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

{"title":"Time course of peritoneal function in automated and continuous peritoneal dialysis.","authors":"Wieneke M Michels,&nbsp;Marion Verduijn,&nbsp;Alena Parikova,&nbsp;Elisabeth W Boeschoten,&nbsp;Dirk G Struijk,&nbsp;Friedo W Dekker,&nbsp;Raymond T Krediet","doi":"10.3747/pdi.2011.00166","DOIUrl":"https://doi.org/10.3747/pdi.2011.00166","url":null,"abstract":"<p><strong>Background and objectives: </strong>In automated peritoneal dialysis (APD), a patient's peritoneal membrane is more intensively exposed to fresh dialysate than it is in continuous ambulatory peritoneal dialysis (CAPD). Our aim was to study, in incident peritoneal dialysis (PD) patients, the influence of APD-compared with that of CAPD-on peritoneal transport over 4 years.</p><p><strong>Design, setting, participants, and measurements: </strong>Patients were included if at least 2 annual standard permeability analyses (SPAs) performed with 3.86% glucose were available while the patient was using the same modality with which they had started PD (APD or CAPD). Patients were followed until their first modality switch. Differences in the pattern of SPA outcomes over time were tested using repeated-measures models adjusted for age, sex, comorbidity, primary kidney disease, and year of PD start.</p><p><strong>Results: </strong>The 59 CAPD patients enrolled were older than the 47 APD patients enrolled (mean age: 58 ± 14 years vs 49 ± 14 years; p < 0.01), and they had started PD earlier (mean start year: 2000 vs 2002). Over time, no differences in solute (p > 0.19) or fluid transport (p > 0.13) were observed. Similarly, free water transport (p = 0.43) and small-pore transport (p = 0.31) were not different between the modalities. Over time, patients on APD showed a faster decline in effective lymphatic absorption rate (ELAR: p = 0.02) and in transcapillary ultrafiltration (TCUF: p = 0.07, adjusted p = 0.05). Further adjustment did not change the results.</p><p><strong>Conclusions: </strong>Compared with patients starting on CAPD, those starting on APD experienced a faster decline in ELAR and TCUF. Other transport parameters were not different over time between the groups.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"605-11"},"PeriodicalIF":2.8,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00166","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39971626","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 influence of initial peritoneal transport characteristics, inflammation, and high glucose exposure on prognosis for peritoneal membrane function.","authors":"M José Fernández-Reyes,&nbsp;M Auxiliadora Bajo,&nbsp;Gloria Del Peso,&nbsp;Marta Ossorio,&nbsp;Raquel Díaz,&nbsp;Beatriz Carretero,&nbsp;Rafael Selgas","doi":"10.3747/pdi.2011.00137","DOIUrl":"https://doi.org/10.3747/pdi.2011.00137","url":null,"abstract":"<p><strong>Background: </strong>Fast transport status, acquired with time on peritoneal dialysis (PD), is a pathology induced by peritoneal exposure to bioincompatible solutions. Fast transport has important clinical consequences and should be prevented.</p><p><strong>Objective: </strong>We analyzed the repercussions of initial peritoneal transport characteristics on the prognosis for peritoneal membrane function, and also whether the influence of peritonitis and high exposure to glucose are different according to the initial peritoneal transport characteristics or the moment when such events occur.</p><p><strong>Methods: </strong>The study included 275 peritoneal dialysis patients with at least 2 peritoneal function studies (at baseline and 1 year). Peritoneal kinetic studies were performed at baseline and annually. Those studies consist of a 4-hour dwell with glucose (1.5% during 1981 - 1990, and 2.27% during 1991 - 2002) to calculate the peritoneal mass transfer coefficients of urea and creatinine (milliliters per minute) using a previously described mathematical model.</p><p><strong>Results: </strong>Membrane prognosis and technique survival were independent of baseline transport characteristics. Fast transport and ultrafiltration (UF) failure are reversible conditions, provided that peritonitis and high glucose exposure are avoided during the early dialysis period. The first year on PD is a main determining factor for the membrane's future, and the mass transfer coefficient of creatinine at year 1 is the best functional predictor of future PD history. After 5 years on dialysis, permeability frequently increases, and UF decreases. Icodextrin is associated with peritoneal protection.</p><p><strong>Conclusions: </strong>Peritoneal membrane prognosis is independent of baseline transport characteristics. Intrinsic fast transport and low UF are reversible conditions when peritonitis and high glucose exposure are avoided during the early dialysis period. Icodextrin helps in glucose avoidance and is associated with peritoneal protection.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"636-44"},"PeriodicalIF":2.8,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2011.00137","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39972101","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 plasma permeability factor in nephrotic syndrome: indirect evidence in pediatric peritoneal dialysis.","authors":"Marta Azocar,&nbsp;Lily Quiroz,&nbsp;Angela Delucchi,&nbsp;Hector Dinamarca,&nbsp;Marcos Emilfork,&nbsp;Francisco Cano","doi":"10.3747/pdi.2009.00251","DOIUrl":"https://doi.org/10.3747/pdi.2009.00251","url":null,"abstract":"<p><strong>Background: </strong>Nephrotic syndrome (NS) in children has been associated with a systemic circulating permeability factor. Therefore, once peritoneal dialysis (PD) has been started, peritoneal protein losses should be higher in the nephrotic than in the non-nephrotic population.</p><p><strong>Objective: </strong>We compared peritoneal protein losses in children with and without NS on PD.</p><p><strong>Methods: </strong>Our retrospective 4-year study analyzed Hispanic patients with NS under PD. Data at dialysis entry and 6 months later were compared. Nutritional support was given according to recommended dietary allowances and recommendations from the Kidney Disease Outcomes Quality Initiative. Clinical and biochemical data were obtained, and 24-hour dialysate and urine samples were collected to measure protein losses. Dialysis dose (Kt/V), daily protein intake (DPI), normalized protein equivalent of nitrogen appearance (nPNA), peritoneal equilibration test (PET), and peritonitis rate were determined. All measurements took place at least 4 weeks after resolution of a peritonitis episode. All patients received automated PD using a HomeChoice PD System cycler (Baxter Healthcare Corporation, Deerfield, IL, USA), with an exchange volume of 1100 mL/m(2) and a dextrose concentration of 1.5% - 2.5%. A control group of non-NS children on PD matched by age and sex were also studied. Data are reported as mean ± standard deviation. Differences between groups were calculated using the Mann-Whitney U-test, and p < 0.05 was considered significant.</p><p><strong>Results: </strong>Each study group consisted of 10 patients [NS patients: 4 boys, mean age of 7.3 ± 4.1 years; control patients: 6 boys, mean age of 7.2 ± 4.7 years (p = nonsignificant)]. In the group with NS, 8 patients were diagnosed by biopsy as having focal segmental glomerulosclerosis, and 2 as having minimal-change disease. At study entry, patients with NS had hourly urinary protein losses of 398 ± 313 mg/m(2) and daily peritoneal protein losses of 3.4 ± 1.9 g/m(2), compared with 29.9 ± 31 mg/m(2) and 1.5 ± 1.1 g/m(2) respectively in the control group (p < 0.05). The same statistical difference was found 6 months later. We observed no statistical differences in PET results, daily exchange volume, and mean dextrose concentration of dialysate. Similarly, no significant between-group differences were observed for Kt/V, DPI, nPNA, and biochemical parameters.</p><p><strong>Conclusions: </strong>Hispanic children with NS on PD show higher peritoneal protein losses than do their control counterparts. Such differences could be secondary to increased peritoneal permeability caused by a systemic permeability factor.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"437-43"},"PeriodicalIF":2.8,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2009.00251","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39972008","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":"Chronic peritoneal dialysis in children with special needs or social disadvantage or both: contraindications are not always contraindications.","authors":"Nejat Aksu,&nbsp;Onder Yavascan,&nbsp;Murat Anil,&nbsp;Orhan Deniz Kara,&nbsp;Alkan Bal,&nbsp;Ayse Berna Anil","doi":"10.3747/pdi.2009.00202","DOIUrl":"https://doi.org/10.3747/pdi.2009.00202","url":null,"abstract":"<p><strong>Objective: </strong>Our aim in the present study was to identify outcomes in children with special needs or social disadvantage, or both, receiving chronic peritoneal dialysis (CPD) treatment in a pediatric dialysis unit.</p><p><strong>Methods: </strong>Among 110 children started on CPD in our unit during the period between November 1995 and November 2008, we identified 13 patients (8 girls, 5 boys) with major physical, mental, or psychosocial problems. Age at CPD initiation in the group with disability ranged from 4.0 years to 16.5 years (median: 7.5 years). Under lying diseases were vesicoureteral reflux (4 patients), neuropathic bladder and vesicoureteral reflux (3 patients), chronic pyelonephritis (3 patients), amyloidosis (2 patients), and Alport syndrome (1 patient). Challenges encountered were adverse family or social circumstances (4 patients), cerebral palsy (3 patients), Down syndrome (1 patient), rectovesical fistula in conjunction with ectopic anus and previous multiple abdominal surgery (1 patient), blindness and deafness (1 patient), ventriculoperitoneal shunt (1 patient), colostomy and malnutrition (1 patient), and mental retardation and blindness (1 patient). All catheters were implanted percutaneously.</p><p><strong>Results: </strong>Median duration of dialysis was 18 months (range: 6 - 124 months). The frequency of peritonitis was not different between children with and without disability (p > 0.05). In children with disability compared with children without disability, the frequencies of catheter-related infections (1 episode/79.3 patient-months vs 1 episode/32.4 patient-months) and of catheter-related non-infectious complications (1 episode/238 patient-months vs 1 episode/115.7 patient-months) were lower (p < 0.05). Chronic peritoneal dialysis was terminated in 5 children (for renal transplantation in 3, switch to hemodialysis in 1, death in 1).</p><p><strong>Conclusions: </strong>Our results suggest that, with appropriate family support and an experienced multidisciplinary team, CPD can be effectively performed in children with special needs or social disadvantage, or both.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"424-30"},"PeriodicalIF":2.8,"publicationDate":"2012-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2009.00202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40119552","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":"A study of the clinical and biochemical profile of peritoneal dialysis fluid low in glucose degradation products.","authors":"Kar Neng Lai,&nbsp;Man Fai Lam,&nbsp;Joseph C K Leung,&nbsp;Loretta Y Chan,&nbsp;Christopher W K Lam,&nbsp;Iris H S Chan,&nbsp;Hoi Wong Chan,&nbsp;Chun Sang Li,&nbsp;Sunny S H Wong,&nbsp;Yiu Wing Ho,&nbsp;Au Cheuk,&nbsp;Matthew K L Tong,&nbsp;Sydney C W Tang","doi":"10.3747/pdi.2010.00176","DOIUrl":"https://doi.org/10.3747/pdi.2010.00176","url":null,"abstract":"<p><strong>Objective: </strong>Although peritoneal dialysis (PD) is a widely accepted form of renal replacement therapy, concerns remain regarding the bioincompatible nature of standard PD fluid (PDF). Short-term studies of new biocompatible PDFs low in glucose degradation products (GDPs) reveal divergent results with respect to peritoneal integrity.</p><p><strong>Methods: </strong>We studied 125 patients on maintenance PD who were assigned, by simple randomization, to receive either conventional or low-GDP PDF at PD initiation. Parameters of dialysis adequacy and peritoneal transport of small solutes were determined at initiation and after a period of maintenance PD at the time when serum and overnight effluent dialysate were simultaneously collected and assayed for various cytokines, chemokines, adipokines, and cardiac biomarkers. All patients were further followed prospectively for an average of 15 months from the day of serum and effluent collection to determine patient survival and cardiovascular events.</p><p><strong>Results: </strong>Patients treated with conventional or low-GDP PDF were matched for sex, age, duration of dialysis, dialysis adequacy, and incidence of cardiovascular disease or diabetes. After an average of 2.3 years of PD treatment, the weekly total and peritoneal creatinine clearance, and the total and peritoneal Kt/V were comparable in the groups. However, urine output was higher in patients using low-GDP PDF despite there having been no difference between the groups at PD initiation. Patients using low-GDP PDF also experienced a slower rate of decline of residual glomerular filtration and urine output than did patients on conventional PDF. Compared with serum concentrations, effluent concentrations of tumor necrosis factor α, hepatocyte growth factor, macrophage migration inhibitory factor, interleukins 8 and 6, C-reactive protein, and leptin were found to be higher in both groups of patients after long-term PD, suggesting that the peritoneal cavity was the major source of those mediators. Compared with patients on low-GDP PDF, patients on conventional fluid showed elevated leptin and reduced adiponectin levels in serum and effluent. The effluent concentration of interleukin 8 was significantly lower in patients using low-GDP PDF. The survival rate and incidence of cardiovascular complications did not differ between these groups after maintenance PD for an average of 3.6 years.</p><p><strong>Conclusions: </strong>It appears that low-GDP PDF results in an improvement of local peritoneal homeostasis through a reduction of chronic inflammatory status in the peritoneum.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"280-91"},"PeriodicalIF":2.8,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2010.00176","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40119551","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":"A peritoneal dialysis regimen low in glucose and glucose degradation products results in increased cancer antigen 125 and peritoneal activation.","authors":"Caatje Y le Poole,&nbsp;Angelique G A Welten,&nbsp;Piet M ter Wee,&nbsp;Nanne J Paauw,&nbsp;Amina N Djorai,&nbsp;Rob M Valentijn,&nbsp;Robert H J Beelen,&nbsp;Jacob van den Born,&nbsp;Frans J van Ittersum","doi":"10.3747/pdi.2010.00115","DOIUrl":"https://doi.org/10.3747/pdi.2010.00115","url":null,"abstract":"<p><strong>Background: </strong>Glucose and glucose degradation products (GDPs) in peritoneal dialysis fluids (PDFs) are both thought to mediate progressive peritoneal worsening.</p><p><strong>Methods: </strong>In a multicenter, prospective, randomized crossover study, incident continuous ambulatory peritoneal dialysis patients were treated either with conventional lactate-buffered PDF (sPD regimen) or with a regimen low in glucose and GDPs: Nutrineal×1, Extraneal×1, and Physioneal×2 (NEPP regimen; all solutions: Baxter Healthcare, Utrecht, The Netherlands). After 6 months, patients were switched to the alternative regimen for another 6 months. After 6 weeks of run-in, before the switch, and at the end of the study, 4-hour peritoneal equilibration tests were performed, and overnight effluents were analyzed for cells and biomarkers. Differences between the regimens were assessed by multivariate analysis corrected for time and regimen sequence.</p><p><strong>Results: </strong>The 45 patients who completed the study were equally distributed over both groups. During NEPP treatment, D(4)/D(0) glucose was lower (p < 0.01) and D/P creatinine was higher (p = 0.04). In NEPP overnight effluent, mesothelial cells (p < 0.0001), cancer antigen 125 (p < 0.0001), hyaluronan (p < 0.0001), leukocytes (p < 0.001), interleukins 6 (p = 0.001) and 8 (p = 0.0001), and vascular endothelial growth factor (VEGF, p < 0.0001) were increased by a factor of 2-3 compared with levels in sPD effluent. The NEPP regimen was associated with higher transport parameters, but that association disappeared after the addition of VEGF to the model. The association between NEPP and higher effluent levels of VEGF could not be attributed to glucose and GDP loads.</p><p><strong>Conclusions: </strong>Study results indicate preservation of the mesothelium and increased peritoneal activation during NEPP treatment. Whether the increase in VEGF reflects an increase in mesothelial cell mass or whether it points to another, undesirable mechanism cannot be determined from the present study. Longitudinal studies are needed to finally evaluate the usefulness of the NEPP regimen for further clinical use.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"305-15"},"PeriodicalIF":2.8,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2010.00115","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40119553","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":"Intraperitoneal vancomycin concentrations during peritoneal dialysis-associated peritonitis: correlation with serum levels.","authors":"Richard Fish,&nbsp;Robert Nipah,&nbsp;Chris Jones,&nbsp;Hazel Finney,&nbsp;Stanley L S Fan","doi":"10.3747/pdi.2010.00294","DOIUrl":"https://doi.org/10.3747/pdi.2010.00294","url":null,"abstract":"<p><strong>Background: </strong>For the treatment of peritoneal dialysis-associated peritonitis (PDP), it has been suggested that serum concentrations of vancomycin be kept above 12 mg/L-15 mg/L. However, studies correlating vancomycin concentrations in serum and peritoneal dialysate effluent (PDE) during active infection are sparse. We undertook the present study to investigate this issue and to determine whether achieving the recommended serum level of vancomycin results in therapeutic levels intraperitoneally.</p><p><strong>Methods: </strong>We studied patients treated with intraperitoneal (i.p.) vancomycin for non-gram-negative PDP. We gave a single dose (approximately 30 mg/kg) at presentation, and we subsequently measured vancomycin levels in PDE on day 5; we wanted to determine if efflux of vancomycin from serum to PDE during a 4-hour dwell was consistent and resulted in therapeutic levels.</p><p><strong>Results: </strong>Of the 48 episodes of PDP studied, serum vancomycin concentrations exceeding 12 mg/L were achieved in 98% of patients, but in 11 patients (23%), a PDE vancomycin level below 4 mg/L--the minimal inhibitory concentration (MIC) of many gram-positive organisms--was observed at the end of a 4-hour dwell on day 5. The correlation between the concentrations of vancomycin in serum and PDE (from efflux of antibiotic over 4 hours) was statistically significant, but poor (R(2) = 0.18).</p><p><strong>Conclusions: </strong>Our data support the International Society for Peritoneal Dialysis statement that adequate serum vancomycin concentrations can be achieved with intermittent dosing (single dose every 5 days), but cannot guarantee therapeutic PDE levels in the treatment of PDP. Intermittent dosing of vancomycin may not consistently result in PDE concentrations markedly greater than MIC of many important pathogens. Although the clinical significance of this finding remains to be determined, it may be preferable to give smaller but more frequent doses of PDE vancomycin (continuous dosing) for adults with PDP (as is currently recommended for children).</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"332-8"},"PeriodicalIF":2.8,"publicationDate":"2012-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2010.00294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40121142","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":"Hemoglobin variability with epoetin beta and continuous erythropoietin receptor activator in patients on peritoneal dialysis.","authors":"Nicholas M Selby,&nbsp;Sally A Fonseca,&nbsp;Richard J Fluck,&nbsp;Maarten W Taal","doi":"10.3747/pdi.2010.00299","DOIUrl":"https://doi.org/10.3747/pdi.2010.00299","url":null,"abstract":"<p><strong>Background and objectives: </strong>The extent to which hemoglobin (Hb) cycling occurs in peritoneal dialysis (PD) patients is unclear. It is also uncertain whether different types of erythropoiesis-stimulating agents (ESAs) affect such cycling. We performed a retrospective cohort study of our PD population before and after the entire program was switched from epoetin beta (NeoRecormon: Hoffman-LaRoche, Basel, Switzerland) to continuous erythropoietin receptor activator [CERA (Mircera: Hoffman-LaRoche)].</p><p><strong>Design, setting, participants, and measurements: </strong>The study included 79 patients receiving PD for end-stage renal failure and being treated with an ESA. Hemoglobin concentrations were measured monthly, and each study period ran for 12 months. Patient demographics and details of intercurrent illness and hospital admission were collected.</p><p><strong>Results: </strong>There was a trend to fewer patients on CERA (26 patients, 68.4%) than on epoetin beta (36 patients, 87.8%, p = 0.054) experiencing Hb excursions. The CERA group also required fewer dose changes. However, there was no difference in the proportion of patients experiencing complete Hb cycles. On logistic regression, the factors associated with Hb cycling were ESA dose increase or decrease and hospital admission. We also observed a positive correlation between the delta ESA dose and the amplitude of Hb excursion, suggesting that the dose changes were causal, rather than reactive.</p><p><strong>Conclusions: </strong>Hemoglobin cycling occurs in PD patients and is largely a consequence of current practice in ESA dosing, plus the effects of intercurrent illness. The longer half life of CERA may offer a small advantage in reducing the degree of Hb variability, possibly because of fewer dose changes per patient.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"177-82"},"PeriodicalIF":2.8,"publicationDate":"2012-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2010.00299","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40121137","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":"Comparison of outcomes on continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis: results from a USA database.","authors":"Trijntje T Cnossen,&nbsp;Len Usvyat,&nbsp;Peter Kotanko,&nbsp;Frank M van der Sande,&nbsp;Jeroen P Kooman,&nbsp;Mary Carter,&nbsp;Karel M L Leunissen,&nbsp;Nathan W Levin","doi":"10.3747/pdi.2010.00004","DOIUrl":"https://doi.org/10.3747/pdi.2010.00004","url":null,"abstract":"<p><strong>Background and objective: </strong>Automated peritoneal dialysis (APD) is being increasingly used as an alternative to continuous ambulatory peritoneal dialysis (CAPD). However, there has been concern regarding reduced sodium removal leading to hypertension and resulting in a faster decline in residual renal function (RRF). The objective of the present study was to compare patient and technique survival and other relevant parameters between patients treated with APD and patients treated with CAPD.</p><p><strong>Methods: </strong>Data for incident patients were retrieved from the database of the Renal Research Institute, New York. Treatment modality was defined 90 days after the start of dialysis treatment. In addition to technique and patient survival, RRF, blood pressure, and laboratory parameters were also compared.</p><p><strong>Results: </strong>179 CAPD and 441 APD patients were studied. Mean as-treated survival was 1407 days [95% confidence interval (CI) 1211 - 1601] in CAPD patients and 1616 days (95% CI 1478 - 1764) in APD patients. Adjusted hazard ratio (HR) for mortality was 1.31 in CAPD compared to APD (95% CI 0.76 - 2.25, p = NS). Unadjusted as-treated technique survival was lower in CAPD compared to APD, with HR 2.84 (95% CI 1.65 - 4.88, p = 0.002); adjusted HR was 1.81 (95% CI 0.94 - 3.57, p = 0.08). Peritonitis rate was 0.3 episodes/patient-year for CAPD and APD; exit-site/tunnel infection rate was 0.1 and 0.3 episodes/patient-year for CAPD and APD respectively (p = NS).</p><p><strong>Conclusions: </strong>Patient survival was not significantly different between APD and CAPD patients, whereas technique survival appeared to be higher in APD patients and could not be explained by differences in infectious complications. No difference in blood pressure control or decline in RRF was observed between the 2 modalities. Based on these results, APD appears to be an acceptable alternative to CAPD, although technique prescription should always follow individual judgment.</p>","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"679-84"},"PeriodicalIF":2.8,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2010.00004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40060144","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":"Peritoneal dialysis catheter removal by nephrologists: technical aspect from a single center.","authors":"Arzu Kahveci,&nbsp;Elif Ari,&nbsp;Ebru Asicioglu,&nbsp;Hakki Arikan,&nbsp;Serhan Tuglular,&nbsp;Cetin Ozener","doi":"10.3747/pdi.2009.00220","DOIUrl":"https://doi.org/10.3747/pdi.2009.00220","url":null,"abstract":"Despite improvements in peritoneal dialysis (PD) techniques during past years, PD-related problems may still warrant removal of the catheter. Mechanical catheter problems, persistent or relapsing peritonitis, and exitsite infections are the most common causes of removal. PD catheters may also be removed after successful renal transplantation. Recent data reported by Asif emphasized that the most common PD access procedures performed by nephrologists include PD catheter insertion, removal, and repositioning (1). Traditionally, PD catheter removal and repositioning are performed by surgeons. Due to surgeons’ long waiting lists, there is usually a delay in the procedure, with adverse effects on outcome. Therefore, we set out to introduce a technique for removal of Tenckhoff PD catheters described by Ash (2). We retrospectively evaluated the PD catheter removal procedures that were performed by nephrologists in our clinic.","PeriodicalId":519220,"journal":{"name":"Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis","volume":" ","pages":"570-2"},"PeriodicalIF":2.8,"publicationDate":"2010-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.3747/pdi.2009.00220","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40058444","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}