our retrospective cohort analysis considered patients initiating PD, calculating 2008 costs and, for comparison, updating the results for 2010. The analysis took the perspective of the Mexican Institute of Social Security, including outpatient clinic and emergency room visits, dialysis procedures, medications, laboratory tests, hospitalizations, and surgeries.</p><p><strong>Results: </strong>No baseline differences were observed for the 41 patients evaluated (22 on CAPD, 19 on APD). Median annual DMCs per patient on PD were US$15 072 in 2008 and US$16 452 in 2010. When analyzing percentage distribution, no differences were found in the DMCs for the modality groups. In both APD and CAPD, the main costs pertained to the dialysis procedure (CAPD 41%, APD 47%) and hospitalizations (CAPD 37%, APD 32%). Dialysis procedures cost significantly more (p = 0.001) in APD (US$7 084) than in CAPD (US$6 071), but total costs (APD US$15 389 vs CAPD US$14 798) and other resources were not different. The presence of peritonitis increased the total costs (US$16 075 vs US$14 705 for patients without peritonitis, p = 0.05), but in the generalized linear model analysis, DMCs were not predicted by age, sex, dialysis modality, or peritonitis. A similar picture was observed for costs extrapolated to 2010, with a 10% - 20% increase for each component--except for laboratory tests, which increased 52%, and dialysis procedures, which decreased 3%, from 2008.</p><p><strong>Conclusions: </strong>The annual DMCs per patient on PD in this study were US$15 072 in 2008 and US$16 452 in 2010. Total DMCs for dialysis procedures were higher in APD than in CAPD, but the difference was not statistically significant. In both APD and CAPD, 90% of costs were attributable to the dialysis procedure, hospitalizations, and medications. In a multivariate analysis, no independent variable significantly predicted a higher DMC.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"679-86"},"PeriodicalIF":2.8,"publicationDate":"2013-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00274","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40242600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower education level is a major risk factor for peritonitis incidence in chronic peritoneal dialysis patients: a retrospective cohort study with 12-year follow-up.","authors":"Yahn-Bor Chern,&nbsp;Pei-Shan Ho,&nbsp;Li-Chueh Kuo,&nbsp;Jin-Bor Chen","doi":"10.3747/pdi.2012.00065","DOIUrl":"https://doi.org/10.3747/pdi.2012.00065","url":null,"abstract":"<p><strong>Background: </strong>Peritoneal dialysis (PD)-related peritonitis remains an important complication in PD patients, potentially causing technique failure and influencing patient outcome. To date, no comprehensive study in the Taiwanese PD population has used a time-dependent statistical method to analyze the factors associated with PD-related peritonitis.</p><p><strong>Methods: </strong>Our single-center retrospective cohort study, conducted in southern Taiwan between February 1999 and July 2010, used time-dependent statistical methods to analyze the factors associated with PD-related peritonitis.</p><p><strong>Results: </strong>The study recruited 404 PD patients for analysis, 150 of whom experienced at least 1 episode of peritonitis during the follow-up period. The incidence rate of peritonitis was highest during the first 6 months after PD start. A comparison of patients in the two groups (peritonitis vs null-peritonitis) by univariate analysis showed that the peritonitis group included fewer men (p = 0.048) and more patients of older age (≥65 years, p = 0.049). In addition, patients who had never received compulsory education showed a statistically higher incidence of PD-related peritonitis in the univariate analysis (p = 0.04). A proportional hazards model identified education level (less than elementary school vs any higher education level) as having an independent association with PD-related peritonitis [hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.01 to 2.06; p = 0.045). Comorbidities measured using the Charlson comorbidity index (score >2 vs ≤2) showed borderline statistical significance (HR: 1.44; 95% CI: 1.00 to 2.13; p = 0.053).</p><p><strong>Conclusions: </strong>A lower education level is a major risk factor for PD-related peritonitis independent of age, sex, hypoalbuminemia, and comorbidities. Our study emphasizes that a comprehensive PD education program is crucial for PD patients with a lower education level.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"552-8"},"PeriodicalIF":2.8,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2012.00065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40242078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood pressure measurement in peritoneal dialysis: which method is best?","authors":"Michelle M O'Shaughnessy,&nbsp;Martin Durcan,&nbsp;Sinead M Kinsella,&nbsp;Matthew D Griffin,&nbsp;Donal N Reddan,&nbsp;David W Lappin","doi":"10.3747/pdi.2012.00027","DOIUrl":"https://doi.org/10.3747/pdi.2012.00027","url":null,"abstract":"<p><strong>Background: </strong>The optimal approach to monitoring blood pressure (BP) in the peritoneal dialysis (PD) population is unclear. Ambulatory BP monitoring reliably predicts prognosis, but can be inconvenient. The accuracy of home BP monitoring in this population is unproven. The automated BpTRU device (BpTRU Medical Devices, Coquitlam, BC, Canada), which provides an average of up to 6 successive in-office BP measurements, has not been studied in this patient group.</p><p><strong>Methods: </strong>We studied 17 patients (average age: 54 ± 12 years; 12 men, 5 women; 94% on automated PD) attending a single center. All patients underwent office, home, BpTRU, and ambulatory BP measurement. The reference standard for analysis was daytime ambulatory BP. Correlation between the referent method and each comparator method was determined (Pearson correlation coefficient), and Bland-Altman scatter plots depicting the differences in the BP measurements were constructed.</p><p><strong>Results: </strong>Mean office BP (126.4 ± 16.9/78.8 ± 11.6 mmHg) and BpTRU BP (123.8 ± 13.7/80.7 ± 11.1 mmHg) closely approximated mean daytime ambulatory BP (129.3 ± 14.8/78.2 ± 7.9 mmHg). Mean home BP (143.8 ± 15.0/89.9 ± 28.1 mmHg) significantly overestimated mean daytime systolic BP by 14.2 mmHg (95% confidence interval: 4.3 mmHg to 24.1 mmHg; p = 0.008). Bland-Altman plots demonstrated poorest agreement between home BP and daytime ambulatory BP. No patient had \"white-coat hypertension,\" and only 1 patient had false-resistant hypertension. Most patients showed abnormal nocturnal dipping patterns (non-dipping: n = 11; reverse-dipping: n = 5; normal dipping: n = 1).</p><p><strong>Conclusions: </strong>We report a novel finding that BP measurement using the BpTRU device is more accurate than home BP measurement in a PD population. Potential explanations for this observation include poor home BP measurement technique, use of poorly validated home BP measurement devices, or a reduced prevalence of white-coat effect among PD patients. Our study also confirms that, in the PD population, BP measurements vary considerably with patient location, time of day, and measurement technique.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"544-51"},"PeriodicalIF":2.8,"publicationDate":"2013-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2012.00027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40242082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil gelatinase-associated lipocalin in peritoneal effluent: evaluation in peritoneal dialysis patients in basal condition.","authors":"Francesca Martino,&nbsp;Ilenia Filippi,&nbsp;Davide Giavarina,&nbsp;Gianpaolo Amici,&nbsp;Massimo de Cal,&nbsp;Manish Kaushik,&nbsp;Maria Pia Rodighiero,&nbsp;Carlo Crepaldi,&nbsp;Claudio Ronco","doi":"10.3747/pdi.2011.00288","DOIUrl":"https://doi.org/10.3747/pdi.2011.00288","url":null,"abstract":"<p><strong>Purpose: </strong>In the present study, we assessed expression of neutrophil gelatinase-associated lipocalin (NGAL) in peritoneal effluent (pNGAL) from peritoneal dialysis (PD) patients, and we evaluated factors that might affect its level in basal conditions.</p><p><strong>Methods: </strong>Our cross-sectional study included all 69 patients on PD at our institution. We evaluated patient history, hydration status, residual renal function, indices of dialysis adequacy, peritoneal transport type, serum C-reactive protein, ferritin, serum NGAL (sNGAL) and pNGAL. Univariate and multivariate linear regression models were used to evaluate predictors of pNGAL.</p><p><strong>Results: </strong>Of the study patients, 39 (56.5%) were men, and 54 (78.3%) were on continuous ambulatory PD. Median age in the group was 61 years [interquartile range (IQR): 46.5 - 71 years]. Median sNGAL was 487 ng/mL (IQR: 407 - 586 ng/mL), and median pNGAL was 35 ng/mL (IQR: 21 - 46 ng/mL). dNGAL correlated directly with weekly dialytic clearance of creatinine (ρ = 0.291, p = 0.02) and with sNGAL (ρ = 0.269, p = 0.031). The same variables were also independent predictors of pNGAL (β = 0.30 and 0.29 respectively, both p < 0.05) in multivariate analysis.</p><p><strong>Conclusions: </strong>In our analysis, basal levels of pNGAL were influenced by sNGAL and by dialytic clearance of creatinine.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"379-81"},"PeriodicalIF":2.8,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40207348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is transition between peritoneal dialysis and hemodialysis really a gradual process?","authors":"Lucie Boissinot,&nbsp;Isabelle Landru,&nbsp;Eric Cardineau,&nbsp;Elie Zagdoun,&nbsp;Jean-Philippe Ryckelycnk,&nbsp;Thierry Lobbedez","doi":"10.3747/pdi.2011.00134","DOIUrl":"https://doi.org/10.3747/pdi.2011.00134","url":null,"abstract":"<p><strong>Background: </strong>Transfer to hemodialysis (HD) is a frequent cause of peritoneal dialysis (PD) cessation. In the present study, we set out to describe the transition period between PD and HD.</p><p><strong>Methods: </strong>All patients in 4 centers of Basse-Normandie who had been treated with PD for more than 90 days and who were permanently transferred to HD between 1 January 2005 and 31 December 2009 were retrospectively reviewed. The rate of unplanned HD start was evaluated.</p><p><strong>Results: </strong>In the 60 patients (39 men, 21 women) included in the study, median score on the Charlson comorbidity index at PD initiation was 5 [interquartile range (IQR): 3 - 7], median age at HD initiation was 62 years (IQR: 54 - 76 years), and median duration on PD was 22 months (IQR: 12 - 36 months). Among the 60 patients, 37 had an unplanned HD initiation. Peritonitis was the most frequent cause of unplanned HD start (n = 20), and dialysis inadequacy (n = 11), the main cause of planned HD start. During the transition period, all patients were hospitalized. Median duration of hospitalization was 4.5 days (IQR: 0 - 25.5 days). Within 2 months after HD initiation, 9 patients died. Two months after starting HD, 6 of the remaining 51 patients were being treated in a self-care HD unit and only 23 patients had a mature fistula.</p><p><strong>Conclusions: </strong>Unplanned HD start is a common problem in patients transferred from PD. Further studies are needed to improve the rate of planned HD start in PD patients transferred to HD.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"391-7"},"PeriodicalIF":2.8,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40207353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of a pre-dialysis patient education program on the relative frequencies of dialysis modalities.","authors":"Werner Ribitsch,&nbsp;Bernd Haditsch,&nbsp;Ronald Otto,&nbsp;Gernot Schilcher,&nbsp;Franz Quehenberger,&nbsp;Johannes M Roob,&nbsp;Alexander R Rosenkranz","doi":"10.3747/pdi.2011.00255","DOIUrl":"https://doi.org/10.3747/pdi.2011.00255","url":null,"abstract":"<p><strong>Background: </strong>Pre-dialysis education can guide the choice of the dialysis modality best tailored to meet the needs and preferences of individual patients with chronic kidney disease.</p><p><strong>Methods: </strong>In a retrospective single-center cohort study, we evaluated the impact of a pre-dialysis education program on the incidence rates of patients using hemodialysis (HD) and peritoneal dialysis (PD) in our unit. The frequency distribution of dialysis modalities between people attending our education program and people not attending the program (control group) was analyzed for the 4-year period 2004 - 2008.</p><p><strong>Results: </strong>From among all the incident chronic kidney disease 5D patients presenting during the 4-year period, we analyzed 227 who started dialysis either with an arteriovenous fistula or a PD catheter. In that cohort, 70 patients (30.8%) took part in the education program, and 157 (69.2%) did not receive structured pre-dialysis counseling. In the group receiving education, 38 patients (54.3%) started with PD, and 32 (45.7%), with HD. In the standard-care group not receiving education, 44 patients (28%) started with PD, and 113 (72%), with HD (p < 0.001).</p><p><strong>Conclusions: </strong>Our multidisciplinary pre-dialysis program had a significant impact on the frequency distribution of dialysis modalities, increasing the proportion of patients initiating dialysis with PD.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"367-71"},"PeriodicalIF":2.8,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00255","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40242080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of low-GDP solution on ultrafiltration and solute transport in continuous ambulatory peritoneal dialysis patients.","authors":"Kyu-Hyang Cho,&nbsp;Jun-Young Do,&nbsp;Jong-Won Park,&nbsp;Kyung-Woo Yoon,&nbsp;Yong-Lim Kim","doi":"10.3747/pdi.2011.00279","DOIUrl":"https://doi.org/10.3747/pdi.2011.00279","url":null,"abstract":"<p><strong>Background: </strong>Several studies have reported benefits for human peritoneal mesothelial cell function of a neutral-pH dialysate low in glucose degradation products (GDPs). However, the effects of low-GDP solution on ultrafiltration (UF), transport of solutes, and control of body water remain elusive. We therefore investigated the effect of low-GDP solution on UF, solute transport, and control of body water.</p><p><strong>Methods: </strong>Among 79 new continuous ambulatory peritoneal dialysis (CAPD) patients, 60 completed a 12-month protocol (28 in a lactate-based high-GDP solution group, 32 in a lactate-based low-GDP solution group). Clinical indices--including 24-hour UF volume (UFV), 24-hour urine volume (UV), residual renal function, and dialysis adequacy--were measured at months 1, 6, and 12. At months 1, 6, and 12, UFV, glucose absorption, 4-hour dialysate-to-plasma (D/P) creatinine, and 1-hour D/P Na(+) were assessed during a modified 4.25% peritoneal equilibration test (PET). Body composition by bioelectric impedance analysis was measured at months 1 and 12 in 26 CAPD patients.</p><p><strong>Results: </strong>Daily UFV was lower in the low-GDP group. Despite similar solute transport and aquaporin function, the low-GDP group also showed lower UFV and higher glucose absorption during the PET. Factors associated with UFV during the PET were lactate-based high-GDP solution and 1-hour D/P Na(+). No differences in volume status and obesity at month 12 were observed, and improvements in hypervolemia were equal in both groups.</p><p><strong>Conclusions: </strong>Compared with the high-GDP group, the low-GDP group had a lower UFV during a PET and a lower daily UFV during the first year after peritoneal dialysis initiation. Although the low-GDP group had a lower daily UFV, no difficulties in controlling edema were encountered.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"382-90"},"PeriodicalIF":2.8,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00279","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40207349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal protein leakage, systemic inflammation, and peritonitis risk in patients on peritoneal dialysis.","authors":"Jie Dong,&nbsp;Yuan Chen,&nbsp;Suping Luo,&nbsp;Rong Xu,&nbsp;Ying Xu","doi":"10.3747/pdi.2011.00326","DOIUrl":"https://doi.org/10.3747/pdi.2011.00326","url":null,"abstract":"<p><strong>Background: </strong>Whether peritoneal protein leakage predicts risk for peritonitis in patients on peritoneal dialysis (PD) is unknown. In this observational cohort study, we aimed to determine that association and, further, to explore if it might be explained by systemic inflammation. ♢</p><p><strong>Methods: </strong>We prospectively followed 305 incident PD patients to first-episode peritonitis, censoring, or the end of the study. Demographics, comorbidity score, biochemistry, and peritoneal protein clearance (PrC) were collected at baseline. The predictors of first-episode peritonitis were analyzed prospectively. ♢</p><p><strong>Results: </strong>During follow-up, 14 868 patient months and 251 episodes of peritonitis were observed. The baseline PrC was 73.2 mL/day (range: 53.2 - 102 mL/day). Patients with a high PrC were prone to be older and malnourished. They also had a higher comorbidity score and higher C-reactive protein values. In 132 first episodes of peritonitis, baseline PrC was shown to be a significant independent predictor after adjustment for age, sex, body mass index, diabetes, residual renal function, hemoglobin, and peritoneal transport rate. Systemic inflammatory markers such as serum albumin, C-reactive protein, and interleukin-6 could not explain the association of PrC and high risk for peritonitis. ♢</p><p><strong>Conclusions: </strong>Baseline peritoneal protein leakage was able to independently predict risk for peritonitis, which is not explained by systemic inflammation. The underlying mechanisms should be explored in future.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"273-9"},"PeriodicalIF":2.8,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00326","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40207347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}