Advances in peritoneal dialysis. Conference on Peritoneal Dialysis最新文献

{"title":"Preoperative Cardiac Evaluation in Kidney Transplant Patients: Is Coronary Angiography Superior? A Focused Review.","authors":"Natraj Katta,&nbsp;Sudarshan Balla,&nbsp;Poonam Velagapudi,&nbsp;Mayank Mittal,&nbsp;Harsh Agrawal,&nbsp;Arun Kumar,&nbsp;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}

{"title":"Bullous Skin Lesions in a Patient with End-Stage Renal Disease and Hepatitis C.","authors":"Michael M Strauss,&nbsp;Anupkumar Shetty,&nbsp;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}

{"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,&nbsp;Hugo Villanueva,&nbsp;Lin Lwin,&nbsp;Madhavi Katikaneni,&nbsp;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}

{"title":"Louisiana State University Nephrology: Initiation of a Multicenter Urgent-Start Peritoneal Dialysis Program.","authors":"Ashwin Jaikishen,&nbsp;Adam Lick,&nbsp;Jonathan G Owen,&nbsp;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}

{"title":"Comparing Dialysis Modality and Cardiovascular Mortality in Patients on Hemodialysis and Peritoneal Dialysis.","authors":"Hany Refaat,&nbsp;Dawlat Sany,&nbsp;Amr Mohab,&nbsp;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}

{"title":"Subcutaneous pathway diversion for peritoneal dialysis catheter salvage.","authors":"Tsutomu Sakurada,&nbsp;Takeshi Okamoto,&nbsp;Daisuke Oishi,&nbsp;Kenichiro Koitabashi,&nbsp;Shina Sueki,&nbsp;Nagayuki Kaneshiro,&nbsp;Katsuomi Matsui,&nbsp;Ryuto Nakazawa,&nbsp;Maki Yoshioka,&nbsp;Yusuke Konno,&nbsp;Yuichi Sato,&nbsp;Yugo Shibagaki,&nbsp;Tatsuya Chikaraishi,&nbsp;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}

{"title":"Long-term survival benefits of combined hemodialysis and peritoneal dialysis.","authors":"Hiromichi Suzuki,&nbsp;Hitosi Hoshi,&nbsp;Tsutomu Inoue,&nbsp;Tomohiro Kikuta,&nbsp;Hiroshi Takane,&nbsp;Tsuneo Takenaka,&nbsp;Yusuke Watanabe,&nbsp;Hirokazu Okada,&nbsp;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}

{"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}

{"title":"Serum magnesium concentration is a significant predictor of mortality in peritoneal dialysis patients.","authors":"Paula Fein,&nbsp;Stacey Weiss,&nbsp;Francis Ramos,&nbsp;Priyanka Singh,&nbsp;Jyotiprakas Chattopadhyay,&nbsp;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}

{"title":"A review of diuretic use in dialysis patients.","authors":"Ruchi Kumra,&nbsp;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}