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Zhang L, Guan X, Liu L, Huang Y, Xiong J, Zhao J. Risk factors and outcomes in patients who switched from peritoneal dialysis to physician-oriented or patient-oriented kidney replacement therapy. Ren Fail 2024; 46:2337286. [PMID: 38604972 PMCID: PMC11011228 DOI: 10.1080/0886022x.2024.2337286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND We aimed to compare the cardiovascular events and mortality in patients who underwent either physician-oriented or patient-oriented kidney replacement therapy (KRT) conversion due to discontinuation of peritoneal dialysis (PD). METHODS Patients with end-stage kidney disease who were receiving PD and required a switch to an alternative KRT were included. They were divided into physician-oriented group or patient-oriented group based on the decision-making process. Logistic regression analysis was used to explore the influencing factors related to KRT conversion in PD patients. The association of physician-oriented or patient-oriented KRT conversion with outcomes after the conversion was assessed by using Cox proportional hazards models. RESULTS A total of 257 PD patients were included in the study. The median age at catheterization was 35 years. 69.6% of the participants were male. The median duration of PD was 20 months. 162 participants had patient-oriented KRT conversion, while 95 had physician-oriented KRT conversion. Younger patients, those with higher education levels, higher income, and no diabetes were more likely to have patient-oriented KRT conversion. Over a median follow-up of 39 months, 40 patients experienced cardiovascular events and 16 patients died. Physician-oriented KRT conversion increased nearly 3.8-fold and 4.0-fold risk of cardiovascular events and death, respectively. After adjusting for confounders, physician-oriented KRT conversion remained about a 3-fold risk of cardiovascular events. CONCLUSION Compared to patient-oriented KRT conversion, PD patients who underwent physician-oriented conversion had higher risks of cardiovascular events and all-cause mortality. Factors included age at catheterization, education level, annual household income, and history of diabetes mellitus.
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Affiliation(s)
- Liu Zhang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Xu Guan
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Liang Liu
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Yinghui Huang
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Jiachuan Xiong
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Jinghong Zhao
- Department of Nephrology, the Key Laboratory for the Prevention and Treatment of Chronic Kidney Disease of Chongqing, Kidney Center of PLA, Xinqiao Hospital, Army Medical University (Third Military Medical University), Chongqing, P.R. China
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Shan Y, Yu M, Dai H, Zhu X, Wang F, You Y, Cao H, Sheng L, Zhao J, Tang L, Shi J, Sheng M. The role of macrophage-derived Exosomes in reversing peritoneal fibrosis: Insights from Astragaloside IV. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 129:155683. [PMID: 38701543 DOI: 10.1016/j.phymed.2024.155683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 04/06/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a successful renal replacement therapy for end-stage renal disease. Long-term PD causes mesothelial-mesenchymal transition (MMT) of peritoneal mesothelial cells (PMCs), leading to peritoneal fibrosis (PF), which reduces the efficiency of PD. Macrophages are thought to play a role in the onset and perpetuation of peritoneal injury. However, the mechanisms by which macrophages-PMCs communication regulates peritoneal fibrosis are not fully understood resulting in a lack of disease-modifying drugs. Astragaloside IV (AS-IV) possessed anti-fibrotic effect towards PF in PD whereas the mechanistic effect of AS-IV in PD is unknown. METHODS The primary macrophages were extracted and treated with LPS or AS-IV, then co-cultured with primary PMCs in transwell plates. The macrophage-derived exosomes were extracted and purified by differential centrifugation, then co-cultured with primary PMCs. Small RNA-seq was used to detect differential miRNAs in exosomes, and then KEGG analysis and q-PCR were performed for validation. In vivo PD rat models were established by inducing with high-glucose peritoneal dialysis fluid and different concentrations of AS-IV and exosomes were intraperitoneal injection. Through qRT-PCR, western blotting, and luciferase reporting, candidate proteins and pathways were validated in vivo and in vitro. The functions of the validated pathways were further investigated using the mimic or inhibition strategy. PF and inflammatory situations were assessed. RESULTS We found AS-IV reversed the MMT of PMCs caused by LPS-stimulated macrophages and the improving effect was mediated by macrophage-derived exosomes in vitro. We also demonstrated that AS-IV significantly reduced the MMT of PMCs in vitro or PF in a rat PD model via regulating exosome-contained miR-204-5p which targets Foxc1/β-catenin signaling pathway. CONCLUSION AS-IV attenuates macrophage-derived exosomes induced fibrosis in PD through the miR-204-5p/Foxc1 pathway.
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Affiliation(s)
- Yun Shan
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China,; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Manshu Yu
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
| | - Huibo Dai
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China,; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Xiaolin Zhu
- Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Funing Wang
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China,; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Yongqing You
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China,; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Huimin Cao
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Li Sheng
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China,; Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Junyi Zhao
- Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Lei Tang
- Key Laboratory for Metabolic Diseases in Chinese Medicine, First College of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Jun Shi
- Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Meixiao Sheng
- Department of nephrology, Jiangsu Province Hospital of Chinese Medicine, The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China,.
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He Y, Xiao F, Luo Q, Liao J, Huang H, He Y, Gao M, Liao Y, Xiong Z. Red cell distribution width to albumin ratio predicts treatment failure in peritoneal dialysis-associated peritonitis. Ther Apher Dial 2024; 28:399-408. [PMID: 38112028 DOI: 10.1111/1744-9987.14098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/24/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND This study aims to investigate the potential correlation between baseline red cell distribution width (RDW) to albumin ratio (RAR) levels and treatment failure in peritoneal dialysis-associated peritonitis (PDAP) patients. METHODS A retrospective single-center study was conducted on 286 PDAP patients. Logistic regression and generalized estimation equation (GEE) analyses were employed to assess the relationship between RAR and treatment failure. RESULTS RAR emerged as a robust predictor of treatment failure in PDAP patients. Elevated RAR levels were associated with an increased risk of treatment failure, exhibiting a linear relationship. Even after adjusting for demographic and clinical variables, this association remained statistically significant. ROC analysis revealed that RAR outperformed RDW and albumin individually in predicting PDAP prognosis. CONCLUSION This study highlights RAR as a superior prognostic marker for treatment failure in PDAP patients, offering new insights into risk assessment and management strategies for this challenging condition.
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Affiliation(s)
- Yujian He
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Fei Xiao
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Qingyun Luo
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Jinlan Liao
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Huie Huang
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Yan He
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Min Gao
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Yumei Liao
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
| | - Zibo Xiong
- Renal Division, Peking University Shenzhen Hospital (PKU-Shenzhen Clinical Institute of Shantou University Medical College, PKU-Shenzhen Clinical Institute of Shenzhen University Medical College), Shenzhen, China
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Zhong W, Fu J, Liao J, Ouyang S, Yin W, Liang Y, Liu K. A protective role of nintedanib in peritoneal fibrosis through H19-EZH2-KLF2 axis via impeding mesothelial-to-mesenchymal transition. Int Urol Nephrol 2024; 56:1987-1999. [PMID: 38097887 DOI: 10.1007/s11255-023-03892-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/16/2023] [Indexed: 05/14/2024]
Abstract
BACKGROUND Peritoneal fibrosis (PF), a common complication of long-term peritoneal dialysis, accounts for peritoneal ultrafiltration failure to develop into increased mortality. Nintedanib has previously been shown to protect against multi-organ fibrosis, including PF. Unfortunately, the precise molecular mechanism underlying nintedanib in the pathogenesis of PF remains elusive. METHODS The mouse model of PF was generated by chlorhexidine gluconate (CG) injection with or without nintedanib administration, either with the simulation for the cell model of PF by constructing high-glucose (HG)-treated human peritoneal mesothelial cells (HPMCs). HE and Masson staining were applied to assess the histopathological changes of peritoneum and collagen deposition. FISH, RT-qPCR, western blot and immunofluorescence were employed to examine distribution or expression of targeted genes. Cell viability was detected using CCK-8 assay. Cell morphology was observed under a microscope. RNA immunoprecipitation (RIP) and chromatin immunoprecipitation (ChIP) assays were applied to validate the H19-EZH2-KLF2 regulatory axis. RESULTS Aberrantly overexpressed H19 was observed in both the mouse and cell model of PF, of which knockdown significantly blocked HG-induced mesothelial-to-mesenchymal transition (MMT) of HPMCs. Moreover, loss of H19 further strengthened nintedanib-mediated suppressive effects against MMT process in a mouse model of PF. Mechanistically, H19 could epigenetically repressed KLF2 via recruiting EZH2. Furthermore, TGF-β/Smad pathway was inactivated by nintedanib through mediating H19/KLF2 axis. CONCLUSION In summary, nintedanib disrupts MMT process through regulating H19/EZH2/KLF2 axis and TGF-β/Smad pathway, which laid the experimental foundation for nintedanib in the treatment of PF.
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Affiliation(s)
- Wei Zhong
- Department of Nephrology and Laboratory of Kidney Disease, Changsha Clinical Research Center for Kidney Disease, Hunan Clinical Research Center for Chronic Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61, Jiefangxi Road, Changsha, 410002, Hunan, People's Republic of China
| | - Jia Fu
- Department of Oncology, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, 410002, Hunan, People's Republic of China
| | - Jin Liao
- Department of Nephrology and Laboratory of Kidney Disease, Changsha Clinical Research Center for Kidney Disease, Hunan Clinical Research Center for Chronic Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61, Jiefangxi Road, Changsha, 410002, Hunan, People's Republic of China
| | - Shaxi Ouyang
- Department of Nephrology and Laboratory of Kidney Disease, Changsha Clinical Research Center for Kidney Disease, Hunan Clinical Research Center for Chronic Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61, Jiefangxi Road, Changsha, 410002, Hunan, People's Republic of China
| | - Wei Yin
- Department of Nephrology and Laboratory of Kidney Disease, Changsha Clinical Research Center for Kidney Disease, Hunan Clinical Research Center for Chronic Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61, Jiefangxi Road, Changsha, 410002, Hunan, People's Republic of China
| | - Yumei Liang
- Department of Nephrology and Laboratory of Kidney Disease, Changsha Clinical Research Center for Kidney Disease, Hunan Clinical Research Center for Chronic Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61, Jiefangxi Road, Changsha, 410002, Hunan, People's Republic of China
| | - Kanghan Liu
- Department of Nephrology and Laboratory of Kidney Disease, Changsha Clinical Research Center for Kidney Disease, Hunan Clinical Research Center for Chronic Kidney Disease, Hunan Provincial People's Hospital (The First Affiliated Hospital of Hunan Normal University), No.61, Jiefangxi Road, Changsha, 410002, Hunan, People's Republic of China.
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Ma N, Zang Z, Liu X, Zhang Y, Zhou X, Tang Y, Li Z. Higher N-terminal pro-brain natriuretic peptide level at onset of peritoneal dialysis-related peritonitis is a risk factor for technique failure. BMC Nephrol 2024; 25:168. [PMID: 38760707 PMCID: PMC11100099 DOI: 10.1186/s12882-024-03603-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Recent studies have suggested that the N-terminal fragment of B-type natriuretic peptide (NT-proBNP) level serve as a significant risk factor for mortality in patients with end-stage renal disease. However, the relationship between NT-proBNP levels and technique failure in peritoneal dialysis-associated peritonitis (PDAP) remains unclear. This study investigated the relationship between NT-proBNP levels at the onset of PDAP and the risk of technique failure in patients with PDAP. METHODS A retrospective analysis was conducted on patients with PDAP from December 1, 2009, to December 31, 2021, at our peritoneal dialysis center. We recorded all demographic and baseline clinical data at the time of admission for each PDAP episode. Logistic and Cox regression analyses were performed to assess the association between NT-proBNP levels and technique failure. RESULTS Of 485 PDAP episodes included in this study, 130 episodes of technique failure were observed. Multivariate logistic analysis revealed that hospital stay, Na and NT-proBNP levels, and peritoneal dialysate white blood cell counts on days 3 and 5 were independently associated with technique failure. The receiver operating characteristic curve demonstrated that the NT-proBNP level was a better indicator than the other four variables in indicating technique failure. In the multivariate Cox regression analysis, after adjusting for confounding factors, higher NT-proBNP levels (HR of 3.020, 95% CI 1.771, 5.150, P < 0.001) were associated with PDAP technique failure. CONCLUSIONS This retrospective study identified the serum NT-proBNP level at the onset of PDAP as an independent risk factor for technique failure in these patients.
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Affiliation(s)
- Niya Ma
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China
| | - Zhiyun Zang
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China
- Department of Nephrology, The Third People's Hospital of Chengdu, Chengdu, 610014, China
| | - Xia Liu
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China
- West China School of Nursing, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yunyun Zhang
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China
| | - Xueli Zhou
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China
- West China School of Nursing, West China Hospital of Sichuan University, Chengdu, 610041, China
| | - Yi Tang
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China
| | - Zi Li
- Department of Nephrology, West China Hospital of Sichuan University, Guoxue Lane 37, Chengdu, 610041, China.
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Su H, Zou R, Su J, Chen X, Yang H, An N, Yang C, Tang J, Liu H, Yao C. Sterile inflammation of peritoneal membrane caused by peritoneal dialysis: focus on the communication between immune cells and peritoneal stroma. Front Immunol 2024; 15:1387292. [PMID: 38779674 PMCID: PMC11109381 DOI: 10.3389/fimmu.2024.1387292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/16/2024] [Indexed: 05/25/2024] Open
Abstract
Peritoneal dialysis is a widely used method for treating kidney failure. However, over time, the peritoneal structure and function can deteriorate, leading to the failure of this therapy. This deterioration is primarily caused by infectious and sterile inflammation. Sterile inflammation, which is inflammation without infection, is particularly concerning as it can be subtle and often goes unnoticed. The onset of sterile inflammation involves various pathological processes. Peritoneal cells detect signals that promote inflammation and release substances that attract immune cells from the bloodstream. These immune cells contribute to the initiation and escalation of the inflammatory response. The existing literature extensively covers the involvement of different cell types in the sterile inflammation, including mesothelial cells, fibroblasts, endothelial cells, and adipocytes, as well as immune cells such as macrophages, lymphocytes, and mast cells. These cells work together to promote the occurrence and progression of sterile inflammation, although the exact mechanisms are not fully understood. This review aims to provide a comprehensive overview of the signals from both stromal cells and components of immune system, as well as the reciprocal interactions between cellular components, during the initiation of sterile inflammation. By understanding the cellular and molecular mechanisms underlying sterile inflammation, we may potentially develop therapeutic interventions to counteract peritoneal membrane damage and restore normal function.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Huafeng Liu
- Guangdong Provincial Key Laboratory of Autophagy and Major Chronic Non-communicable Diseases, Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Cuiwei Yao
- Guangdong Provincial Key Laboratory of Autophagy and Major Chronic Non-communicable Diseases, Key Laboratory of Prevention and Management of Chronic Kidney Disease of Zhanjiang City, Institute of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
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Nel H, Debbie F, Narelle H, Sean R, Aron C. A retrospective clinical and economic analysis of an assisted automated peritoneal dialysis programme in Western Australia . Perit Dial Int 2024; 44:203-210. [PMID: 37635394 DOI: 10.1177/08968608231190772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Assisted peritoneal dialysis (aPD) represents an alternative kidney replacement therapy for dialysis-dependent patients whose only other options are prolonged hospitalisations or transfer to in-centre haemodialysis (HD). Most programmes have not examined the role of temporary aPD, and there is limited data surrounding the economic implications of temporary aPD programmes. The main aim of this study was to describe the cost-effectiveness of an assisted automated peritoneal dialysis (aAPD) programme, for patients whose only reason to stay in hospital was the temporary inability to independently perform PD at home. METHODS Retrospective, single-centre analysis of 45 referrals for aAPD from November 2015 to May 2021. Two groups of patients were enrolled in the study: respite patients already established on PD (to facilitate discharge or prevent admission) and new patients who were not yet trained (to facilitate discharge). To calculate the cost differential, patients were allocated to either staying in hospital or transferring to centre-based HD with comparison to costs on aAPD. Costs were calculated using a healthcare system perspective over the duration of aAPD assistance. Clinical outcomes including peritonitis rate, hospitalisation and mortality were also assessed. RESULTS Overall, 1349 episodes of aAPD care were delivered. One thousand forty-two episodes (77%) were for respite patients and 307 episodes (23%) were for new patients awaiting training. The mean duration of assistance was 18 days for pretraining patients and 37 days for respite patients. Overall, the mean length of stay on the programme was 30 days with a range of 1-263 days (SD 43) and 73% of patients graduated to self-care PD. The cost of the aAPD programme was $242 per visit, with an average cost $7260 per patient-episode. The aAPD programme was significantly cheaper than the alternatives, with average hospitalization costs $46,170 per episode, and in-centre HD costs of $9667. $1.497 million was saved over the course of the study. Eleven hospitalisations occurred and the peritonitis rate was 0.8 episodes per patient-year. Two patients died while on aAPD. CONCLUSION This study provides the first detailed description of an aAPD respite programme in Australia. We conclude that the implementation of a temporary aAPD programme could lead to a significant reduction in healthcare costs, however peritonitis rates were high.
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Affiliation(s)
- Henco Nel
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Fortnum Debbie
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Hawkins Narelle
- HomeLink Service, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Randall Sean
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Chakera Aron
- Renal Unit, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Fung WW, SZE RKH, Szeto CC, Chow KM. Staphylococcus lugdunensis Peritoneal Dialysis-Related Peritonitis: A Matched Comparative Analysis. Kidney Med 2024; 6:100811. [PMID: 38650953 PMCID: PMC11033185 DOI: 10.1016/j.xkme.2024.100811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Rationale & Objective Staphylococcus lugdunensis (S lugdunensis) is a coagulase-negative staphylococcus species that has been increasingly recognized to cause serious infections with virulence resembling Staphylococcus aureus (S aureus). No studies have evaluated the characteristics and outcomes of patients with S lugdunensis peritoneal dialysis-related peritonitis compared with those with S aureus peritonitis. We aim to evaluate the clinical course of peritonitis as caused by these organisms. Study Design A retrospective matched comparative analysis involving a single tertiary center from July 2000 to July 2020. Setting & Participants Forty-eight episodes of S aureus peritonitis were matched to 19 cases of S lugdunensis peritonitis. Analytical Approach The cases were individually matched for year of peritonitis, sex, age (±10 years), and Charlson Comorbidity Index (±3). A comparative analysis was performed between the 2 organisms. The outcome includes responses at day 5 of peritonitis and the rate of complete response. Results There is a higher predilection of diabetes in those with S aureus peritonitis than in those with S lugdunensis (64.6% vs 31.6%; P = 0.03). Patients with S aureus peritonitis also have a much higher total cell count at presentation (4,463.9 ± 5,479.5 vs 1,807.9 ± 3,322.7; P = 0.05); a higher prevalence of poor response at day 5 (50.0% vs 15.8%; P = 0.03); a lower rate of complete response (64.6% vs 94.7%; P = 0.01) and are more prone to relapse with the same organism (29.2% vs 0%, respectively; P = 0.01) as compared to those with S lugdunensis. Limitations The result of this small retrospective study involving a single center may not be generalizable to other centers. There is also no data for comparative analysis on other coagulase-negative staphylococci such as Staphylococcus epidermidis, which belongs to the same family as S lugdunensis. Conclusions Although S aureus peritonitis is more virulent with significant morbidity, S lugdunensis can cause similarly serious peritonitis. This largest case series of S lugdunensis peritonitis enabled better characterization of clinical features and outcomes of patients with S lugdunensis peritonitis.
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Affiliation(s)
- Winston W.S. Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Ryan K.-H. SZE
- Department of Microbiology, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
- Li Ka Shing Institute of Health Sciences (LiHS), The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
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Li A, Wu S, Li Q, Wang Q, Chen Y. Elucidating the Molecular Pathways and Therapeutic Interventions of Gaseous Mediators in the Context of Fibrosis. Antioxidants (Basel) 2024; 13:515. [PMID: 38790620 PMCID: PMC11117599 DOI: 10.3390/antiox13050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/13/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
Fibrosis, a pathological alteration of the repair response, involves continuous organ damage, scar formation, and eventual functional failure in various chronic inflammatory disorders. Unfortunately, clinical practice offers limited treatment strategies, leading to high mortality rates in chronic diseases. As part of investigations into gaseous mediators, or gasotransmitters, including nitric oxide (NO), carbon monoxide (CO), and hydrogen sulfide (H2S), numerous studies have confirmed their beneficial roles in attenuating fibrosis. Their therapeutic mechanisms, which involve inhibiting oxidative stress, inflammation, apoptosis, and proliferation, have been increasingly elucidated. Additionally, novel gasotransmitters like hydrogen (H2) and sulfur dioxide (SO2) have emerged as promising options for fibrosis treatment. In this review, we primarily demonstrate and summarize the protective and therapeutic effects of gaseous mediators in the process of fibrosis, with a focus on elucidating the underlying molecular mechanisms involved in combating fibrosis.
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Affiliation(s)
- Aohan Li
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
| | - Siyuan Wu
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
| | - Qian Li
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
| | - Qianqian Wang
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
- Engineering Technology Research Center for The Utilization of Functional Components of Organic Natural Products, Dalian University, Dalian 116622, China
| | - Yingqing Chen
- Chronic Disease Research Center, Medical College, Dalian University, Dalian 116622, China; (A.L.); (S.W.); (Q.L.)
- Engineering Technology Research Center for The Utilization of Functional Components of Organic Natural Products, Dalian University, Dalian 116622, China
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10
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Miljuš G, Penezić A, Pažitná L, Gligorijević N, Baralić M, Vilotić A, Šunderić M, Robajac D, Dobrijević Z, Katrlík J, Nedić O. Glycosylation and Characterization of Human Transferrin in an End-Stage Kidney Disease. Int J Mol Sci 2024; 25:4625. [PMID: 38731843 PMCID: PMC11083005 DOI: 10.3390/ijms25094625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/10/2024] [Accepted: 04/17/2024] [Indexed: 05/13/2024] Open
Abstract
Chronic kidney disease (CKD) is a global health concern affecting approximately one billion individuals worldwide. End-stage kidney disease (ESKD), the most severe form of CKD, is often accompanied by anemia. Peritoneal dialysis (PD), a common treatment for ESKD, utilizes the peritoneum for solute transfer but is associated with complications including protein loss, including transferrin (Tf) a key protein involved in iron transport. This study investigated Tf characteristics in ESKD patients compared to healthy individuals using lectin microarray, spectroscopic techniques and immunocytochemical analysis to assess Tf interaction with transferrin receptors (TfRs). ESKD patients exhibited altered Tf glycosylation patterns, evidenced by significant changes in lectin reactivity compared to healthy controls. However, structural analyses revealed no significant differences in the Tf secondary or tertiary structures between the two groups. A functional analysis demonstrated comparable Tf-TfR interaction in both PD and healthy samples. Despite significant alterations in Tf glycosylation, structural integrity and Tf-TfR interaction remained preserved in PD patients. These findings suggest that while glycosylation changes may influence iron metabolism, they do not impair Tf function. The study highlights the importance of a glucose-free dialysis solutions in managing anemia exacerbation in PD patients with poorly controlled anemia, potentially offering a targeted therapeutic approach to improve patient outcomes.
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Affiliation(s)
- Goran Miljuš
- Institute for the Application of Nuclear Energy (INEP), Department for Metabolism, University of Belgrade, 11000 Belgrade, Serbia
| | - Ana Penezić
- Institute for the Application of Nuclear Energy (INEP), Department for Metabolism, University of Belgrade, 11000 Belgrade, Serbia
| | - Lucia Pažitná
- Institute of Chemistry, Slovak Academy of Sciences, 84538 Bratislava, Slovakia
| | - Nikola Gligorijević
- Institute of Chemistry, Technology and Metallurgy, Department of Chemistry, University of Belgrade, 11000 Belgrade, Serbia
| | - Marko Baralić
- School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Clinic of Nephrology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Aleksandra Vilotić
- Institute for the Application of Nuclear Energy (INEP), Department for Biology of Reproduction, University of Belgrade, 11000 Belgrade, Serbia
| | - Miloš Šunderić
- Institute for the Application of Nuclear Energy (INEP), Department for Metabolism, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragana Robajac
- Institute for the Application of Nuclear Energy (INEP), Department for Metabolism, University of Belgrade, 11000 Belgrade, Serbia
| | - Zorana Dobrijević
- Institute for the Application of Nuclear Energy (INEP), Department for Metabolism, University of Belgrade, 11000 Belgrade, Serbia
| | - Jaroslav Katrlík
- Institute of Chemistry, Slovak Academy of Sciences, 84538 Bratislava, Slovakia
| | - Olgica Nedić
- Institute for the Application of Nuclear Energy (INEP), Department for Metabolism, University of Belgrade, 11000 Belgrade, Serbia
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11
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Hsu CM, Li NC, Lacson EK, Weiner DE, Paine S, Majchrzak K, Argyropoulos C, Roumelioti ME, Pankratz VS, Miskulin D, Manley HJ, Salenger P, Johnson D, Johnson HK, Harford A. Peritoneal Dialysis Technique Survival: A Cohort Study. Am J Kidney Dis 2024:S0272-6386(24)00718-2. [PMID: 38640994 DOI: 10.1053/j.ajkd.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/17/2024] [Accepted: 03/01/2024] [Indexed: 04/21/2024]
Abstract
RATIONALE & OBJECTIVE Reasons for transfer from peritoneal dialysis (PD) to hemodialysis (HD) remain incompletely understood. Among incident and prevalent patients receiving PD, we evaluated the association between prior treatment with HD and PD technique survival. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Adults who initiated PD at a Dialysis Clinic, Inc. (DCI) outpatient facility between January 1, 2010 and September 30, 2019. EXPOSURES The primary exposure of interest was timing of PD start, categorized as PD-first, PD-early, or PD-late. Other covariates included demographics, clinical characteristics, and routine laboratory results. OUTCOMES Modality switch from PD to HD sustained for more than 90 days. ANALYTICAL APPROACH Multivariable Fine-Gray models with competing risks and time-varying covariates, stratified at 9 months to account for lack of proportionality. RESULTS Among 5224 patients who initiated PD at a DCI facility, 3174 initiated dialysis with PD ("PD-first"), 942 transitioned from HD to PD within 90 days ("PD-early"), and 1108 transitioned beyond 90 days ("PD-late"); 1472 (28%) subsequently transferred from PD to HD. PD-early and PD-late patients had higher risk of transfer to HD as compared to PD-first patients [adjusted hazard ratio (aHR) 1.51 (95% CI: 1.17-1.96) and 2.41 (1.94-3.00), respectively, in the first 9 months and aHR 1.16 (0.99-1.35) and 1.43 (1.24-1.65), respectively, after 9 months]. More peritonitis episodes, fewer home visits, lower serum albumin, lower residual kidney function, and lower peritoneal clearance calculated with weekly Kt/V were additional risk factors for PD-to-HD transfer. LIMITATIONS Missing data on dialysis adequacy and residual kidney function, confounded by short PD technique survival. CONCLUSIONS Initiating dialysis with PD is associated with greater PD technique survival, though many of those who initiate PD late in their dialysis course still experience substantial time on PD. Peritonitis, lower serum albumin, and lower Kt/V are risk factors for PD-to-HD transfer that may be amenable to intervention.
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Affiliation(s)
| | | | - Eduardo K Lacson
- Tufts Medical Center, Boston, MA; Dialysis Clinic Inc., Nashville, TN
| | | | | | | | | | | | | | | | | | | | | | | | - Antonia Harford
- Dialysis Clinic Inc., Nashville, TN; University of New Mexico, Albuquerque, NM
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12
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Chen C, Wang X, Li H, Zuo H. Effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis. Int Wound J 2024; 21:e14795. [PMID: 38572781 PMCID: PMC10993332 DOI: 10.1111/iwj.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 02/04/2024] [Indexed: 04/05/2024] Open
Abstract
This study investigates the effects of comprehensive nursing interventions on wound pain in patients undergoing catheter insertion for peritoneal dialysis. Sixty patients who underwent catheter insertion for peritoneal dialysis from January 2021 to January 2023 at our hospital were selected as subjects and randomly divided into an experimental group and a control group using a random number table method. The control group received routine nursing care, while the experimental group was subjected to comprehensive nursing interventions. The study compared the impact of nursing measures on visual analogue scale (VAS), self-rating anxiety scale (SAS), self-rating depression scale (SDS) and nursing satisfaction between the two groups. The analysis revealed that on the third, fifth and seventh days post-intervention, the experimental group's wound VAS scores were significantly lower than those of the control group (p < 0.001). Furthermore, levels of anxiety and depression were markedly lower in the experimental group compared with the control group (p < 0.001). In addition, the nursing satisfaction rate was significantly higher in the experimental group than in the control group (96.67% vs. 73.33%, p = 0.011). This study indicates that the application of comprehensive nursing interventions in patients undergoing catheter insertion for peritoneal dialysis is highly effective. It can alleviate wound pain and negative emotions to a certain extent, while also achieving high patient satisfaction, thus demonstrating significant clinical value.
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Affiliation(s)
- Chao Chen
- Department of NephrologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xiang‐Lei Wang
- Department of NephrologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hui Li
- Department of NephrologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Hong Zuo
- Department of NephrologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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13
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Wang IK, Chan CI, Lin AHF, Yu TM, Yen TH, Lai PC, Li CY, Sung FC. The impact of icodextrin on the outcomes of incident peritoneal dialysis patients. PLoS One 2024; 19:e0297688. [PMID: 38551920 PMCID: PMC10980222 DOI: 10.1371/journal.pone.0297688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/09/2024] [Indexed: 04/01/2024] Open
Abstract
OBJECTIVE The aim of the study is to investigate the effects of icodextrin on the risks of death, technique failure and the first episode of peritonitis in peritoneal dialysis (PD) patients. METHODS From medical records of a medical center in Taiwan, a total of 725 newly diagnosed end-stage kidney disease patients receiving PD for at least 90 days from January 1, 2007 to December 31, 2018 were identified. These patients were grouped as 190 icodextrin users and 535 non-users. Users were defined as utilization of icodextrin for ≥ 50% of their PD duration. The use of icodextrin was considered a time-varying exposure in the Cox proportional hazard model. The risks of death, technique failure and the first episode of peritonitis were compared between two cohorts by the end of 2018. RESULTS Compared to the non-users, the icodextrin users had significant lower risks of mortality (6.5 vs.7.2 per 100 person-years; adjusted HR = 0.62, 95% CI = 0.42-0.91) and technique failure (12.7 vs. 15.2 per 100 person-years; adjusted HR = 0.61, 95% CI = 0.47-0.81), and the first peritonitis episode (5.0 vs. 17.0 per 100 person-years; adjusted HR = 0.22, 95% CI = 0.14-0.35). The risk of peritonitis reduced further in icodextrin users with diabetes and with cardiovascular disease. CONCLUSION Icodextrin was associated with lower risks of mortality, technique failure, and the first episode of peritonitis.
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Affiliation(s)
- I-Kuan Wang
- Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
| | - Chan Ip Chan
- Baxter Healthcare Ltd., Taipei, Taiwan
- Graduate Institute of Management, National Taiwan University of Science and Technology, Taipei, Taiwan
| | | | - Tung-Min Yu
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Division of Nephrology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tzung-Hai Yen
- Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ping-Chin Lai
- Divisions of Nephrology, China Medical University Hospital, Taichung, Taiwan
| | - Chi-Yuan Li
- Department of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University College of Public Health, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
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14
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Huo Z, Liu D, Ye P, Zhang Y, Cao L, Gong N, Dou X, Ren C, Zhu Q, Li D, Zhang W, Kong Y, Wang G, Ai J. Longer serum phosphorus time in range associated with lower mortality risk among peritoneal dialysis patients: a multicenter retrospective cohort study. BMC Nephrol 2024; 25:117. [PMID: 38553732 PMCID: PMC10981292 DOI: 10.1186/s12882-023-03395-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/09/2023] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Relationship between serum phosphorus time in range and mortality risk in peritoneal dialysis (PD) patients remains uncertain. We aimed to evaluate the association between serum phosphorus time in range and all-cause mortality in Chinese PD population. METHODS This was a multicenter, retrospective, cohort study of 1,915 patients collected from January 2008 to October 2020 in 4 Chinese centers. Serum phosphorus time in range was estimated as the months during the first year that a patient's serum phosphorus level was within the target range (defined as 1.13-1.78 mmol/L). The primary outcome was all-cause mortality. The secondary outcomes were cardiovascular (CV) mortality and PD withdrawal. Cox proportional hazards regression model with comprehensive adjustments was used to assess the association. RESULTS The primary outcome occurred in 249 (13.0%) PD patients over a median follow-up of 28 months. Overall, the serum phosphorus time in range was negatively associated with all-cause mortality (per 3-month increments, adjusted HR [aHR], 0.83; 95%CI: 0.75-0.92), CV mortality (per 3-month increments, aHR, 0.87; 95%CI: 0.77-0.99), and PD withdrawal (per 3-month increments, aHR, 0.89; 95%CI: 0.83-0.95). Competing-risk model showed that the relationship of serum phosphorus time in range with all-cause mortality remained stable. None of the variables including demographics, history of diabetes and CV disease, as well as several PD-related and clinical indicators modified this association. CONCLUSIONS PD patients with longer serum phosphorus time in range in the first year was negatively associated with all-cause mortality and CV mortality. Our findings highlight the importance of maintaining serum phosphorus levels within 1.13-1.78 mmol/L for PD patients.
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Affiliation(s)
- Zhihao Huo
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
- Department of Nephrology, Guangdong Clinical Research Academy of Chinese Medicine, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Dehui Liu
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People's Hospital), Ganzhou, China
| | - Peiyi Ye
- Nephrology Department, The First People's Hospital of Foshan, Foshan, China
| | - Yuehang Zhang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Lisha Cao
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Nirong Gong
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Xianrui Dou
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Chengfa Ren
- Department of Nephrology, Nanfang Hospital, Ganzhou (Ganzhou People's Hospital), Ganzhou, China
| | - Qingyao Zhu
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Dan Li
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China
| | - Wei Zhang
- Department of Nephrology, Shunde Hospital, Southern Medical University, Foshan, China
| | - Yaozhong Kong
- Nephrology Department, The First People's Hospital of Foshan, Foshan, China
| | - Guobao Wang
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
| | - Jun Ai
- Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.
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15
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Yudianto B, Jaure A, Shen J, Cho Y, Brown E, Dong J, Dunning T, Mehrotra R, Naicker S, Pecoits-Filho R, Perl J, Wang AYM, Wilkie M, Guha C, Scholes-Robertson N, Craig J, Johnson D, Manera K. Nephrologists' perspectives on communication and decision-making regarding technique survival in peritoneal dialysis: an international qualitative interview study. BMJ Open 2024; 14:e082184. [PMID: 38471683 DOI: 10.1136/bmjopen-2023-082184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVES Peritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a major challenge for nephrologists. This study aims to describe nephrologists' perspectives on technique survival in PD. DESIGN Qualitative semistructured interview study. Transcripts were thematically analysed. SETTING AND PARTICIPANTS 30 nephrologists across 11 countries including Australia, the USA, the UK, Hong Kong, Canada, Singapore, Japan, New Zealand, Thailand, Colombia and Uruguay were interviewed from April 2017 to November 2019. RESULTS We identified four themes: defining patient suitability (confidence in capacity for self-management, ensuring clinical stability and expected resilience), building endurance (facilitating access to practical support, improving mental well-being, optimising quality of care and training to reduce risk of complications), establishing rapport through effective communications (managing expectations to enhance trust, individualising care and harnessing a multidisciplinary approach) and confronting fear and acknowledging barriers to haemodialysis (preventing crash landing to haemodialysis, facing concerns of losing independence and positive framing of haemodialysis). CONCLUSION Nephrologists reported that technique survival in PD is influenced by patients' medical circumstances, psychological motivation and positively influenced by the education and support provided by treating clinicians and families. Strategies to enhance patients' knowledge on PD and communication with patients about technique survival in PD are needed to build trust, set patient expectations of treatment and improve the process of transition off PD.
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Affiliation(s)
- Benedicta Yudianto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jenny Shen
- The Lundquist Institute, Harbor-UCLA Medical Centre, Torrance, California, USA
| | - Yeoungjee Cho
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Edwina Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK
| | - Jie Dong
- Department of Medicine, Peking University First Hospital, Beijing, People's Republic of China
| | - Tony Dunning
- South Bank TAFE, Brisbane, Queensland, Australia
| | - Rajnish Mehrotra
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Saraladevi Naicker
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Martin Wilkie
- Department of Nephrology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia
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16
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Trionfetti F, Montaldo C, Caiello I, Bontempi G, Terri M, Tiberi M, Marchant V, Domenici A, Menè P, Cordani M, Zwergel C, Prencipe G, Ruiz-Ortega M, Valente S, Mai A, Tripodi M, Strippoli R. Mechanisms of mesothelial cell response to viral infections: HDAC1-3 inhibition blocks poly(I:C)-induced type I interferon response and modulates the mesenchymal/inflammatory phenotype. Front Cell Infect Microbiol 2024; 14:1308362. [PMID: 38476167 PMCID: PMC10927979 DOI: 10.3389/fcimb.2024.1308362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/24/2024] [Indexed: 03/14/2024] Open
Abstract
Infectious peritonitis is a leading cause of peritoneal functional impairment and a primary factor for therapy discontinuation in peritoneal dialysis (PD) patients. Although bacterial infections are a common cause of peritonitis episodes, emerging evidence suggests a role for viral pathogens. Toll-like receptors (TLRs) specifically recognize conserved pathogen-associated molecular patterns (PAMPs) from bacteria, viruses, and fungi, thereby orchestrating the ensuing inflammatory/immune responses. Among TLRs, TLR3 recognizes viral dsRNA and triggers antiviral response cascades upon activation. Epigenetic regulation, mediated by histone deacetylase (HDAC), has been demonstrated to control several cellular functions in response to various extracellular stimuli. Employing epigenetic target modulators, such as epidrugs, is a current therapeutic option in several cancers and holds promise in treating viral diseases. This study aims to elucidate the impact of TLR3 stimulation on the plasticity of human mesothelial cells (MCs) in PD patients and to investigate the effects of HDAC1-3 inhibition. Treatment of MCs from PD patients with the TLR3 agonist polyinosinic:polycytidylic acid (Poly(I:C)), led to the acquisition of a bona fide mesothelial-to-mesenchymal transition (MMT) characterized by the upregulation of mesenchymal genes and loss of epithelial-like features. Moreover, Poly(I:C) modulated the expression of several inflammatory cytokines and chemokines. A quantitative proteomic analysis of MCs treated with MS-275, an HDAC1-3 inhibitor, unveiled altered expression of several proteins, including inflammatory cytokines/chemokines and interferon-stimulated genes (ISGs). Treatment with MS-275 facilitated MMT reversal and inhibited the interferon signature, which was associated with reduced STAT1 phosphorylation. However, the modulation of inflammatory cytokine/chemokine production was not univocal, as IL-6 and CXCL8 were augmented while TNF-α and CXCL10 were decreased. Collectively, our findings underline the significance of viral infections in acquiring a mesenchymal-like phenotype by MCs and the potential consequences of virus-associated peritonitis episodes for PD patients. The observed promotion of MMT reversal and interferon response inhibition by an HDAC1-3 inhibitor, albeit without a general impact on inflammatory cytokine production, has translational implications deserving further analysis.
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Affiliation(s)
- Flavia Trionfetti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Claudia Montaldo
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Ivan Caiello
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Giulio Bontempi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Michela Terri
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Marta Tiberi
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Vanessa Marchant
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
- 15 REDINREN/RICORS2040, Madrid, Spain
| | - Alessandro Domenici
- Renal Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Paolo Menè
- Renal Unit, Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Cordani
- Department of Biochemistry and Molecular Biology, Faculty of Biology, Complutense University of Madrid, Madrid, Spain
- Instituto de Investigaciones Sanitarias San Carlos (IdISSC), Madrid, Spain
| | - Clemens Zwergel
- Department of Drug Chemistry and Technologies, Sapienza University of Rome, Rome, Italy
| | - Giusi Prencipe
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Marta Ruiz-Ortega
- Cellular Biology in Renal Diseases Laboratory, IIS-Fundación Jiménez Díaz-Universidad Autónoma Madrid, Madrid, Spain
- 15 REDINREN/RICORS2040, Madrid, Spain
| | - Sergio Valente
- Department of Drug Chemistry and Technologies, Sapienza University of Rome, Rome, Italy
| | - Antonello Mai
- Department of Drug Chemistry and Technologies, Sapienza University of Rome, Rome, Italy
| | - Marco Tripodi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
| | - Raffaele Strippoli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- Gene Expression Laboratory, National Institute for Infectious Diseases, Lazzaro Spallanzani IRCCS, Rome, Italy
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17
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Giles HE, Parameswaran V, Lasky R, Ficociello LH, Mullon C, Chatoth DK, Kraus M, Anger MS. Trends in Automated Peritoneal Dialysis Prescriptions in a Large Dialysis Organization in the United States. Clin J Am Soc Nephrol 2024:01277230-990000000-00357. [PMID: 38373051 DOI: 10.2215/cjn.0000000000000436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Abstract
Key Points
This is the largest analysis of incident automated peritoneal dialysis (PD) prescriptions conducted in the United States to date.There was limited variability of automated PD prescriptions across the first 4 months of therapy.PD prescriptions tailored to meet the dialysis needs and lifestyle of patients may make PD a more attractive choice and increase longevity on PD.
Background
Changes in health care policies and recognition of patient benefit have contributed to increases in home-based dialysis, including peritoneal dialysis (PD). Frequent monitoring and early individualization of PD prescriptions are key prerequisites for the delivery of high-quality PD. The present analysis aimed to assess variations in PD prescriptions among incident automated PD (APD) patients who remain on PD for 120+ days.
Methods
This retrospective analysis examined data from patients within a large dialysis organization that initiated PD with APD between 2015 and 2019. PD prescription data were described by calendar year, timing of PD, and residual renal function categories. Changes in prescriptions from PD initiation (day 1) to day 120 were assessed descriptively.
Results
The cohort included 11,659 patients. The mean age at PD initiation increased from 2015 (56 [15] years) through 2019 (58 [15] years), whereas most other variables demonstrated no clear temporal change. Most patients (86%) had nighttime PD prescribed, with an average of 4.9 (1.3) cycles per day, a mean total treatment volume of 9.3 (2.5) L, and a median daily total dwell time of 7 (6–9.5) hours. Relative to day 1 nighttime prescriptions, there were (1) small increases in the proportion of patients receiving three or fewer cycles per day and those receiving 6+ cycles per day, (2) a 100 ml mean increase in fill volume per exchange, and (3) a mean 0.5 L increase in total nighttime treatment volume at day 120. When changes in nighttime APD prescriptions were examined at the patient level, 49% of patients had day 120 prescriptions that were unchanged from their initial prescription.
Conclusions
In the largest analysis of incident APD prescriptions conducted in the United States to date, most patients were prescribed nocturnal PD only with limited variability across the first 4 months of therapy.
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Affiliation(s)
- Harold E Giles
- Nephrology Associates PC, Birmingham, Alabama
- Fresenius Medical Care Birmingham Home Clinic, Birmingham, Alabama
| | | | - Rachel Lasky
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | | | - Claudy Mullon
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | - Dinesh K Chatoth
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | - Michael Kraus
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
| | - Michael S Anger
- Fresenius Medical Care, Global Medical Office, Waltham, Massachusetts
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18
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Li X, Fan C, Wang C, Zhang Y, Niu L. Non-linear relationship between baseline fasting blood glucose and mortality in peritoneal dialysis patients, a retrospective cohort study. Front Med (Lausanne) 2024; 11:1325914. [PMID: 38435391 PMCID: PMC10904652 DOI: 10.3389/fmed.2024.1325914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 01/31/2024] [Indexed: 03/05/2024] Open
Abstract
Background The relationship between baseline fasting blood glucose (bFBG) and mortality in peritoneal dialysis (PD) patients has been the subject of debate, with limited exploration of the non-linear relationship between bFBG and death in these patients. Methods This retrospective study categorized patients into four groups based on their bFBG using quartiles. Baseline clinical data at the initiation of dialysis were compared. Survival curves were plotted, and subgroup analyses were stratified by relevant covariates. To address the non-linear relationship, curve fitting and a threshold effect analysis were performed. Results The study included 379 PD patients with a median follow-up of 41.8 (22.6, 60.1) months. The COX proportional hazards model showed an association between bFBG and the risk of death after adjusting for confounding factors [hazard ratio (HR): 1.22, 95% CI: 1.05-1.41, P = 0.009]. Stratified analyses indicated a stable correlation between bFBG and mortality. The Kaplan-Meier curve analysis revealed significant differences in survival rates among different groups based on bFBG levels (P < 0.01). The curve fitting analysis revealed a U-shaped relationship between bFBG and mortality, with an inflection point at approximately 5.1 mmol/L. Conclusion Our study has demonstrated a non-linear relationship between bFBG and mortality in PD patients. Additionally, we have found that the optimal bFBG value associated with the lowest risk of mortality is approximately 5.1 mmol/L.
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Affiliation(s)
- Xiang Li
- Department of Nephrology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chengjuan Fan
- Department of Nephrology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chen Wang
- Department of Nephrology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yiming Zhang
- Department of Nephrology, Affiliated Hospital of Jining Medical University, Jining, China
| | - Lingling Niu
- Department of Gastroenterology, Affiliated Hospital of Jining Medical University, Jining, China
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19
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Cheng L, Hu N, Song D, Chen Y. Mortality of Peritoneal Dialysis versus Hemodialysis in Older Adults: An Updated Systematic Review and Meta-Analysis. Gerontology 2024; 70:461-478. [PMID: 38325351 PMCID: PMC11098023 DOI: 10.1159/000536648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/27/2024] [Indexed: 02/09/2024] Open
Abstract
INTRODUCTION The optimal choice of dialysis modality remains contentious in older adults threatened by advanced age and high risk of comorbidities. METHODS We conducted a systematic review and meta-analysis of cohort and case-control studies to assess mortality risk between peritoneal dialysis (PD) and hemodialysis (HD) in older adults using PubMed, Embase, and the Cochrane Library database from inception to June 1, 2022. The outcome of interest is all-cause mortality. RESULTS Thirty-one eligible studies with >774,000 older patients were included. Pooled analysis showed that PD had a higher mortality rate than HD in older dialysis population (HR 1.17, 95% CI: 1.10-1.25). When stratified by co-variables, our study showed an increased mortality risk of PD versus HD in older patients with diabetes mellitus or comorbidity who underwent longer dialysis duration (more than 3 years) or who started dialysis before 2010. However, definitive conclusions were constrained by significant heterogeneity. CONCLUSION From the survival point of view, caution is needed to employ PD for long-term use in older populations with diabetes mellitus or comorbid conditions. However, a tailored treatment choice needs to take account of what matters to older adults at an individual level, especially in the context of limited survival improvements and loss of quality of life. Further research is still awaited to conclude this topic.
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Affiliation(s)
- Linan Cheng
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Nan Hu
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Di Song
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
| | - Yuqing Chen
- Renal Division, Peking University First Hospital, Beijing, China
- Institute of Nephrology, Peking University, Beijing, China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China
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20
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Hamdan Z, Abdel-Hafez Y, Enaya A, Sarsour A, Kharraz L, Nazzal Z. Dapagliflozin in peritoneal dialysis patients: a pilot study evaluating peritoneal membrane function. BMC Nephrol 2024; 25:37. [PMID: 38279109 PMCID: PMC10811926 DOI: 10.1186/s12882-023-03429-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/06/2023] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND Patients taking SGLT-2 inhibitors may experience delayed peritoneal fibrosis, better ultrafiltration of water and toxins, and higher survival rates. We aimed to evaluate the possible effects of Dapagliflozin in changing the peritoneal solute transfer rate, reducing peritoneal glucose absorption, and, hence, increasing ultrafiltration. METHODOLOGY A pilot pre-post interventional study was used to evaluate 20 patients on continuous ambulatory peritoneal dialysis (CAPD) enrolled in a one-month self-controlled study [Trial#: NCT04923295]. Inclusion criteria included being over 18, and having a Peritoneal Dialysis (PD) vintage of at least six months. All participants were classified as having high or average high transport status based on their Peritoneal Equilibrium Test with a D0/D4 > 0.39. and using at least two exchanges with 2.35% dextrose over the previous three months before enrollment. RESULTS Following the treatment, 13 patients had an increase in median D4/D0 from 0.26 [0.17-0.38] to 0.31 [0.23-0.40], while seven patients had a decline from 0.28 [0.17-0.38] to 0.23 [0.14-0.33]. Additionally, nine patients had a decrease in median D/P from 0.88 [0.67-0.92] to 0.81 [0.54-0.85], while 11 patients had an increase from 0.70 [0.6-0.83] to 0.76 [0.63-0.91]. CONCLUSION According to the findings of this study, Dapagliflozin usage in peritoneal dialysis patients did not result in a reduction in glucose absorption across the peritoneal membrane. Additionally, Dapagliflozin was also associated with a small increase in sodium dip, a decrease in peritoneal VEGF, and a decrease in systemic IL-6 levels all of which were not statistically significant. Further large-scale studies are required to corroborate these conclusions.
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Affiliation(s)
- Zakaria Hamdan
- Internal Medicine Department, An-Najah National University Hospital, Box 7, Nablus, 707, Palestine.
| | | | - Ahmad Enaya
- Internal Medicine Department, An-Najah National University Hospital, Box 7, Nablus, 707, Palestine
| | - Alaa Sarsour
- Kidney and Dialysis Section, An-Najah National University Hospital, Nablus, Palestine
| | - Lubna Kharraz
- Pathology and Medical Laboratory Sciences, An-Najah National University, Nablus, Palestine
| | - Zaher Nazzal
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Box 7, Nablus, 707, Palestine.
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21
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Zang Z, Xu Q, Zhou X, Ma N, Pu L, Tang Y, Li Z. Random forest can accurately predict the technique failure of peritoneal dialysis associated peritonitis patients. Front Med (Lausanne) 2024; 10:1335232. [PMID: 38298506 PMCID: PMC10829598 DOI: 10.3389/fmed.2023.1335232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024] Open
Abstract
Instructions Peritoneal dialysis associated peritonitis (PDAP) is a major cause of technique failure in peritoneal dialysis (PD) patients. The purpose of this study is to construct risk prediction models by multiple machine learning (ML) algorithms and select the best one to predict technique failure in PDAP patients accurately. Methods This retrospective cohort study included maintenance PD patients in our center from January 1, 2010 to December 31, 2021. The risk prediction models for technique failure were constructed based on five ML algorithms: random forest (RF), the least absolute shrinkage and selection operator (LASSO), decision tree, k nearest neighbor (KNN), and logistic regression (LR). The internal validation was conducted in the test cohort. Results Five hundred and eight episodes of peritonitis were included in this study. The technique failure accounted for 26.38%, and the mortality rate was 4.53%. There were resignificant statistical differences between technique failure group and technique survival group in multiple baseline characteristics. The RF prediction model is the best able to predict the technique failure in PDAP patients, with the accuracy of 93.70% and area under curve (AUC) of 0.916. The sensitivity and specificity of this model was 96.67 and 86.49%, respectively. Conclusion RF prediction model could accurately predict the technique failure of PDAP patients, which demonstrated excellent predictive performance and may assist in clinical decision making.
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Affiliation(s)
- Zhiyun Zang
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Qijiang Xu
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
- Department of Nephrology, Yibin Second People's Hospital, Yibin, China
| | - Xueli Zhou
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Niya Ma
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Li Pu
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Yi Tang
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
| | - Zi Li
- Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China
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22
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Yang J, Wan J, Feng L, Hou S, Yv K, Xu L, Chen K. Machine learning algorithms for the prediction of adverse prognosis in patients undergoing peritoneal dialysis. BMC Med Inform Decis Mak 2024; 24:8. [PMID: 38166909 PMCID: PMC10763100 DOI: 10.1186/s12911-023-02412-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND An appropriate prediction model for adverse prognosis before peritoneal dialysis (PD) is lacking. Thus, we retrospectively analysed patients who underwent PD to construct a predictive model for adverse prognoses using machine learning (ML). METHODS A retrospective analysis was conducted on 873 patients who underwent PD from August 2007 to December 2020. A total of 824 patients who met the inclusion criteria were included in the analysis. Five commonly used ML algorithms were used for the initial model training. By using the area under the curve (AUC) and accuracy (ACC), we ranked the indicators with the highest impact and displayed them using the values of Shapley additive explanation (SHAP) version 0.41.0. The top 20 indicators were selected to build a compact model that is conducive to clinical application. All model-building steps were implemented in Python 3.8.3. RESULTS At the end of follow-up, 353 patients withdrew from PD (converted to haemodialysis or died), and 471 patients continued receiving PD. In the complete model, the categorical boosting classifier (CatBoost) model exhibited the strongest performance (AUC = 0.80, 95% confidence interval [CI] = 0.76-0.83; ACC: 0.78, 95% CI = 0.72-0.83) and was selected for subsequent analysis. We reconstructed a compression model by extracting 20 key features ranked by the SHAP values, and the CatBoost model still showed the strongest performance (AUC = 0.79, ACC = 0.74). CONCLUSIONS The CatBoost model, which was built using the intelligent analysis technology of ML, demonstrated the best predictive performance. Therefore, our developed prediction model has potential value in patient screening before PD and hierarchical management after PD.
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Affiliation(s)
- Jie Yang
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Jingfang Wan
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Lei Feng
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
- Teaching Office, Medical Research Department, Army Special Medical Center, Chongqing, China
| | - Shihui Hou
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Kaizhen Yv
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China
| | - Liang Xu
- Department of Medical Engineering, The Second Affiliated Hospital of the Army Medical University, Chongqing, 400037, China.
| | - Kehong Chen
- Department of Nephrology, Daping Hospital, Army Medical University, Chongqing, 400042, China.
- State Key Laboratory of Trauma, Burns and Combined Injury, Wound Trauma Medical Center, Army Medical University, Chongqing, China.
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23
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Liu T, Wang Y. The influence of different peritoneal dialysis techniques on wound infection in patients with peritoneal dialysis tube. Int Wound J 2024; 21:e14352. [PMID: 37622537 PMCID: PMC10781592 DOI: 10.1111/iwj.14352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023] Open
Abstract
More and more research has started to investigate the effect of peritoneal dialysis treatment on the incidence of pericatheter wound complications in chronic kidney disease (CKD). This meta-study evaluated the effect of emergency peritoneal dialysis (EPD) with conventional peritoneal dialysis (CPD) in patients with catheter-related complications. We looked up 4 databases: PubMed, EMBASE, Cochrane, and Web of Science, and analysed the data with RevMan 5. There were a total of 15 studies with 3034 participants. While the quality of the research included was fairly good, the evidence was mediocre. In the meta-analyses, the risk of leak in the conduit with PD was very high (OR, 2.48; 95% CI, 1.72, 3.59, p < 0.00001). However, for those treated with urgent medical method prior to initiation of PD, the risk for peritonitis, catheter dysfunction and bleeding was similar compared with CPD. Based on limited information, immediate initiation of PDs is advised in order to increase the quality of life for people in urgent need, except if there is no consideration for loss of fluid. The low quality of the evidence is holding up the evidence. This research, however, is also informative because of the large number of available data. Consequently, additional high quality, large, randomized controlled studies are required to establish.
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Affiliation(s)
- Ting Liu
- Department of General PracticeThe Second Hospital of Dalian Medical UniversityDalianChina
| | - Yuan Wang
- Department of NephrologyThe Second Hospital of Dalian Medical UniversityDalianChina
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24
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Kayes M, Potter D, Wong J, Spicer T. Peritoneal dialysis-associated peritonitis with Elizabethkingia miricola. BMJ Case Rep 2023; 16:e255491. [PMID: 38081734 PMCID: PMC10729244 DOI: 10.1136/bcr-2023-255491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Peritoneal dialysis (PD)-associated peritonitis is linked to increased mortality rates and transfer to haemodialysis or PD discontinuation. Rare and emerging pathogens can pose challenges in management. We present the first case of PD peritonitis caused by Elizabethkingia miricola through direct contamination, which was successfully treated with intraperitoneal and oral antibiotics.
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Affiliation(s)
- Masnun Kayes
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Daniela Potter
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Jeffrey Wong
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Tim Spicer
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Renal Medicine, Liverpool Hospital, Liverpool, New South Wales, Australia
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25
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Zhou D, Yang H, Zeng L, Yang W, Guo F, Cui W, Chen C, Zhao J, Wu S, Yang N, Lin H, Yin A, Li L. Calculated inflammatory markers derived from complete blood count results, along with routine laboratory and clinical data, predict treatment failure of acute peritonitis in chronic peritoneal dialysis patients. Ren Fail 2023; 45:2179856. [PMID: 36908218 PMCID: PMC10013372 DOI: 10.1080/0886022x.2023.2179856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND & AIMS Complete blood count (CBC)-derived inflammatory markers are predictive biomarkers for the prognosis of many diseases. However, there was no study on patients with peritoneal dialysis-associated peritonitis (PDAP). We aimed to investigate the value of these markers in predicting treatment failure of acute peritonitis in chronic PD patients. METHODS The records of 138 peritonitis episodes were reviewed and divided into treatment success or failure groups in a single center for 10 years. CBC-derived markers and other routine data were recorded before peritonitis treatment was initiated. Univariate and multivariate regression analyses and the receiver operating characteristic (ROC) curve about the predictors of treatment outcomes were performed. RESULTS Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and derived NLR were significantly higher in the failure group. Univariate logistic regression results showed that NLR and PLR were risk factors of treatment outcomes. The backward stepwise multivariate logistic regression results demonstrated that NLR [adjusted odds ratio (aOR), 1.376; 95% confidence intervals (CI), 1.105-1.713; p = .004], PLR (aOR, 1.010; 95%CI, 1.004-1.017; p = .002) were risk factors, but hemoglobin-to-lymphocyte ratio (HLR) (aOR, 0.977; 95%CI, 0.963-0.991; p = .001), and SII (aOR, 0.999; 95%CI, 0.998-1.000; p = .040) were protective factors. A combination of age, PD vintage, Gram-positive peritonitis, staphylococcus aureus, culture-negative, NLR, PLR, HLR, and SII would improve prognostic performance. The area under this ROC curve was 0.85, higher than other factors. CONCLUSIONS NLR, PLR, HLR, and SII were associated with PDAP outcomes. Age, PD vintage, NLR, and PLR were significant risk factors in PDAP patients.
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Affiliation(s)
- Dan Zhou
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China.,College of Integrative Medicine, Dalian Medical University, Dalian, China.,Graduate School, Dalian Medical University, Dalian, China
| | - Huibin Yang
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Li Zeng
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Wei Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Fujia Guo
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Wenting Cui
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Cong Chen
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Jiayao Zhao
- First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Shuran Wu
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Ning Yang
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongli Lin
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Anchun Yin
- College of Integrative Medicine, Dalian Medical University, Dalian, China.,Graduate School, Dalian Medical University, Dalian, China.,First Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Longkai Li
- Department of Nephrology, Liaoning Translational Medicine Center of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Deng J, Tang X, Tang R, Chen J, Guo H, Zhou Q, Zhan X, Long H, Peng F, Wang X, Wen Y, Feng X, Su N, Tian N, Wu X, Xu Q. Atherogenic index predicts all-cause and cardiovascular mortality in incident peritoneal dialysis patients. Atherosclerosis 2023; 387:117389. [PMID: 38011764 DOI: 10.1016/j.atherosclerosis.2023.117389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 10/06/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND AND AIMS Atherosclerosis, the main cause of cardiovascular disease (CVD), is prevalent in patients undergoing peritoneal dialysis (PD). Atherogenic index (AI) is a strong predictor of atherosclerosis. However, its prognostic value in CVD outcomes and all-cause mortality among patients undergoing PD remains uncertain. Therefore, we aimed to evaluate the association between AI and all-cause and CVD mortality in PD patients. METHODS Calculated based on lipid profiles obtained through standard laboratory procedures, AI was evaluated in 2682 patients who underwent PD therapy between January 2006 and December 2017 and were followed up until December 2018. The study population was divided into four groups according to the quartile distribution of AI (Q1: <2.20, Q2: 2.20 to <2.97, Q3: 2.97 to <4.04, and Q4: ≥4.04). Multivariable Cox models were employed to explore the associations between AI and CVD and all-cause mortality was evaluated. RESULTS During a median follow-up of 35.5 months (interquartile range, 20.9-57.2 months), 800 patients died, including 416 deaths from CVD. Restricted cubic splines showed non-linear relationship between AI and adverse clinical outcomes. The risks of all-cause and CVD mortality gradually increased across quartiles (log-rank, p < 0.001). After adjusting for potential confounders, the highest quartile (Q4) showed significantly elevated hazard ratio (HR) for both all-cause mortality (HR 1.54 [95% confidence interval (CI), 1.21-1.96]) and CVD mortality risk (HR 1.78 [95% CI, 1.26-2.52]), compared to the lowest quartile (Q1). CONCLUSIONS AI was independently associated with all-cause and CVD mortality in patients undergoing PD, suggesting that AI might be a useful prognostic marker.
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Affiliation(s)
- Jihong Deng
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen, China
| | - Xingming Tang
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, DongGuan, China
| | - Ruiying Tang
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen, China
| | - Jiexin Chen
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen, China
| | - Huankai Guo
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen Univeristy, Guangzhou, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haibo Long
- Department of Nephrology, Zhujiang Hospital, Southern Medical University Guangzhou, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital, Southern Medical University Guangzhou, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou Univeristy, ZhengZhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang NO.1 People's Hospital, Jiujiang, China
| | - Ning Su
- Department of Hematology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People's Hospital, Shanghai Jiao Tong Univeristy, Shanghai, China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen, China.
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27
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Meyer TW, Bargman JM. The Removal of Uremic Solutes by Peritoneal Dialysis. J Am Soc Nephrol 2023; 34:1919-1927. [PMID: 37553867 PMCID: PMC10703087 DOI: 10.1681/asn.0000000000000211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/24/2023] [Indexed: 08/10/2023] Open
Abstract
ABSTRACT Peritoneal dialysis (PD) is now commonly prescribed to achieve target clearances for urea or creatinine. The International Society for Peritoneal Dialysis has proposed however that such targets should no longer be imposed. The Society's new guidelines suggest rather that the PD prescription should be adjusted to achieve well-being in individual patients. The relaxation of treatment targets could allow increased use of PD. Measurement of solute levels in patients receiving dialysis individualized to relieve uremic symptoms could also help us identify the solutes responsible for those symptoms and then devise new means to limit their accumulation. This possibility has prompted us to review the extent to which different uremic solutes are removed by PD.
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Affiliation(s)
- Timothy W. Meyer
- Departments of Medicine, Stanford University and VA Palo Alto HCS, Palo Alto, California
| | - Joanne M. Bargman
- Division of Nephrology and Department of Medicine, University Health Network and the University of Toronto, Canada
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Sheng YP, Ma XY, Liu Y, Yang XM, Sun FY. Independent risk factors for depression in older adult patients receiving peritoneal dialysis for chronic kidney disease. World J Psychiatry 2023; 13:884-892. [DOI: 10.5498/wjp.v13.i11.884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/22/2023] [Accepted: 10/11/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND According to the trend of global population aging, the proportion of elderly patients with chronic kidney disease (CKD) is expected to increase. However, there are more than 20 million people in China with decompensated kidney function, of which 19.25% are elderly people. Therefore, special attention should be paid to the education years, sleep quality, anxiety status, comorbidities with diabetes, cardiovascular disease (CVD), and anemia as independent risk factors for depression in elderly CKD patients. This study explores the clinical mana-gement of elderly CKD patients that should address these risk factors to prevent depression and improve their prognosis.
AIM To investigate depression risk factors in older patients receiving peritoneal dialysis, aiding future prevention of depression in these patients.
METHODS This retrospective study included a primary study population of 170 patients with CKD who received peritoneal dialysis from January 2020 to December 2022. We assessed the patients’ mental status using the Beck Depression Inventory Score-II (BDI-II), Self-Rating Anxiety Scale (SAS), Anxiety Inventory Score, and the Pittsburgh Sleep Quality Index (PSQI). Logistic regression was employed to identify depression independent risk factors among these patients.
RESULTS The non-depressed group had a significantly longer education period than the depressed group (P < 0.05). The depressed group exhibited significantly higher mental status scores than the non-depressed group (P < 0.001). Patients with diabetes mellitus (DM) or CVD had a higher probability of developing dep-ression. Patients with depression had significantly lower hemoglobin and albumin levels than patients without depression (P < 0.05). Spearman correlation analysis of BDI-II scale scores, measuring depression, indicated positive correlations with BDI-II and SAS scores as risk factors for depression in patients with CKD. In contrast, years of education, hemoglobin levels, and peritoneal Kt/V were negatively correlated, serving as protective factors against depression. An analysis of variance for influences with significant differences in the univariate analysis revealed that years of schooling, BDI-II, SAS, PSQI, DM, CVD, and hemoglobin levels independently influenced depression in older patients with CKD.
CONCLUSION Education, BDI-II, SAS, PSQI, DM, and CVD are independent risk factors for depression in older patients with CKD; therefore, post-treatment psychological monitoring of high-risk patients is crucial to prevent depression.
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Affiliation(s)
- Yu-Ping Sheng
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Xiao-Ying Ma
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Ye Liu
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Xing-Meng Yang
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
| | - Fu-Yun Sun
- Department of Nephrology, Cangzhou Central Hospital, Cangzhou 061000, Hebei Province, China
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Chow JSF, Boudville N, Cho Y, Palmer S, Pascoe EM, Hawley CM, Reidlinger DM, Hickey LE, Stastny R, Valks A, Vergara L, Movva R, Kiriwandeniya C, Candler H, Mihala G, Buisman B, Equinox KL, Figueiredo AE, Fuge T, Howard K, Howell M, Jaure A, Jose MD, Lee A, Miguel SS, Moodie JA, Nguyen TT, Pinlac G, Reynolds A, Saweirs WWM, Steiner-Lim GZ, TeWhare B, Tomlins M, Upjohn M, Voss D, Walker RC, Wilson J, Johnson DW. Multi-center, pragmatic, cluster-randomized, controlled trial of standardized peritoneal dialysis (PD) training versus usual care on PD-related infections (the TEACH-PD trial): trial protocol. Trials 2023; 24:730. [PMID: 37964367 PMCID: PMC10647147 DOI: 10.1186/s13063-023-07715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/07/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Peritoneal dialysis (PD)-related infections, such as peritonitis, exit site, and tunnel infections, substantially impair the sustainability of PD. Accordingly, PD-related infection is the top-priority research outcome for patients and caregivers. While PD nurse trainers teach patients to perform their own PD, PD training curricula are not standardized or informed by an evidentiary base and may offer a potential approach to prevent PD infections. The Targeted Education ApproaCH to improve Peritoneal Dialysis outcomes (TEACH-PD) trial evaluates whether a standardized training curriculum for PD nurse trainers and incident PD patients based on the International Society for Peritoneal Dialysis (ISPD) guidelines reduces PD-related infections compared to usual training practices. METHODS The TEACH-PD trial is a registry-based, pragmatic, open-label, multi-center, binational, cluster-randomized controlled trial. TEACH-PD will recruit adults aged 18 years or older who have not previously undergone PD training at 42 PD treatment units (clusters) in Australia and New Zealand (ANZ) between July 2019 and June 2023. Clusters will be randomized 1:1 to standardized TEACH-PD training curriculum or usual training practice. The primary trial outcome is the time to the first occurrence of any PD-related infection (exit site infection, tunnel infection, or peritonitis). The secondary trial outcomes are the individual components of the primary outcome, infection-associated catheter removal, transfer to hemodialysis (greater than 30 days and 180 days), quality of life, hospitalization, all-cause death, a composite of transfer to hemodialysis or all-cause death, and cost-effectiveness. Participants are followed for a minimum of 12 months with a targeted average follow-up period of 2 years. Participant and outcome data are collected from the ANZ Dialysis and Transplant Registry (ANZDATA) and the New Zealand Peritoneal Dialysis (NZPD) Registry. This protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. DISCUSSION TEACH-PD is a registry-based, cluster-randomized pragmatic trial that aims to provide high-certainty evidence about whether an ISPD guideline-informed standardized PD training curriculum for PD nurse trainers and adult patients prevents PD-related infections. TRIAL REGISTRATION ClinicalTrials.gov NCT03816111. Registered on 24 January 2019.
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Affiliation(s)
- Josephine S F Chow
- South Western Sydney Local Health District, Liverpool, NSW, Australia.
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia.
- University of New South Wales, Kennington, NSW, Australia.
- Western Sydney University, Sydney, NSW, Australia.
- University of Tasmania, Hobart, TAS, Australia.
| | - Neil Boudville
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Yeoungjee Cho
- Department of Kidney and Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago, Christchurch, New Zealand
- Te Whatu Ora Health New Zealand, Hamilton, New Zealand
| | - Elaine M Pascoe
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Carmel M Hawley
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
- Translational Research Institute, Brisbane, QLD, Australia
- Metro South Kidney and Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Donna M Reidlinger
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Laura E Hickey
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth Stastny
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Andrea Valks
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Liza Vergara
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ramya Movva
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Charani Kiriwandeniya
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Hayley Candler
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Gabor Mihala
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Bernadette Buisman
- Health New Zealand, Te Whatu Ora Te Tai Tokerau, Hamilton, New Zealand
- University of Auckland, Te Tai Tokerau Northtec, Auckland, New Zealand
| | | | - Ana E Figueiredo
- School of Nursing, Escola de Ciências da Saúde E da Vida, Pontifícia Universidade Católica Do Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Martin Howell
- Menzies Centre for Health Policy and Economics, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Allison Jaure
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Matthew D Jose
- University of Tasmania, Hobart, TAS, Australia
- Renal Unit, Royal Hobart Hospital, Hobart, TAS, Australia
| | | | - Susana S Miguel
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | | | - Thu T Nguyen
- Health New Zealand, Te Whatu Ora Te Toka Tumai, Hamilton, New Zealand
| | - Geraldine Pinlac
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Annie Reynolds
- Health New Zealand, Te Whatu Ora Te Matua a Māui Hawkes Bay, Hamilton, New Zealand
| | - Walaa W M Saweirs
- Health New Zealand, Te Whatu Ora Te Tai Tokerau, Hamilton, New Zealand
| | - Genevieve Z Steiner-Lim
- NICM Health Research Institute, Western Sydney University Sydney, Campbelltown, NSW, Australia
| | - Bronwen TeWhare
- Health New Zealand, Te Whatu Ora Taranaki, Hamilton, New Zealand
| | - Melinda Tomlins
- Department of Nephrology, Hunter New England Local Health District, New Lambton, NSW, Australia
| | - Megan Upjohn
- Health New Zealand, Te Whatu Ora Te Toka Tumai, Hamilton, New Zealand
| | - David Voss
- Health New Zealand, Te Whatu Ora Counties Manukau, Hamilton, New Zealand
| | - Rachael C Walker
- Te Pukenga Eastern Institute of Technology, Christchurch, New Zealand
| | - Joanne Wilson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - David W Johnson
- Department of Kidney and Transplant Service, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Australasian Kidney Trials Network, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
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Zhang Y, Jin Y, Wang H, He L, Zhang Y, Liu Q, Xin Y, Li X. Identification of Genes Associated with Decreasing Abundance of Monocytes in Long-Term Peritoneal Dialysis Patients. Int J Gen Med 2023; 16:5017-5030. [PMID: 37942472 PMCID: PMC10629397 DOI: 10.2147/ijgm.s435041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
Purpose Chronic kidney disease (CKD) will become an end-stage renal disease (ESRD) at stage 5. Peritoneal dialysis (PD) is required for renal replacement therapy. This study aims to identify monocytes-related genes in peritoneal cells from long-term PD (LPD) patients and short-term PD (SPD) patients. Methods Bulk RNA-seq data (GSE125498 dataset) and ScRNA-seq data (GSE130888) were downloaded to identify differentially expressed genes, monocytes-related genes, and monocytes marker genes in LPD patients. Immune infiltration was analyzed in the GSE125498 dataset. Core genes associated with monocytes changes were screened out, followed by functional analysis and expression validation using RT-PCR. Results Monocytes are the most abundant immune cell in PD. The number of monocytes was remarkably decreased in LPD compared with SPD. A total of 16 up-regulated core genes negatively correlated with the abundance of monocytes were obtained in LPD. The expression of 16 core genes was lower in monocyte clusters than that in other cell clusters. In addition, LCK, CD3G, CD3E, CD3D, and LAT were involved in the signaling pathways of Th1 and Th2 cell differentiation, T cell receptor signaling pathway, and Th17 cell differentiation. CD2 was involved in hematopoietic cell lineage signaling pathway. Conclusion Identification of monocytes related-genes and related signaling pathways could be helpful in understanding the molecular mechanism of monocytes changes during PD.
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Affiliation(s)
- Yinghui Zhang
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Yanhua Jin
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Huan Wang
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Long He
- Organ Transplant Center, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Yanning Zhang
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Qi Liu
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Yu Xin
- Department of Nephrology, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
| | - Xueyu Li
- Nursing Department, General Hospital of Northern Theater Command, Shenyang, Liaoning Province, People’s Republic of China
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Heimbürger O, Hegbrant J, Martus G, Wilkie M, De Leon C, Carlsson O, Johansson AC. Effects of Steady Glucose Concentration Peritoneal Dialysis on Ultrafiltration Volume and Sodium Removal: A Pilot Crossover Trial. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00280. [PMID: 37902732 PMCID: PMC10861104 DOI: 10.2215/cjn.0000000000000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/23/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Volume overload is common in patients treated with peritoneal dialysis (PD) and is associated with poor clinical outcome. Steady concentration PD is where a continuous glucose infusion maintains the intraperitoneal glucose concentration and as a result provides continuous ultrafiltration throughout the dwell. The primary objective of this study was to investigate the ultrafiltration rate and glucose ultrafiltration efficiency for steady concentration PD in comparison with a standard continuous ambulatory PD (CAPD) dwell, using the novel Carry Life UF device. METHODS Eight stable patients treated with PD (six fast and two fast average transporters) were investigated four times: a standard 4-hour CAPD dwell with 2 L of 2.5% dextrose solution as control and three 5-hour steady concentration PD treatments (glucose dose 11, 14, 20 g/h, initial fill 1.5 L of 1.5% dextrose solution). All investigations were preceded by an overnight 2 L 7.5% icodextrin dwell. RESULTS Intraperitoneal glucose concentration increased during the first 1-2 hours of the steady concentration PD treatments and remained stable thereafter. Ultrafiltration rates were significantly higher with steady concentration PD treatments (124±49, 146±63, and 168±78 mL/h with 11, 14, and 20 g/h, respectively, versus 40±60 mL/h with the control dwell). Sodium removal and glucose ultrafiltration efficiency (ultrafiltration volume/gram glucose uptake) were significantly higher with steady concentration PD treatments versus the control dwell, where the 11 g/h glucose dose was most efficient. CONCLUSIONS Steady concentration PD performed with the Carry Life UF device resulted in higher ultrafiltration rates, more efficient use of glucose (increased ultrafiltration volume/gram glucose absorbed), and greater sodium removal compared with a standard 2.5% dextrose CAPD dwell. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER A Performance Analysis of the Peritoneal Ultrafiltration (PUF) Achieved With the Carry Life ® UF, NCT03724682 .
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Affiliation(s)
- Olof Heimbürger
- Medical Unit Renal Medicine, Karolinska University Hospital, and CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Jörgen Hegbrant
- Division of Nephrology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Giedre Martus
- Department of Nephrology, Skåne University Hospital, Lund, Sweden
| | - Martin Wilkie
- Sheffield Teaching Hospitals, Sheffield, United Kingdom
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Levai E, Marinovic I, Bartosova M, Zhang C, Schaefer B, Jenei H, Du Z, Drozdz D, Klaus G, Arbeiter K, Romero P, Schwenger V, Schwab C, Szabo AJ, Zarogiannis SG, Schmitt CP. Human peritoneal tight junction, transporter and channel expression in health and kidney failure, and associated solute transport. Sci Rep 2023; 13:17429. [PMID: 37833387 PMCID: PMC10575882 DOI: 10.1038/s41598-023-44466-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023] Open
Abstract
Next to the skin, the peritoneum is the largest human organ, essentially involved in abdominal health and disease states, but information on peritoneal paracellular tight junctions and transcellular channels and transporters relative to peritoneal transmembrane transport is scant. We studied their peritoneal localization and quantity by immunohistochemistry and confocal microscopy in health, in chronic kidney disease (CKD) and on peritoneal dialysis (PD), with the latter allowing for functional characterizations, in a total of 93 individuals (0-75 years). Claudin-1 to -5, and -15, zonula occludens-1, occludin and tricellulin, SGLT1, PiT1/SLC20A1 and ENaC were consistently detected in mesothelial and arteriolar endothelial cells, with age dependent differences for mesothelial claudin-1 and arteriolar claudin-2/3. In CKD mesothelial claudin-1 and arteriolar claudin-2 and -3 were more abundant. Peritonea from PD patients exhibited increased mesothelial and arteriolar claudin-1 and mesothelial claudin-2 abundance and reduced mesothelial and arteriolar claudin-3 and arteriolar ENaC. Transperitoneal creatinine and glucose transport correlated with pore forming arteriolar claudin-2 and mesothelial claudin-4/-15, and creatinine transport with mesothelial sodium/phosphate cotransporter PiT1/SLC20A1. In multivariable analysis, claudin-2 independently predicted the peritoneal transport rates. In conclusion, tight junction, transcellular transporter and channel proteins are consistently expressed in peritoneal mesothelial and endothelial cells with minor variations across age groups, specific modifications by CKD and PD and distinct associations with transperitoneal creatinine and glucose transport rates. The latter deserve experimental studies to demonstrate mechanistic links.Clinical Trial registration: The study was performed according to the Declaration of Helsinki and is registered at www.clinicaltrials.gov (NCT01893710).
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Affiliation(s)
- Eszter Levai
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
- HUNREN SE Pediatrics and Nephrology Research Group, Budapest, Hungary
| | - Iva Marinovic
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Maria Bartosova
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Conghui Zhang
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Betti Schaefer
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Hanna Jenei
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Zhiwei Du
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
| | - Dorota Drozdz
- Jagiellonian University Medical College, Krakow, Poland
| | | | - Klaus Arbeiter
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Philipp Romero
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Vedat Schwenger
- Department of Nephrology, Klinikum der Landeshauptstadt Stuttgart, Stuttgart, Germany
| | | | - Attila J Szabo
- Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary
- HUNREN SE Pediatrics and Nephrology Research Group, Budapest, Hungary
| | - Sotirios G Zarogiannis
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany
- Department of Physiology, Faculty of Medicine, University of Thessaly, Larissa, Greece
| | - Claus Peter Schmitt
- Division of Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120, Heidelberg, Germany.
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Xiang S, Zuo M, Deng Y, Luo X, Dong Q, Chen J, Siu CW, Yin L. Volume markers in left ventricular diastolic dysfunction and adverse outcomes in peritoneal dialysis patients: a prospective cohort study. Sci Rep 2023; 13:16892. [PMID: 37803046 PMCID: PMC10558440 DOI: 10.1038/s41598-023-43442-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023] Open
Abstract
Left ventricular diastolic dysfunction (LVDD) is an early event associated with cardiovascular complications and poor prognosis in chronic kidney disease patients undergoing dialysis. In this study, we investigated whether diastolic dysfunction, measured by the E/E' ratio, affects adverse outcomes in peritoneal dialysis (PD) patients (n = 148). Our results showed that patients with an E/E' ratio ≥ 15 were more likely to be female, have a longer dialysis vintage, have significantly higher left atrial volume index and left atrial kinetic energy levels, have lower E' levels and LV hypertrophy (LVH) degree, and have higher volume markers. Kaplan-Meier curves revealed that patients with a higher E/E' ratio had worse survival and a higher risk of heart failure than those with a lower E/E' ratio. Subgroup analysis demonstrated that non-diabetic patients with a higher E/E' ratio had a higher risk of heart failure than those with a lower E/E' ratio. Cox proportional hazard regression analysis indicated that the ECW/ICW ratio was strongly associated with LVDD and confirmed that the E/E' ratio was an independent risk factor for overall death. Our study suggests that monitoring the E/E' ratio in PD patients is important for improving their prognosis.
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Affiliation(s)
- Shoubo Xiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mingliang Zuo
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yan Deng
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xian Luo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianhua Dong
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jin Chen
- Department of Nephrology, Institute of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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Yang N, Yang K, Pan S, He Q, Jin J. Progress in the application of the neutrophil-to-lymphocyte ratio in dialysis-related complications. Ren Fail 2023; 45:2259996. [PMID: 37791567 PMCID: PMC10552595 DOI: 10.1080/0886022x.2023.2259996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/12/2023] [Indexed: 10/05/2023] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) is a novel predictive biomarker that reflects systemic inflammatory status and is routinely measured in blood tests. Owing to its ease of use and affordability, it is being increasing used as a prognostic indicator of cardiovascular disease, tumors, autoimmune disorders, and kidney disease. In recent years, a number of studies have demonstrated the clinical utility of the NLR in identifying and predicting complications associated with hemodialysis and peritoneal dialysis, including cardiovascular disease and infection. This review aimed to provide a new perspective on the application of the NLR as a valuable tool enabling clinicians to better assess the occurrence and prognosis of complications in patients undergoing dialysis.
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Affiliation(s)
- Nan Yang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Kaibi Yang
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Shujun Pan
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Qiang He
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou, Zhejiang, China
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Zhang Y, He P, He L. Body surface area and treatment failure in peritoneal dialysis-associated peritonitis. Ther Apher Dial 2023; 27:926-936. [PMID: 37381103 DOI: 10.1111/1744-9987.14026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/28/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION This study mainly discussed the relationship between body surface area (BSA) and treatment failure of peritoneal dialysis-associated peritonitis (PDAP). METHODS The exposures were BSA grouped by the tertiles of BSA levels. The association between BSA and the risk of treatment failure in PDAP, defined as the temporary or permanent switch to hemodialysis and kidney transplantation, was evaluated in Cox proportional hazards models. RESULTS A total of 483 episodes in 285 patients were recorded in our center. As a three-level categorical variable, in reference to G3, the G1 of BSA displayed a 4.054-fold increased venture of treatment failure in a fully adjusted model. In sensitivity analysis, a lower value of BSA (G1) was identified as an independent risk factor for peritonitis episodes (odds ratio = 2.433, 95% confidence interval: 1.184-4.999, p = 0.015). CONCLUSION A lower level of body surface area was remarkably associated with a higher incidence of treatment failure among peritoneal dialysis-associated peritonitis episodes.
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Affiliation(s)
- Yuting Zhang
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Peng He
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Lijie He
- Department of Nephrology, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Cuevas-Budhart MA, Trejo-Villeda MA, Cabrera Delgado M, Hernandez-Franco B, Ávila Díaz M, Ramos-Sanchez A, Paniagua R. Remote monitoring as a surveillance method in patients on automated peritoneal dialysis for preventing complications and COVID-19 contagion. J Infect Public Health 2023; 16:1619-1624. [PMID: 37586134 DOI: 10.1016/j.jiph.2023.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/12/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Due to the health emergency of COVID-19, telemedicine has become more relevant. Remote monitoring conspicuous as a valuable tool for the clinical follow-up of kidney patients, in this case, who are treated with automated peritoneal dialysis. This study aims to describe the use of remote monitoring as a surveillance method in a cohort of patients on automated peritoneal dialysis prevent complications and COVID-19 contagion. METHODS Study of a cohort of patients who initially participated in a randomized block clinical trial in which the use of Automated Peritoneal Dialysis with Remote Monitoring (APD-RM) was compared with conventional treatment. A descriptive analysis was performed of the rates of infection by COVID-19, the time of incidence until this, mortality, and rates of transfer to hemodialysis. In addition, survival was measured by survival curves. RESULTS Of the 509 patients, 19 were positive for COVID-19 (incidence rate of 7.0 episodes/100 patient-year), and only six patients recovered from the infection; the death rate was 2.6 % compared to all-cause death of 9.8 %. The most affected group of patients were those over 50 years old, with 71.4 % mortality, in contrast to younger patients infected, with a mortality of 60 %. During the follow-up period, 21 patients were transferred to HD: six due to peritonitis, five due to UF failure, seven due to catheter dysfunction, one due to uremic syndrome, one due to COVID-19, and one by surgical intervention. CONCLUSION APD-RM patients have a significant advantage over other dialysis therapies because the use of telemedicine not only provides continuity in the patient's clinical treatment but also favors the prevention of COVID-19 infection, the management and prevention of complications inherent to therapy and the preservation of the life of Peritoneal Dialysis patients.
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Affiliation(s)
- Miguel A Cuevas-Budhart
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | - Miguel A Trejo-Villeda
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | | | - Beatriz Hernandez-Franco
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | - Marcela Ávila Díaz
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico
| | | | - Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades, Centro Médico Siglo XXI, Instituto del Seguro Social, Mexico City, Mexico.
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Bai Y, Wang L, TingYang, Wang L, Ge W. Silymarin ameliorates peritoneal fibrosis by inhibiting the TGF-β/Smad signaling pathway. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:2379-2391. [PMID: 37052642 DOI: 10.1007/s00210-023-02450-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 02/24/2023] [Indexed: 04/14/2023]
Abstract
Peritoneal dialysis (PD) is the mainstay of treatment for renal failure replacement therapy. Although PD has greatly improved the quality of life of end-stage renal disease (ESRD) patients, long-term PD can lead to ultrafiltration failure, which in turn causes peritoneal fibrosis (PF). Silymarin (SM) is a polyphenolic flavonoid isolated from the milk thistle (Silybum marianum) species that has a variety of pharmacological actions, including antioxidant, anti-inflammatory, antiviral, and anti-fibrotic pharmacological activities. However, the effect of SM on PF and its potential mechanisms have not been clarified. The aim of this study was to investigate the preventive effect of SM on PF in vitro and in vivo as well as elucidate the underlying mechanisms. We established PF mouse models and human pleural mesothelial cell fibrosis in vitro by intraperitoneal injection of high-glucose peritoneal dialysis solution (PDS) or transforming growth factor-β1 (TGF-β1), and evaluated the effect of SM on peritoneal fibrosis in vivo and in vitro. We found that SM alleviated peritoneal dysfunction. Meanwhile, SM inhibited the expression of fibrotic markers (TGF-β1, collagen I, fibronectin) and restored the expression of E-cadherin, BMP-7 in PF mice and TGF-β1-treated Met-5A cells. Furthermore, SM markedly down-regulated the expression of TGF-β1, p-Smad2, and p-Smad3 and up-regulated the expression of smad7. In conclusion, these findings suggested that SM may be an efficient and novel therapy for the prevention of PF through inhibition of TGF-β/Smad signaling.
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Affiliation(s)
- Yingwen Bai
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu Province, China
| | - Lulu Wang
- Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu Province, China
| | - TingYang
- Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu Province, China
| | - Lingyun Wang
- Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, 210023, Jiangsu Province, China
| | - Weihong Ge
- Nanjing Drum Tower Hospital, Nanjing, 210008, Jiangsu Province, China.
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Hong T, Wang X, Li S, Zhai L, Wu N, Yang H, Yao C, Liu H. Association between dialysis effluent leukocyte count after initial antibiotic treatment and outcomes of patients with peritoneal dialysis-associated peritonitis: a retrospective study. Ren Fail 2023; 45:2258990. [PMID: 37737145 PMCID: PMC10519253 DOI: 10.1080/0886022x.2023.2258990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/10/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Among patients with peritoneal dialysis-associated peritonitis (PDAP), It has been regarded as an indicator of deterioration of clinical condition that peritoneal dialysis effluent leukocyte count (PDELC) cannot be restored to normal after initial antibiotic therapy. However, the precise relationship between PDELC on day 5 and the clinical outcomes of PDAP episodes remains uncertain. AIMS To explore the association between PDELC on day 5 and clinical outcomes of PDAP episodes. METHODS This retrospective study was based on the medical chart database of the Affiliated Hospital of Guangdong Medical University. Multivariable regressions were used to evaluate the association between PDELC on day 5 and 60-day mortality, half-year mortality, treatment failure, and the length of stay in hospital with adjustment for confounding factors. RESULTS A total of 549 PDAP episodes in 309 patients were enrolled. The total 60-day mortality, half-year mortality, and rate of treatment failure was 6.0%, 9.8%, and 14.2%, respectively. Compared with patients with normal PDELC, those with PDELC ≥2000 × 106/L on day 5 had significantly higher 60-day mortality (31.1% vs 2.7%), half-year mortality (35.6% vs 5.6%), and treatment failure (46.7% vs 5.7%). In multivariate adjusted regression, the ORs (95%CI) were 6.99 (2.33, 20.92; p = 0.001), 4.97(1.93, 12.77; p = 0.001), and 5.77 (2.07, 16.11; p = 0.001), respectively. Patients with PDELC were 100-2000 × 106/L on day 5 had a higher rate of treatment failure than those with normal PDELC (26.9% vs 5.7%) (OR = 3.03, 95%CI 1.42, 6.46; p = 0.004). After sensitivity analysis, the results remained robust. CONCLUSIONS Among patients with PDAP, increased PDELC on day 5 was associated with a greater risk of 60-day mortality, half-year mortality, and treatment failure.
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Affiliation(s)
- Tao Hong
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaoxia Wang
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Shangmei Li
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liping Zhai
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Na Wu
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Haijuan Yang
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Cuiwei Yao
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Huafeng Liu
- Department of Nephrology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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Cheng XBJ, Chan CT. Systems Innovations to Increase Home Dialysis Utilization. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00231. [PMID: 37651291 PMCID: PMC10843223 DOI: 10.2215/cjn.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023]
Abstract
Globally, there is an interest to increase home dialysis utilization. The most recent United States Renal Data System (USRDS) data report that 13.3% of incident dialysis patients in the United States are started on home dialysis, while most patients continue to initiate KRT with in-center hemodialysis. To effect meaningful change, a multifaceted innovative approach will be needed to substantially increase the use of home dialysis. Patient and provider education is the first step to enhance home dialysis knowledge awareness. Ideally, one should maximize the number of patients with CKD stage 5 transitioning to home therapies. If this is not possible, infrastructures including transitional dialysis units and community dialysis houses may help patients increase self-care efficacy and eventually transition care to home. From a policy perspective, adopting a home dialysis preference mandate and providing financial support to recuperate increased costs for patients and providers have led to higher uptake in home dialysis. Finally, respite care and planned home-to-home transitions can reduce the incidence of transitioning to in-center hemodialysis. We speculate that an ecosystem of complementary system innovations is needed to cause a sufficient change in patient and provider behavior, which will ultimately modify overall home dialysis utilization.
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Affiliation(s)
- Xin Bo Justin Cheng
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
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Morelle J, Lambie M, Öberg CM, Davies S. The Peritoneal Membrane and its Role in Peritoneal Dialysis. Clin J Am Soc Nephrol 2023; 19:01277230-990000000-00223. [PMID: 37616463 PMCID: PMC10861113 DOI: 10.2215/cjn.0000000000000282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
A healthy and functional peritoneal membrane is key to achieve sufficient ultrafiltration and to restore fluid balance, a major component of high-quality prescription in patients treated with peritoneal dialysis (PD). Variability in membrane function at the start of PD or changes over time on treatment influence dialysis prescription and outcomes, and dysfunction of the peritoneal membrane contributes to fluid overload and associated complications. In this review, we summarize the current knowledge about the structure, function and pathophysiology of the peritoneal membrane with a focus on clinical implications for patient-centered care. We also discuss the molecular and genetic mechanisms of solute and water transport across the peritoneal membrane, including the role of aquaporin water channels in crystalloid vs. colloid osmosis; why and how to assess membrane function using peritoneal equilibration tests; the etiologies of membrane dysfunction and their specific management; and the impact of genetic variation on membrane function and outcomes in patients treated with PD. This review also identifies the gaps in current knowledge and perspectives for future research to improve our understanding of the peritoneal membrane and, ultimately, to improve the care of patients treated with PD.
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Affiliation(s)
- Johann Morelle
- Division of Nephrology, Cliniques universitaires Saint-Luc, Brussels, Belgium
- UCLouvain School of Medicine, UCLouvain, Brussels, Belgium
| | - Mark Lambie
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
| | - Carl M. Öberg
- Division of Nephrology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Simon Davies
- Faculty of Medicine and Health Sciences, Keele University, Keele, United Kingdom
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41
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Wei Z, Jin Y, Cheng J, Han X, Liu J, Liu S. Chinese experience on comparison of clinical efficacy and safety of hemodialysis and peritoneal dialysis in the treatment of diabetic kidney failure: a systematic review and meta-analysis. Front Med (Lausanne) 2023; 10:1116103. [PMID: 37636569 PMCID: PMC10449255 DOI: 10.3389/fmed.2023.1116103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Objective This meta-analysis aims to compare the efficacy and safety of peritoneal dialysis (PD) and hemodialysis (HD) in the treatment of diabetic kidney failure. Methods Five databases were selected to retrieve research on PD and HD for diabetic kidney failure until 6 August 2022. A fixed-effects or random-effects model was utilized to calculate the standardized mean difference (SMD) or odds ratio (OR) based on the heterogeneity among studies. Results Sixteen studies were included. The results showed that patients with diabetic kidney failure treated with PD had lower levels of albumin, total protein, and systolic blood pressure (SBP) and higher levels of urine volume, creatinine, and blood urea nitrogen (BUN) and lower risk of cardiovascular and bleeding events, with significant statistical difference when compared with patients treated with HD (albumin: SMD = -1.22, 95%CI: -1.53, -0.91; total protein: SMD = -0.96, 95%CI: -1.16, -0.77; SBP: SMD = -0.35, 95%CI: -0.64, -0.06; urine volume: SMD = 0.68, 95%CI: 0.40, 0.96; creatinine: SMD = 0.49, 95%CI: 0.27, 0.72; BUN: SMD = 0.55, 95%CI: 0.25, 0.85; cardiovascular events: OR = 0.42, 95%CI: 0.28, 0.62; bleeding: OR = 0.41, 95%CI 0.27, 0.62). Conclusion This meta-analysis summarized the advantages and disadvantages of PD and HD for treating diabetic kidney failure patients. Compared with HD, PD is more effective in preserving residual kidney function, reducing hemodynamic effect, and lowering the risk of bleeding and cardiovascular events in diabetic kidney failure patients, but it also predisposes to protein-energy malnutrition and increases the risk of infection.
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Affiliation(s)
| | | | | | | | | | - Shengjun Liu
- Department of Nephrology, The Frist Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei, China
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42
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Chu ECP, Yau K, Yun SMH. Spondylodiscitis in a Patient Undergoing Chronic Peritoneal Dialysis Presenting to a Chiropractor: Case Report and a Review of the Literature. Cureus 2023; 15:e44312. [PMID: 37779747 PMCID: PMC10535716 DOI: 10.7759/cureus.44312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
Spondylodiscitis is a rare but severe condition characterized by spinal and paraspinal infections that will present to healthcare providers, including chiropractors, because of neck pain. Patients who undergo peritoneal dialysis for end-stage renal disease or have a complex medical history may present with musculoskeletal complaints with complicated and uncommon underlying causes. This report reviews the possible relationship between spinal infection and dialysis, as well as the role of the chiropractor in identifying and managing critical conditions. A 66-year-old Asian man undergoing peritoneal dialysis presented to a chiropractic clinic with pain in the left arm. The patient did not present with a fever. Upon examination, the upper limb muscle strength and reflexes were diminished. Neck pain was also experienced during the range of motion examination, and movement was limited in all directions. Magnetic resonance imaging was ordered. The patient was diagnosed with acute spondylodiscitis. Due to its nonspecific presentation, patients with severe and urgent cases, such as spondylodiscitis, may present to chiropractic offices to seek conservative treatment of pain symptoms. This report highlights the potential role of chiropractors in the early detection and management of complex conditions such as spondylodiscitis in patients on chronic dialysis.
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Affiliation(s)
- Eric Chun-Pu Chu
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
| | - Kristy Yau
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
| | - Steve Ming Hei Yun
- Chiropractic and Physiotherapy Center, New York Medical Group, Hong Kong, CHN
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Meng M, Lu M, Feng J, Zhou X, Meng P, Chen L, Zou X, Liu X, Liu L, Gao X, Zhang Y. Exosomal PPARγ derived from macrophages suppresses LPS-induced peritonitis by negative regulation of CD14/TLR4 axis. Inflamm Res 2023; 72:1567-1581. [PMID: 37438583 DOI: 10.1007/s00011-023-01765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Intercellular communication between macrophages and peritoneal mesothelial cells (PMCs) has been suggested as a key factor regulating peritonitis development. Here, we explored whether PPARγ (peroxisome proliferator-activated receptor gamma) can be packaged into macrophage exosomes to mediate intercellular communication and regulate peritonitis. METHODS Macrophage exosomes were isolated by ultracentrifugation and identified by nanoparticle tracking analysis and transmission electron microscopy. Proteomic analysis of macrophage-derived exosomes was performed using mass spectrometry. Co-culture models of supernatants or exosomes with PMCs, as well as a mouse peritonitis model induced by lipopolysaccharide (LPS), were employed. RESULTS In this study, using stable Raw264.7 cells overexpressing GFP-FLAG-PPARγ (OE-PPARγ), we found that PPARγ inhibited LPS-induced inflammatory responses in Raw264.7 cells and that PPARγ was incorporated into macrophage exosomes during this process. Overexpression of PPARγ mainly regulated the secretion of differentially expressed exosomal proteins involved in the biological processes of protein transport, lipid metabolic process, cell cycle, apoptotic process, DNA damage stimulus, as well as the KEGG pathway of salmonella infection. Using co-culture models and mouse peritonitis model, we showed that exosomes from Raw264.7 cells overexpressing PPARγ inhibited LPS-induced inflammation in co-cultured human PMCs and in mice through downregulating CD14 and TLR4, two key regulators of the salmonella infection pathway. Pretreatment of the PPARγ inhibitor GW9662 abolished the anti-inflammatory effect of exosomes from Raw264.7 OE-PPARγ cells on human PMCs. CONCLUSIONS These results suggested that overexpression of PPARγ largely altered the proteomic profile of macrophage exosomes and that exosomal PPARγ from macrophages acted as a regulator of intercellular communication to suppress LPS-induced inflammatory responses in vitro and in vivo via negatively regulating the CD14/TLR4 axis.
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Affiliation(s)
- Meng Meng
- MOE Key Laboratory of Tumor Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University, Guangzhou, 510632, China
| | - Meizhi Lu
- Department of Nephrology, Affiliated Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), Guangzhou, China
| | - Junxia Feng
- Department of Nephrology, Affiliated Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), Guangzhou, China
| | - Xiaoying Zhou
- Department of Nephrology, Affiliated Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), Guangzhou, China
| | - Ping Meng
- Department of Nephrology, Affiliated Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), Guangzhou, China
| | - Luxuan Chen
- MOE Key Laboratory of Tumor Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University, Guangzhou, 510632, China
| | - Xunliang Zou
- Department of Nephrology, The Fifth Affiliated (Zhuhai) Hospital of Zunyi Medical University, Zhuhai, 519100, China
| | - Xiaohui Liu
- MOE Key Laboratory of Tumor Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University, Guangzhou, 510632, China
| | - Langxia Liu
- MOE Key Laboratory of Tumor Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University, Guangzhou, 510632, China.
| | - Xuejuan Gao
- MOE Key Laboratory of Tumor Molecular Biology and Key Laboratory of Functional Protein Research of Guangdong Higher Education Institutes, Institute of Life and Health Engineering, College of Life Science and Technology, Jinan University, Guangzhou, 510632, China.
| | - Yunfang Zhang
- Department of Nephrology, Affiliated Huadu Hospital, Southern Medical University (People's Hospital of Huadu District), Guangzhou, China.
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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Mumtha C, Subashri D, Mahalingam PU. Enhancing biohydrogen production from mono-substrates and co-substrates using a novel bacterial strains. 3 Biotech 2023; 13:270. [PMID: 37449248 PMCID: PMC10335983 DOI: 10.1007/s13205-023-03687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023] Open
Abstract
The staggering increase in pollution associated with a sharp tightening in global energy demand is a major concern for organic substances. Renewable biofuel production through simultaneous waste reduction is a sustainable approach to meet this energy demand. This study co-fermentation of dairy whey and SCB was performed using mixed and pure bacterial cultures of Salmonella bongori, Escherichia coli, and Shewanella oneidensis by dark fermentation process for hydrogen production. The maximum H2 production was 202.7 ± 5.5 H2/mL/L, 237.3 ± 6.0 H2/mL/L, and 198 ± 9.9 H2/mL/L obtained in fermentation reactions containing dairy whey, solid and liquid hydrolysis of pretreated sugarcane bagasse as mono-substrates. The H2 production was greater in co-substrate by 347.3 ± 18.5 H2/mL/L under optimized conditions (pH 7.0, temperature 37 °C, substrate concentration 30:50 g/L) than expected in mono-substrate conditions, which confirms that co-fermentation of different substrates enhances the H2 potential. Fermentation medium during bio-H2 production under GC analysis has stated that using mixed cultures in dark fermentation favored acetic acid and butyric acid. Co-substrate degradation produces ethyl alcohol, benzoic acid, propionic acid, and butanol as metabolic by-products. The difference in the treated and untreated substrate and carbon enrichment in the substrates was evaluated by FT-IR analysis. The present study justifies that rather than the usage of mono-substrate for bio-H2 production, the co-substrate provided highly stable H2 production by mixed bacterial cultures. Fabricate the homemade single-chamber microbial fuel cell to generate electricity. Supplementary Information The online version contains supplementary material available at 10.1007/s13205-023-03687-9.
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Affiliation(s)
- Chelladurai Mumtha
- Department of Biology, The Gandhigram Rural Institute (Deemed to Be University), Gandhigram, Dindigul, 624 302 Tamil Nadu India
| | - Dhanasekaran Subashri
- Department of Biology, The Gandhigram Rural Institute (Deemed to Be University), Gandhigram, Dindigul, 624 302 Tamil Nadu India
| | - Pambayan Ulagan Mahalingam
- Department of Biology, The Gandhigram Rural Institute (Deemed to Be University), Gandhigram, Dindigul, 624 302 Tamil Nadu India
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Than WH, Chan GCK, Kwan BCH, Lai KB, Chan RCK, Teoh JYC, Ng JKC, Fung WWS, Chow KM, Cheng PMS, Li PKT, Szeto CC. Plasma vaspin levels and clinical outcome in incident peritoneal dialysis patients. BMC Nephrol 2023; 24:206. [PMID: 37438733 DOI: 10.1186/s12882-023-03259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/29/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Vaspin is an adipokine that regulates glucose and lipid metabolism. Plasma vaspin level is increased in chronic kidney disease but decreased in hemodialysis patients. However, plasma vaspin level in peritoneal dialysis (PD) patients, as well as its prognostic role, has not been studied. METHODS We recruited 146 incident PD patients. Their baseline plasma vaspin levels, body anthropometry, the profile of insulin resistance, bioimpedance spectroscopy parameters, dialysis adequacy, and nutritional indices were measured. They were followed for up to 5 years for survival analysis. RESULTS The average age was 58.4 ± 11.8 years; 96 patients (65.8%) were men, and 90 (61.6%) had diabetes. The median vaspin level was 0.18 ng/dL (interquartile range [IQR] 0.11 to 0.30 ng/dL). Plasma vaspin level did not have a significant correlation with adipose tissue mass or baseline insulin level. However, plasma vaspin level had a modest correlation with the change in insulin resistance, as represented by the HOMA-IR index, in non-diabetic patients (r = -0.358, p = 0.048). Although the plasma vaspin level quartile did not have a significant association with patient survival in the entire cohort, it had a significant interaction with diabetic status (p < 0.001). In nondiabetic patients, plasma vaspin level quartile was an independent predictor of patient survival after adjusting for confounding clinical factors (adjusted hazard ratio 2.038, 95% confidence interval 1.191-3.487, p = 0.009), while the result for diabetic patients was not significant. CONCLUSIONS Plasma vaspin level quartile had a significant association with patient survival in non-diabetic PD patients. Baseline plasma vaspin level also had a modest inverse correlation with the subsequent change in the severity of insulin resistance, but the exact biological role of vaspin deserves further studies.
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Affiliation(s)
- Win Hlaing Than
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
| | - Gordon Chun-Kau Chan
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Bonnie Ching-Ha Kwan
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
| | - Ka-Bik Lai
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
| | - Ronald Cheong-Kin Chan
- Department of Anatomical & Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Jack Kit-Chung Ng
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Winston Wing-Shing Fung
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Kai-Ming Chow
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Phyllis Mei-Shan Cheng
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China
- Li Ka Shing Institute of Health Sciences (LiHS), The Chinese University of Hong Kong, Hong Kong, China
| | - Philip Kam-Tao Li
- Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, Shatin, NT, China
| | - Cheuk-Chun Szeto
- Carol & Richard Yu Peritoneal Dialysis Research Centre, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, Shatin, NT, China.
- Li Ka Shing Institute of Health Sciences (LiHS), The Chinese University of Hong Kong, Hong Kong, China.
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Cui S, Zhang B, Li L. The relationship between bullous pemphigoid and renal disease and related treatments: a review of the current literature. Expert Rev Clin Immunol 2023; 19:1407-1417. [PMID: 37707350 DOI: 10.1080/1744666x.2023.2249238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disorder in older adults. There is increasing evidence that BP has connections with renal diseases, such as glomerulopathy and neoplasm; it is also linked to the receipt of renal replacement therapy. AREAS COVERED In this review, we summarize the current evidence that BP is a comorbidity of common renal diseases. Furthermore, our exploration of the characteristics and possible mechanisms underlying these connections provides insights that may facilitate the prevention, diagnosis, and management of BP. EXPERT OPINION There is mounting proof that BP is not just a skin immunological disorder but rather a systemic immune-mediated illness. Quantities of case reports focused on BP as a renal disease comorbidity and the coexistence of them is not accidental. However, the underlying mechanisms are still needed to be investigated. Clinicians should be alert to the comorbidities in order to facilitate effective treatment and improve patient prognosis.
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Affiliation(s)
- Shengnan Cui
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Bingjie Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
| | - Li Li
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, China
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Pushevski V, Nikolov IG, Karagjozov P, Dzambaz D, Rambabova-Bushljetik I. Percutaneous Onsite Insertion of Catheter for Peritoneal Dialysis - A New Method Introduction in the Country. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2023; 44:107-112. [PMID: 37453112 DOI: 10.2478/prilozi-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Peritoneal dialysis (PD) is one of the options for renal replacement therapy (RRT) in the end stage renal disease (ESRD) patients. Compared to hemodialysis (HD), patients on PD experience a greater sense of well-being, an improved steady state in terms of extracellular fluid volume shifts and hemodynamics and it is preferred method for patients with problematic vascular access, bleeding tendencies, heart failure and elderly patients. In order to perform PD, a tunneled catheter should be placed through the abdominal wall and into peritoneal space, with positioning of the catheter within the most dependent portion of pelvis. Currently, there are several techniques available for PD catheter placement: open surgery, laparoscopic and percutaneous. We present for the first time in our country a case of 65 year old male patient to whom percutaneous onsite insertion of peritoneal catheter was performed. The idea is to emphasize that sometimes this should be a method of choice for RRT, especially in patients where general anesthesia should be avoid. Compared to other methods, percutaneous insertion is a simple procedure with no need for general anesthesia, and the benefits of quick recovery, earlier ambulation, and less delay in catheter placement.
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Affiliation(s)
- Vladimir Pushevski
- 1University Clinic of Nephrology, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Igor G Nikolov
- 1University Clinic of Nephrology, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Pance Karagjozov
- 2University Clinic of Digestive surgery, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Darko Dzambaz
- 2University Clinic of Digestive surgery, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
| | - Irena Rambabova-Bushljetik
- 1University Clinic of Nephrology, Faculty of Medicine, University "SS Cyril and Methodius", Skopje, RN Macedonia
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Zhang S, Ren HF, Du RX, Sun WL, Fu ML, Zhang XC. Global, regional, and national burden of kidney dysfunction from 1990 to 2019: a systematic analysis from the global burden of disease study 2019. BMC Public Health 2023; 23:1218. [PMID: 37353821 PMCID: PMC10288715 DOI: 10.1186/s12889-023-16130-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/15/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVE We aim to explore the prevalence and temporal trends of the burden of kidney dysfunction (KD) in global, regional and national level, since a lack of related studies. DESIGN Cross-sectional study. MATERIALS The data of this research was obtained from Global Burden of Diseases Study 2019. The estimation of the prevalence, which was measured by the summary exposure value (SEV), and attributable burden of KD was performed by DisMod-MR 2.1, a Bayesian meta-regression tool. The Spearman rank order correlation method was adopted to perform correlation analysis. The temporal trends were represented by the estimated annual percentage change (EAPC). RESULTS In 2019, there were total 3.16 million deaths and 76.5 million disability-adjusted life years (DALYs) attributable to KD, increased by 101.1% and 81.7% compared with that in 1990, respectively. From 1990 to 2019, the prevalence of KD has increased in worldwide, but decreased in High-income Asia Pacific. Nearly 48.5% of countries globally, such as South Africa, Egypt and Mexico had increased mortality rates of KD from 1990 to 2019 while 44.6% for disability rate. Countries with lower socio-demographic index (SDI) are facing a higher prevalence as well as mortality and disability rate compared with those with higher SDI. Compared with females, the prevalence of KD was lower in males, however the attributable mortality and disability rate were higher in all years from 1990 to 2019. CONCLUSION With the progress of senescent, we will face more severe challenges of reducing the prevalence and attributable burden of KD, especially in regions with lower SDI. Effective measures are urgently required to alleviate the prevalence and burden of KD.
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Affiliation(s)
- Shu Zhang
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Hui-Fang Ren
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Rong-Xin Du
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei-Li Sun
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Mei-Li Fu
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiao-Chao Zhang
- Department of Urology, Shanxi Bethune Hospital, Shanxi Academy of Medical Science, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan, China.
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Liu J, Zhang T, Sun S. Molecular Dynamics Simulations of Ion Transport through Protein Nanochannels in Peritoneal Dialysis. Int J Mol Sci 2023; 24:10074. [PMID: 37373224 DOI: 10.3390/ijms241210074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
In recent decades, the development of dialysis techniques has greatly improved the survival rate of renal failure patients, and peritoneal dialysis is gradually showing dominance over hemodialysis. This method relies on the abundant membrane proteins in the peritoneum, avoiding the use of artificial semipermeable membranes, and the ion fluid transport is partly controlled by the protein nanochannels. Hence, this study investigated ion transport in these nanochannels by using molecular dynamics (MD) simulations and an MD Monte Carlo (MDMC) algorithm for a generalized protein nanochannel model and a saline fluid environment. The spatial distribution of ions was determined via MD simulations, and it agreed with that modeled via the MDMC method; the effects of simulation duration and external electronic fields were also explored to validate the MDMC algorithm. The specific atomic sequence within a nanochannel was visualized, which was the rare transport state during the ion transport process. The residence time was assessed through both methods to represent the involved dynamic process, and its values showed the temporal sequential order of different components in the nanochannel as follows: H2O > Na+ > Cl-. The accurate prediction using the MDMC method of the spatial and temporal properties proves its suitability to handle ion transport problems in protein nanochannels.
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Affiliation(s)
- Jie Liu
- Computational Transport Phenomena Laboratory, Physical Science and Engineering Division (PSE), King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Tao Zhang
- Computational Transport Phenomena Laboratory, Physical Science and Engineering Division (PSE), King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
| | - Shuyu Sun
- Computational Transport Phenomena Laboratory, Physical Science and Engineering Division (PSE), King Abdullah University of Science and Technology, Thuwal 23955-6900, Saudi Arabia
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Bucur R, Botosineanu CC, Donderski R. "Sweet" Hydrothorax in a Peritoneal Dialysis Patient. A Case Report and Review of the Literature on Novel Diagnostic and Therapeutical Approaches. MAEDICA 2023; 18:352-356. [PMID: 37588815 PMCID: PMC10427105 DOI: 10.26574/maedica.2023.18.2.352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
"Sweet" hydrothorax is a rare complication of peritoneal dialysis (PD). It is characterized by the presence of peritoneal fluid in the pleural cavity. We describe the case of a 41-year-old woman who developed this complication three days after starting continuous ambulatory peritoneal dialysis (CAPD). We present the current diagnostic approach and treatment of this rare complication.
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Affiliation(s)
- Ruxandra Bucur
- Student in International Erasmus Exchange Programme (2022-2023), "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Carmen Cristina Botosineanu
- Student in International Erasmus Exchange Programme (2022-2023), "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Rafal Donderski
- bDepartment of Nephrology, Hypertension and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
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