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Makhyoun CN, Ullian ME. Antibiotic availability for outpatient treatment of acute peritonitis in chronic peritoneal dialysis patients: A case series. Am J Med Sci 2023; 365:263-269. [PMID: 36521531 DOI: 10.1016/j.amjms.2022.12.002] [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: 02/18/2022] [Revised: 09/07/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is a commonly used form of renal replacement therapy for patients that have reached end-stage renal disease. Acute bacterial peritonitis (ABP) in chronic PD patients results in pain, increased costs, injury to the peritoneal membrane, and PD modality failure. Optimal antibiotic treatment of acute bacterial peritonitis (ABP) in chronic PD patients should be intraperitoneal, outpatient-based, appropriate, prompt, and uninterrupted. We investigated the frequency of and predisposition to suboptimal antibiotic courses for ABP in our chronic PD patients. METHODS Twenty-four charts of patients with ABP were reviewed, to test the null hypothesis that all ABP patients received antibiotics optimally. RESULTS After 12 patient exclusions (hospitalization), 9 suboptimal antibiotic events were detected in 6 of the remaining 12 patients, disproving the null hypothesis (p < 0.02). Most suboptimal antibiotics courses (7 of 9) resulted from delays and/or gaps in therapy or antibiotics prescribed outside of community standard. Suboptimal antibiotic events occurred on nights and weekends rather than during the workweek (p < 0.02) and in the emergency room rather than the PD clinic (p < 0.02). CONCLUSIONS Suboptimal ABP antibiotic therapy occurs commonly and is influenced by time and location of presentation and lack of knowledge by patients and physicians. Prevention of suboptimal antibiotic courses in the treatment of ABP in chronic PD patients includes education of patients and providers and allowing emergency rooms and PD clinics to dispense antibiotics for home use.
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Affiliation(s)
- Camilia N Makhyoun
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA
| | - Michael E Ullian
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC, USA.
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Luo PT, Li W, Li XY, Zhang Y, Du B, Cui WP. Impact of peritoneal dialysis modality on patient and PD survival: A systematic review. ARCH ESP UROL 2022; 43:128-138. [PMID: 36476184 DOI: 10.1177/08968608221140788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We conducted a systematic review and meta-analysis to determine the effect of the peritoneal dialysis (PD) modality, automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD), on all-cause mortality (ACM) and PD failure. Studies were identified in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Infrastructure, Weipu and Wanfang databases from database inception until April 1, 2021. The inclusion and exclusion criteria were based on the Population, Intervention, Comparison, Outcome, and Study (PICOS) design. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were used to pool outcome estimates. Seventeen studies (more than 230,000 patients) were included. Our meta-analysis showed that compared with CAPD, APD demonstrated a significantly lower ACM risk (HR 0.87 [95% CI 0.77–0.99], p = 0.04), especially in studies involving an as-treated analysis (HR 0.75 [95% CI, 0.63–0.90], p = 0.00), published in Asia (HR 0.76 [95% CI, 0.67–0.86], p < 0.001) or Europe (HR 0.81 [95% CI, 0.74–0.89], p < 0.00), or published after 2012 (HR 0.82 [95% CI, 0.68–0.99], p = 0.04). However, APD was as effective as CAPD for PD survival (HR, 0.87 [95% CI, 0.75 to 1.00], p = 0.05 or HR, 0.90 [95% CI, 0.60 to 1.35], p = 0.61). Our results demonstrate a significant survival benefit for APD and provide evidence for increasing the global use of APD, especially in developing nations, where APD use has been hampered by a lack of reimbursement for care.
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Affiliation(s)
- Pei-Ting Luo
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Xin-Yang Li
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Yu Zhang
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Bing Du
- Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wen-Peng Cui
- Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin, China
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3
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Gil-Casares B, Portolés J, López-Sánchez P, Tornero F, Marques M, Rojo-Álvarez JL. Transitions in an integrated model of renal replacement therapy in a regional health system. Nefrologia 2022; 42:438-447. [PMID: 36266230 DOI: 10.1016/j.nefroe.2022.10.002] [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: 02/19/2021] [Accepted: 07/11/2021] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. Most patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. This has been called «integrated model of RRT» that implies new questions about the best sequence of techniques. MATERIAL AND METHODS The study describes the impact of transitions between RRT modalities on survival using the Madrid Registry of Renal Patients (2008-2018). This study used the proportional hazards models and competitive risk models to perform an intention-to-treat (ITT), according to their 1st RRT modality and as-treated (AT) analysis, that consider also their 1st transition. RESULTS A total of 8971 patients started RRT during this period in Madrid (6.6 Million population): 7207 (80.3%) on hemodialysis (HD), 1401 (15.6%) on peritoneal dialysis (PD) and 363 (4.2%) received a pre-emptive kidney transplantation (KT). Incident HD-patients were older (HD group 65.3 years (SD 15.3) vs PD group 58.1 years (SD 14.8) vs KTX group 52 years (SD 17.2); p < 0.001) and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs KTX group 8.3%, p < 0.001) and less access to a transplant (HD group 30.4% vs PD group 51.6%; p < 0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (HD → PD: 0.7 years (SD 1.1) vs PD → HD: 1.5 years (SD 1.4) p < 0.001), are younger (HD → PD: 53.5 years (SD 16.7) vs PD → HD: 61.6 years (SD 14.6); p < 0.001), presented less mortality (HD → PD: 24.5% vs PD → HD: 32.0%; p < 0.001) and higher access to a transplant (HD → PD: 49.4% vs PD → HD: 31.7%; p < 0.001). Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 51.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). In this analysis, survival of patients who change from one technique to another, is more similar to the destination modality than the origin one. CONCLUSION Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and could be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and reports of renal registries.
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Affiliation(s)
- Beatriz Gil-Casares
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, Spain; Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain
| | - Jose Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; REDInREN RETIC ISCIII 16/009/009.
| | - Paula López-Sánchez
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Fernando Tornero
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, Spain
| | - María Marques
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; REDInREN RETIC ISCIII 16/009/009
| | - José Luis Rojo-Álvarez
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, Spain
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Stergar J, Lakota K, Perše M, Tomšič M, Milanič M. Hyperspectral evaluation of vasculature in induced peritonitis mouse models. BIOMEDICAL OPTICS EXPRESS 2022; 13:3461-3475. [PMID: 35781958 PMCID: PMC9208583 DOI: 10.1364/boe.460288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/28/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Imaging of blood vessel structure in combination with functional information about blood oxygenation can be important in characterizing many different health conditions in which the growth of new vessels contributes to the overall condition. In this paper, we present a method for extracting comprehensive maps of the vasculature from hyperspectral images that include tissue and vascular oxygenation. We also show results from a preclinical study of peritonitis in mice. First, we analyze hyperspectral images using Beer-Lambert exponential attenuation law to obtain maps of hemoglobin species throughout the sample. We then use an automatic segmentation algorithm to extract blood vessels from the hemoglobin map and combine them into a vascular structure-oxygenation map. We apply this methodology to a series of hyperspectral images of the abdominal wall of mice with and without induced peritonitis. Peritonitis is an inflammation of peritoneum that leads, if untreated, to complications such as peritoneal sclerosis and even death. Characteristic inflammatory response can also be accompanied by changes in vasculature, such as neoangiogenesis. We demonstrate a potential application of the proposed segmentation and processing method by introducing an abnormal tissue fraction metric that quantifies the amount of tissue that deviates from the average values of healthy controls. It is shown that the proposed metric successfully discriminates between healthy control subjects and model subjects with induced peritonitis and has a high statistical significance.
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Affiliation(s)
- Jošt Stergar
- J. Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, 1000 Ljubljana, Slovenia
| | - Katja Lakota
- FAMNIT, University of Primorska, Glagoljaska 8, 6000 Koper, Slovenia
- University Medical Centre, Department of Rheumatology, Vodnikova ulica 62, 1000 Ljubljana, Slovenia
| | - Martina Perše
- Faculty of Medicine,University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Matija Tomšič
- University Medical Centre, Department of Rheumatology, Vodnikova ulica 62, 1000 Ljubljana, Slovenia
- Faculty of Medicine,University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Matija Milanič
- J. Stefan Institute, Jamova cesta 39, 1000 Ljubljana, Slovenia
- Faculty of Mathematics and Physics, University of Ljubljana, Jadranska ulica 19, 1000 Ljubljana, Slovenia
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5
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Fox DE, King-Shier KM, James MT, Venturato L, Clarke A, Ravani P, Oliver MJ, Quinn RR. The availability of support and peritoneal dialysis survival: A cohort study. ARCH ESP UROL 2022; 42:353-360. [PMID: 35353014 DOI: 10.1177/08968608221086752] [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: 11/15/2022]
Abstract
BACKGROUND Providing support is important to maintain a patient on peritoneal dialysis (PD), though its impact on outcomes has not been investigated thoroughly. We examined the association between having support and risk of a transfer to hemodialysis. METHODS In this retrospective observational cohort study, we used data captured in the Dialysis Measurement Analysis and Reporting system about patients who started PD in Alberta, Canada, between 1 January 2013 and 30 September 2018. Support was defined as the availability of a support person in the home who was able, willing and available to provide support for PD in the patient's residence. The outcome of interest was a transfer to hemodialysis for at least 90 days. We estimated the cumulative incidence of a transfer over time accounting for competing risks and hazard ratios to summarise the association between support and a transfer. We split follow-up time as hazard ratios varied over time. RESULTS Six hundred and eighty-three incident PD patients, median age 58 years (IQR: 47-68) and 35% female, were followed for a median of 15 months. The cumulative incidence of a transfer to hemodialysis at 24 months was 26%. Having support was associated with a reduced risk of a transfer between 3 and 12 months after the start of dialysis (HR3-12mo: 0.44; 95% CI: 0.25-0.78), but not earlier (hazard ratio (HR)<3mo: 0.96; 95% confidence interval (CI): 0.55-1.69) or later (HR>12mo: 1.19; 95% CI: 0.65-2.17). CONCLUSIONS A transfer to hemodialysis is common. Having a support person at home is associated with a short-term protective effect after the initiation of PD.
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Affiliation(s)
- Danielle E Fox
- Department of Community Health Sciences, The University of Calgary, Alberta, Canada
| | - Kathryn M King-Shier
- Faculty of Nursing and Department of Community Health Sciences, The University of Calgary, Alberta, Canada
| | - Matthew T James
- Departments of Medicine and Community Health Sciences, The University of Calgary, Alberta, Canada
| | | | - Alix Clarke
- Department of Medicine, The University of Calgary, Alberta, Canada
| | - Pietro Ravani
- Departments of Medicine and Community Health Sciences, The University of Calgary, Alberta, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, The University of Toronto, Ontario, Canada
| | - Robert R Quinn
- Departments of Medicine and Community Health Sciences, The University of Calgary, Alberta, Canada
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He S, Xiong Q, Li L, Lin X, Zhao J, Guo X, He Y, Liang W, Ying C, Zuo X. Increased risk of modality failure with higher serum uric acid level in continuous ambulatory peritoneal dialysis patients: a prospective cohort study. Ren Fail 2022; 44:272-281. [PMID: 35172675 PMCID: PMC8856069 DOI: 10.1080/0886022x.2022.2035762] [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: 10/29/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is one of the most important kidney replacement therapies for patients with end-stage kidney disease (ESKD). PD technique failure can lead to an escalated cost and increased infectious and cardiovascular risk, up and including to death. The accumulation of uric acid (UA) was associated with adverse outcomes in ESKD patients. However, the relationship between serum UA and technique failure is little explored. METHODS Here, a total of 266 continuous ambulatory peritoneal dialysis (CAPD) patients (age, 41.8 ± 12.6 years; 125 males) were enrolled and followed up for 31.7 months. Serum UA levels were examined at baseline and each visit. Subjects were divided into three groups according to their baseline serum UA concentrations. Multivariable Cox regression models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of PD technique failure. RESULTS The level of serum UA increased gradually as time prolonged. During the follow-up period, 77 (28.9%) patients occurred PD technique failure, of which 56 (21.1%) transferred to hemodialysis (HD) and 21 (7.9%) died. Compared to the lowest UA tertile, after adjusting for potential confounders, HRs of technique failure in tertile 2 and tertile 3 were 1.82 (95% CI: 0.95-3.49) and 2.03 (95% CI: 1.05-3.92), respectively, and p for trend was 0.043. Adjusted HRs of all-cause technique failure, transferring to HD and mortality with each 1 mg/dL increase in serum UA were 1.20 (95% CI: 1.03-1.40, p = 0.019), 1.22 (95% CI: 1.01-1.48, p = 0.039), and 1.25 (95% CI: 0.94-1.67, p = 0.128), respectively. CONCLUSION Higher serum UA level predicted higher risk of technique failure in CAPD patients.
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Affiliation(s)
- Shuiqing He
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Qianqian Xiong
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Li Li
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuechun Lin
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhao
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaolei Guo
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yuqin He
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wangqun Liang
- Department of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenjiang Ying
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Luyan G, Haixia Z, Sheng F, Gang S, Jing Z, Ying L, Linsen J, Kai S, Zhi W, Huaying S. Regression of Left Ventricular Hypertrophy in Patients Combined with Peritoneal Dialysis and Hemodialysis. Int J Clin Pract 2022; 2022:2652380. [PMID: 36518909 PMCID: PMC9719434 DOI: 10.1155/2022/2652380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/18/2022] [Accepted: 11/19/2022] [Indexed: 11/27/2022] Open
Abstract
METHODS This retrospective study enrolled 58 patients at The Second Affiliated Hospital of Soochow University who switched from PD to PHD. Clinical data and echocardiographic examination results were collected. Data from the two groups with a normal distribution were compared with the paired t-test. A pvalue <0.05 (two-tailed) was considered statistically significant. RESULTS A total of 58 subjects were enrolled, including 46 males and 12 females, with a median age of 50.2 ± 11.1 (47-68) years. The mean duration of peritoneal dialysis was 67.2 ± 33.6 months. Before and after PHD, the ultrafiltration volume (p = 0.021) and hemoglobin (p = 0.001) were increased, while SBP (p = 0.002), DBP (p = 0.002), phosphorus (p < 0.001), and ESA dosage (p < 0.001) were decreased. Before and after combined dialysis (PHD), the incidence of LVH was 76.4% and 61.8%, respectively (p = 0.013), and LVMI decreased from 173.8 ± 86.2 g/m2 to 160.6 ± 78.5 g/m2 (p < 0.001). CONCLUSION Compared with PD alone, the combination of PD and HD resulted in regression of LVH and reduced LVMI.
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Affiliation(s)
- Gao Luyan
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhang Haixia
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Feng Sheng
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sun Gang
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhu Jing
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Lu Ying
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiang Linsen
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Song Kai
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Wang Zhi
- The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Shen Huaying
- The Second Affiliated Hospital of Soochow University, Suzhou, China
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Gil-Casares B, Portolés J, López-Sánchez P, Tornero F, Marques M, Rojo-Álvarez JL. Transitions in an integrated model of renal replacement therapy in a regional health system. Nefrologia 2021; 42:S0211-6995(21)00149-1. [PMID: 34481678 DOI: 10.1016/j.nefro.2021.07.004] [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: 02/19/2021] [Revised: 06/01/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES The choice of renal replacement therapy (RRT) is an important decision that determines the quality of life and survival. Most patients change from one RRT modality to another to adapt RRT to clinical and psychosocial needs. This has been called «integrated model of RRT» that implies new questions about the best sequence of techniques. MATERIAL AND METHODS The study describes the impact of transitions between RRT modalities on survival using the Madrid Registry of Renal Patients (2008-2018). This study used the proportional hazards models and competitive risk models to perform an intention-to-treat (ITT), according to their 1st RRT modality and as-treated (AT) analysis, that consider also their 1st transition. RESULTS A total of 8971 patients started RRT during this period in Madrid (6.6 Million population): 7207 (80.3%) on hemodialysis (HD), 1401 (15.6%) on peritoneal dialysis (PD) and 363 (4.2%) received a pre-emptive kidney transplantation (KTX). Incident HD-patients were older (HD group 65.3 years (SD 15.3) vs PD group 58.1 years (SD 14.8) vs KTX group 52 years (SD 17.2); p<0.001) and had more comorbidities. They presented higher mortality (HD group 40.9% vs PD group 22.8% vs 8.3% KTX group, p<0.001) and less access to a transplant (HD group 30.4% vs DP group 51.6%; p<0.001). Transitions between dialysis techniques define different groups of patients with different clinical outcomes. Those who change from HD to PD do it earlier (HD→PD: 0.7 years (SD 1.1) vs PD→HD: 1.5 years (SD 1.4) p<0.001), are younger (HD→PD: 53.5 years (SD 16.7) vs PD→HD: 61.6 years (SD 14.6); p<0.001), presented less mortality (HD→PD: 24.5% vs PD→HD: 32.0%; p<0.001) and higher access to a transplant (HD→PD: 49.4% vs PD→HD: 31.7%; p<0.001). Survival analysis by competitive risks is essential for integrated RRT models, especially in groups such as PD patients, where 51.6% of the patients were considered as lost follow-up (received a KTX after during the first 2.5 years on PD). In this analysis, survival of patients who change from one technique to another, is more similar to the destination modality than the origin one. CONCLUSION Our data suggest that transitions between RRT-techniques describes different patients, who associate different risks, and could be analyzed in an integrated manner to define improvement actions. This approach should be incorporated into the analysis and reports of renal registries.
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Affiliation(s)
- Beatriz Gil-Casares
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, España; Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España
| | - Jose Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; REDInREN RETIC ISCIII 16/009/009.
| | - Paula López-Sánchez
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Fernando Tornero
- Servicio de Nefrología, Hospital del Sureste, Arganda del Rey, Madrid, España
| | - María Marques
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España; REDInREN RETIC ISCIII 16/009/009
| | - José Luis Rojo-Álvarez
- Departamento de Teoría de la Señal y Comunicaciones y Sistemas Telemáticos y de Computación, Universidad Rey Juan Carlos, Fuenlabrada, Madrid, España
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Semple DJ, Sypek M, Ullah S, Davies C, McDonald S. Mortality After Home Hemodialysis Treatment Failure and Return to In-Center Hemodialysis. Am J Kidney Dis 2021; 79:15-23.e1. [PMID: 34274359 DOI: 10.1053/j.ajkd.2021.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 05/11/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE OBJECTIVE Patients on home hemodialysis (HHD) may eventually return to in-center hemodialysis (ICHD) for clinical, technical or psycho-social reasons. We studied the mortality of patients returning to ICHD after HHD comparing it to the mortality experience among patients receiving HHD and patients receiving ICHD without prior treatment with HHD. STUDY DESIGN Retrospective cohort study. SETTING PARTICIPANTS All patients represented in the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry who commenced HD during 2005-2015 and were treated for >90 days. EXPOSURES ICHD and/or HHD, and clinical characteristics at study entry. OUTCOMES Mortality and cause of death. ANALYTICAL APPROACH A time-varying multivariate Cox proportional hazards analysis with shared frailty was implemented to explore the association between patient treatment states and mortality. Patients were censored at the time of transplantation and change in treatment modality to peritoneal dialysis. RESULTS A total of 19,306 patients initiated HD and were treated for >90 days. The mean age of patients was 60.8y (SD=15.4y), 62% were male and 49% had diabetes. After HHD treatment failure, adjusted mortality was increased compared to continued HHD at 0-30 days (HR 3.93, 95% CI 2.09-7.40 p<0.001), 30-90 days (HR 3.34, 95% CI 1.98-5.62, p<0.001) and >90 days (HR 2.29, CI 1.84-2.85, p<0.001). LIMITATIONS Covariates recorded at dialysis initiation. Residual confounding underlying successful initiation of HHD treatment.Observational data lacking detail on cause of HHD treatment failure. CONCLUSIONS HHD treatment failure is associated with a significant increase in mortality compared to continued HHD. This risk was present in both the early (first 30 days and 30-90 days) and late (>90 days) periods after HHD treatment failure. Further investigation into the specific causes of treatment failure and death may highlight specific high-risk patients.
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Affiliation(s)
- David J Semple
- Department of Renal Medicine, Auckland District Health Board, Auckland, NZ; Faculty of Medical and Health Sciences, University of Auckland, Auckland, NZ.
| | - Matthew Sypek
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria
| | - Shahid Ullah
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Adelaide Medical School, University of Adelaide, Adelaide, SA; College of Medicine and Public Health, Flinders University, Adelaide, SA
| | - Christopher Davies
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Adelaide Medical School, University of Adelaide, Adelaide, SA
| | - Stephen McDonald
- ANZDATA Registry, SA Health and Medical Research Institute, Adelaide, SA; Adelaide Medical School, University of Adelaide, Adelaide, SA
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10
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Clarke A, Ravani P, Oliver MJ, Mahsin M, Lam NN, Fox DE, Qirjazi E, Ward DR, MacRae JM, Quinn RR. Four steps to standardize reporting of peritoneal dialysis technique failure: A proposed approach. Perit Dial Int 2020; 42:270-278. [PMID: 33272118 DOI: 10.1177/0896860820976935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Technique failure is an important outcome measure in research and quality improvement in peritoneal dialysis (PD) programs, but there is a lack of consistency in how it is reported. METHODS We used data collected about incident dialysis patients from 10 Canadian dialysis programs between 1 January 2004 and 31 December 2018. We identified four main steps that are required when calculating the risk of technique failure. We changed one variable at a time, and then all steps, simultaneously, to determine the impact on the observed risk of technique failure at 24 months. RESULTS A total of 1448 patients received PD. Selecting different cohorts of PD patients changed the observed risk of technique failure at 24 months by 2%. More than one-third of patients who switched to hemodialysis returned to PD-90% returned within 180 days. The use of different time windows of observation for a return to PD resulted in risks of technique failure that differed by 16%. The way in which exit events were handled during the time window impacted the risk of technique failure by 4% and choice of statistical method changed results by 4%. Overall, the observed risk of technique failure at 24 months differed by 20%, simply by applying different approaches to the same data set. CONCLUSIONS The approach to reporting technique failure has an important impact on the observed results. We present a robust and transparent methodology to track technique failure over time and to compare performance between programs.
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Affiliation(s)
- Alix Clarke
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Pietro Ravani
- Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Matthew J Oliver
- Division of Nephrology, Department of Medicine, University of Toronto, Ontario, Canada
| | - Mohamed Mahsin
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Ngan N Lam
- Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | - Danielle E Fox
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Elena Qirjazi
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - David R Ward
- Cumming School of Medicine, University of Calgary, Alberta, Canada
| | | | - Robert R Quinn
- Cumming School of Medicine, University of Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Alberta, Canada
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11
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Jeong JC, Kim S, Kim KP, Yi Y, Ahn SY, Jin DC, Chin HJ, Chae DW, Na KY. Changes in mortality hazard of the Korean long-term dialysis population: The dependencies of time and modality switch. Perit Dial Int 2020; 41:69-78. [PMID: 32319853 DOI: 10.1177/0896860820915024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Many studies have compared patient survival outcome between hemodialysis (HD) and peritoneal dialysis (PD); however, time-varying risks of dialysis modality have been rarely investigated. This study aimed to investigate dialysis modality switch and its association with the survival outcome in the Korean population. METHODS Data from the Korean Society of Nephrology were used. A total of 21,840 incident dialysis patients who started dialysis in or after 2000 were analyzed. For the survival analysis, both proportional and non-proportional hazard assumptions were applied. For the modality switch, time-varying covariate Cox regression was applied. RESULTS During the median follow-up of 8 years, PD group showed increased adjusted hazard ratio (HR) of 1.248 (95% CI 1.071-1.454, p = 0.004) for mortality. Interaction of PD status with female sex was significant with an HR of 1.080 (95% CI 1.000-1.165, p = 0.050). Dialysis modality switch was associated with increased HR of 1.094 (95% CI 1.015-1.180, p = 0.019), albeit switch from PD to HD did not show significant HR until 6 years. Interestingly, time-varying risk analysis showed a decreased HR of PD after 10 years in the non-switcher group, which was consistent in patients with high traditional risk factors (with diabetes, elderly). CONCLUSIONS PD was associated with increased HR of mortality in the first 8 years, then it was associated with decreased HR of mortality after 10 years. Dialysis modality switch was associated with increased mortality risk, but switch from PD to HD within 6 years did not show significant hazard of mortality.
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Affiliation(s)
- Jong Cheol Jeong
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sejoong Kim
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Pyo Kim
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yongjin Yi
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Shin Young Ahn
- Division of Nephrology, Department of Internal Medicine, Korea University Medical Center, 58934Korea University Guro Hospital, Seoul, Republic of Korea
| | - Dong-Chan Jin
- Department of Internal Medicine, College of Medicine, The 34923Catholic University of Korea, Seoul, Republic of Korea
| | - Ho Jun Chin
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, College of Medicine, 65462Seoul National University, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, College of Medicine, 65462Seoul National University, Republic of Korea
| | - Ki Young Na
- Department of Internal Medicine, 65462Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Internal Medicine, College of Medicine, 65462Seoul National University, Republic of Korea
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12
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Imbeault B, Nadeau-Fredette AC. Optimization of Dialysis Modality Transitions for Improved Patient Care. Can J Kidney Health Dis 2019; 6:2054358119882664. [PMID: 31666977 PMCID: PMC6798163 DOI: 10.1177/2054358119882664] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 08/17/2019] [Indexed: 02/01/2023] Open
Abstract
Purpose of review: Initial and subsequent modality decisions are important, impacting both
clinical outcomes and quality of life. Transition from chronic kidney
disease to dialysis and between dialysis modalities are periods were
patients may be especially vulnerable. Reviewing our current knowledge
surrounding these critical periods and identifying areas for future research
may allow us to develop dialysis strategies beneficial to patients. Sources of information: We searched the electronic database PubMed and queried Google Scholar for
English peer-reviewed articles using appropriate keywords (non-exhaustive
list): dialysis transitions, peritoneal dialysis, home hemodialysis,
integrated care pathway, and health-related quality of life. Primary sources
were accessed whenever possible. Methods: In this narrative review, we aim to expose the controversies surrounding
home-dialysis first strategies and examine the evidence underpinning
home-dialysis first strategies as well as home-to-home and home-to-in-center
transitions. Key findings: Diverse factors must be taken into consideration when choosing initial and
subsequent dialysis modalities. Given the limitations of available data (and
lack of convincing benefit or detriment of one modality over the other),
patient-centered considerations may prime over suspected mortality benefits
of one modality or another. Limitations: Available data stem almost exclusively from retrospective and observational
studies, often using large national and international databases, susceptible
to bias. Furthermore, this is a narrative review which takes into account
the views and opinions of the authors, especially as it pertains to optimal
dialysis pathways. Implications: Emphasis must be placed on individual patient goals and preferences during
modality selection while planning ahead to achieve timely and appropriate
transitions limiting discomfort and anxiety for patients. Further research
is required to ascertain specific interventions which may be beneficial to
patients.
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Affiliation(s)
- Benoit Imbeault
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Division of Nephrology, University Health Network, Toronto, ON, Canada
| | - Annie-Claire Nadeau-Fredette
- Division of Nephrology, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada.,Research Center, Maisonneuve-Rosemont Hospital, Montreal, QC, Canada
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13
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Nadeau-Fredette AC, Bargman JM. Characteristics Associated With Peritoneal Dialysis Technique Failure: Are We Asking the Right Questions? Am J Kidney Dis 2019; 74:586-588. [PMID: 31515139 DOI: 10.1053/j.ajkd.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022]
Affiliation(s)
| | - Joanne M Bargman
- University Health Network/Toronto General Hospital, Toronto, ON, Canada.
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14
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Chan C, Combes G, Davies S, Finkelstein F, Firanek C, Gomez R, Jager KJ, George VJ, Johnson DW, Lambie M, Madero M, Masakane I, McDonald S, Misra M, Mitra S, Moraes T, Nadeau-Fredette AC, Mukhopadhyay P, Perl J, Pisoni R, Robinson B, Ryu DR, Saran R, Sloand J, Sukul N, Tong A, Szeto CC, Van Biesen W. Transition Between Different Renal Replacement Modalities: Gaps in Knowledge and Care-The Integrated Research Initiative. Perit Dial Int 2019; 39:4-12. [PMID: 30692232 DOI: 10.3747/pdi.2017.00242] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 01/06/2018] [Indexed: 12/27/2022] Open
Abstract
Patients with end-stage kidney disease (ESKD) have different options to replace the function of their failing kidneys. The "integrated care" model considers treatment pathways rather than individual renal replacement therapy (RRT) techniques. In such a paradigm, the optimal strategy to plan and enact transitions between the different modalities is very relevant, but so far, only limited data on transitions have been published. Perspectives of patients, caregivers, and health professionals on the process of transitioning are even less well documented. Available literature suggests that poor coordination causes significant morbidity and mortality.This review briefly provides the background, development, and scope of the INTErnational Group Research Assessing Transition Effects in Dialysis (INTEGRATED) initiative. We summarize the literature on the transition between different RRT modalities. Further, we present an international research plan to quantify the epidemiology and to assess the qualitative aspects of transition between different modalities.
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Affiliation(s)
| | - Christopher Chan
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Simon Davies
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | | | | | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, The Netherlands
| | | | | | - Mark Lambie
- Institute for Applied Clinical Sciences, Keele University, Keele, UK, and Department of Nephrology, University Hospitals of North Midlands, Stoke-on-Trent, UK
| | | | - Ikuto Masakane
- Department of Nephrology, Yabuki Hospital, Yamagata, Japan
| | - Stephen McDonald
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia, and University of Adelaide, Adelaide, Australia
| | - Madhukar Misra
- Department of Medicine, Division of Nephrology, University of Missouri, Columbia, MO, USA
| | - Sandip Mitra
- Nephrology Department, Central Manchester University Hospital NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Thyago Moraes
- Nephrology, School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, Brazil
| | | | | | - Jeff Perl
- Division of Nephrology, University Health Network, Toronto, Ontario, Canada
| | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Rajiv Saran
- Division of Nephrology, Department of Medicine & Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - James Sloand
- Renal Division, Baxter Healthcare Corporation, Deerfield, IL, USA
| | - Nidhi Sukul
- Nephrology Department, University of Michigan, Ann Arbor, MI, USA
| | - Allison Tong
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Cheuk-Chun Szeto
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China
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15
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Raby AC, Labéta MO. Preventing Peritoneal Dialysis-Associated Fibrosis by Therapeutic Blunting of Peritoneal Toll-Like Receptor Activity. Front Physiol 2018; 9:1692. [PMID: 30538643 PMCID: PMC6277495 DOI: 10.3389/fphys.2018.01692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/09/2018] [Indexed: 12/30/2022] Open
Abstract
Peritoneal dialysis (PD) is an essential daily life-saving treatment for end-stage renal failure. PD therapy is limited by peritoneal inflammation, which leads to peritoneal membrane failure as a result of progressive fibrosis. Peritoneal infections, with the concomitant acute inflammatory response and membrane fibrosis development, worsen PD patient outcomes. Patients who remain infection-free, however, also show evidence of inflammation-induced membrane damage and fibrosis, leading to PD cessation. In this case, uraemia, prolonged exposure to bio-incompatible PD solutions and surgical catheter insertion have been reported to induce sterile peritoneal inflammation and fibrosis as a result of cellular stress or tissue injury. Attempts to reduce inflammation (either infection-induced or sterile) and, thus, minimize fibrosis development in PD have been hampered because the immunological mechanisms underlying this PD-associated pathology remain to be fully defined. Toll-like receptors (TLRs) are central to mediating inflammatory responses by recognizing a wide variety of microorganisms and endogenous components released following cellular stress or generated as a consequence of extracellular matrix degradation during tissue injury. Given the close link between inflammation and fibrosis, recent investigations have evaluated the role that TLRs play in infection-induced and sterile peritoneal fibrosis development during PD. Here, we review the findings and discuss the potential of reducing peritoneal TLR activity by using a TLR inhibitor, soluble TLR2, as a therapeutic strategy to prevent PD-associated peritoneal fibrosis.
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Affiliation(s)
- Anne-Catherine Raby
- The Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Mario O Labéta
- The Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
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16
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Ferreira H, Nunes A, Oliveira A, Beco A, Santos J, Pestana M. Planning Vascular Access in Peritoneal Dialysis-Defining High-Risk Patients. Perit Dial Int 2018; 38:271-277. [PMID: 29875179 DOI: 10.3747/pdi.2017.00180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/09/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Peritoneal dialysis (PD) is an effective renal replacement technique. However, every year a considerable number of patients are transferred to hemodialysis (HD). Our aim was to identify those at risk, in order to place an arteriovenous fistula (AVF). METHODS Case-control study enrolling all prevalent patients in 2014 and 2015 in our clinic. Groups: 72 case patients who were transferred definitively to HD, 111 control patients (remaining on PD, transplanted, recovered renal function, or deceased). RESULTS A total of 183 patients were eligible, with a mean age of 55.2 ± 14.8 years, 56.3% male, 31.1% diabetic, and 49.7% on continuous ambulatory PD. The mean follow-up time was 42.1 ± 25.6 months. Eighty-five patients had an AVF. The groups differed in diabetic nephropathy etiology, and in some PD-related characteristics (Kt/V, creatinine clearance, residual renal function, mean ultrafiltration, natriuretic peptide, peritonitis, hospitalizations, and hypervolemia). In multivariate analysis, Kt/V < 1.7 (odds ratio [OR] 3.00, 95% confidence interval [CI]: 1.20 - 7.50], albumin < 35 g/L (OR 4.03, 95% CI: 1.26 - 12.92), number of hospitalizations 1 to 3 (OR 2.74, 95% CI: 1.15 - 6.53) and 4 or more (OR 10.48, 95% CI: 3.62 - 30.36), and 2 or more peritonitis episodes (OR 2.50, 95% CI: 1.03 - 6.07) were predictors of PD transfer to HD. In those patients who were transferred to HD, 34 initiated HD by AVF, 2 needed a catheter due to a non-functioning AVF, and 36 did not have an AVF needing catheter placement. CONCLUSIONS Low Kt/V, low albumin, higher number of hospitalizations, and peritonitis were factors associated with PD transfer to HD, probably indicative of a high-risk PD population where arteriovenous access should be weighed.
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Affiliation(s)
- Hugo Ferreira
- Nephrology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Nunes
- Nephrology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Oliveira
- Nephrology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Beco
- Nephrology Department, Centro Hospitalar de São João, Porto, Portugal
| | - Joana Santos
- Nephrology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal
| | - Manuel Pestana
- Nephrology Department, Centro Hospitalar de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Porto, Portugal.,Nephrology and Infectious Diseases Research and Development Group, INEB-(I3S), Porto, Portugal
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17
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Obi Y, Streja E, Mehrotra R, Rivara MB, Rhee CM, Soohoo M, Gillen DL, Lau WL, Kovesdy CP, Kalantar-Zadeh K. Impact of Obesity on Modality Longevity, Residual Kidney Function, Peritonitis, and Survival Among Incident Peritoneal Dialysis Patients. Am J Kidney Dis 2018; 71:802-813. [PMID: 29223620 PMCID: PMC5970950 DOI: 10.1053/j.ajkd.2017.09.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 09/07/2017] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of severe obesity, often considered a contraindication to peritoneal dialysis (PD), has increased over time. However, mortality has decreased more rapidly in the PD population than the hemodialysis (HD) population in the United States. The association between obesity and clinical outcomes among patients with end-stage kidney disease remains unclear in the current era. STUDY DESIGN Historical cohort study. SETTING & PARTICIPANTS 15,573 incident PD patients from a large US dialysis organization (2007-2011). PREDICTOR Body mass index (BMI). OUTCOMES Modality longevity, residual renal creatinine clearance, peritonitis, and survival. RESULTS Higher BMI was significantly associated with shorter time to transfer to HD therapy (P for trend < 0.001), longer time to kidney transplantation (P for trend < 0.001), and, with borderline significance, more frequent peritonitis-related hospitalization (P for trend = 0.05). Compared with lean patients, obese patients had faster declines in residual kidney function (P for trend < 0.001) and consistently achieved lower total Kt/V over time (P for trend < 0.001) despite greater increases in dialysis Kt/V (P for trend < 0.001). There was a U-shaped association between BMI and mortality, with the greatest survival associated with the BMI range of 30 to < 35kg/m2 in the case-mix adjusted model. Compared with matched HD patients, PD patients had lower mortality in the BMI categories of < 25 and 25 to < 35kg/m2 and had equivalent survival in the BMI category ≥ 35kg/m2 (P for interaction = 0.001 [vs < 25 kg/m2]). This attenuation in survival difference among patients with severe obesity was observed only in patients with diabetes, but not those without diabetes. LIMITATIONS Inability to evaluate causal associations. Potential indication bias. CONCLUSIONS Whereas obese PD patients had higher risk for complications than nonobese PD patients, their survival was no worse than matched HD patients.
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Affiliation(s)
- Yoshitsugu Obi
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Elani Streja
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Rajnish Mehrotra
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA
| | - Matthew B Rivara
- Kidney Research Institute and Harborview Medical Center, Division of Nephrology, University of Washington, Seattle, WA
| | - Connie M Rhee
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Melissa Soohoo
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Daniel L Gillen
- Department of Statistics, University of California Irvine, School of Medicine, Orange, CA
| | - Wei-Ling Lau
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN; Nephrology Section, Memphis VA Medical Center, Memphis, TN
| | - Kamyar Kalantar-Zadeh
- Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine, School of Medicine, Orange, CA; Fielding School of Public Health at UCLA, Los Angeles, CA; Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA.
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18
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Chen JHC, Johnson DW, Hawley C, Boudville N, Lim WH. Association between causes of peritoneal dialysis technique failure and all-cause mortality. Sci Rep 2018; 8:3980. [PMID: 29507305 PMCID: PMC5838094 DOI: 10.1038/s41598-018-22335-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 02/21/2018] [Indexed: 01/27/2023] Open
Abstract
Technique failure is a frequent complication of peritoneal dialysis (PD), but the association between causes of death-censored technique failure and mortality remains unclear. Using Australian and New Zealand Dialysis and Transplant (ANZDATA) registry data, we examined the associations between technique failure causes and mortality in all incident PD patients who experienced technique failure between 1989-2014. Of 4663 patients, 2415 experienced technique failure attributed to infection, 883 to inadequate dialysis, 836 to mechanical failure and 529 to social reasons. Compared to infection, the adjusted hazard ratios (HR) for all-cause mortality in the first 2 years were 0.83 (95%CI 0.70-0.98) for inadequate dialysis, 0.78 (95%CI 0.66-0.93) for mechanical failure and 1.46 (95%CI 1.24-1.72) for social reasons. The estimates from the competing risk models were similar. There was an interaction between age and causes of technique failure (pinteraction < 0.001), such that the greatest premature mortality was observed in patients aged >60 years post social-related technique failure. There was no association between causes of technique failure and mortality beyond 2 years. In conclusion, infection and social-related technique failure are associated with premature mortality within 2 years post technique failure. Future studies examining the associations may help to improve outcomes in these patients.
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Affiliation(s)
- Jenny H C Chen
- Department of Nephrology, Prince of Wales Hospital, Sydney, Australia.
- School of Medicine, University of New South, Sydney, Australia.
| | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Brisbane, Australia
| | - Carmel Hawley
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Translational Research Institute, Brisbane, Australia
- Australasian Kidney Trials Network, Brisbane, Australia
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Wai H Lim
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
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19
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Functional and Transcriptomic Characterization of Peritoneal Immune-Modulation by Addition of Alanyl-Glutamine to Dialysis Fluid. Sci Rep 2017; 7:6229. [PMID: 28740213 PMCID: PMC5524796 DOI: 10.1038/s41598-017-05872-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 06/05/2017] [Indexed: 01/01/2023] Open
Abstract
Peritonitis remains a major cause of morbidity and mortality during chronic peritoneal dialysis (PD). Glucose-based PD fluids reduce immunological defenses in the peritoneal cavity. Low concentrations of peritoneal extracellular glutamine during PD may contribute to this immune deficit. For these reasons we have developed a clinical assay to measure the function of the immune-competent cells in PD effluent from PD patients. We then applied this assay to test the impact on peritoneal immune-competence of PD fluid supplementation with alanyl-glutamine (AlaGln) in 6 patients in an open-label, randomized, crossover pilot trial (EudraCT 2012-004004-36), and related the functional results to transcriptome changes in PD effluent cells. Ex-vivo stimulation of PD effluent peritoneal cells increased release of interleukin (IL) 6 and tumor necrosis factor (TNF) α. Both IL-6 and TNF-α were lower at 1 h than at 4 h of the peritoneal equilibration test but the reductions in cytokine release were attenuated in AlaGln-supplemented samples. AlaGln-supplemented samples exhibited priming of IL-6-related pathways and downregulation of TNF-α upstream elements. Results from measurement of cytokine release and transcriptome analysis in this pilot clinical study support the conclusion that suppression of PD effluent cell immune function in human subjects by standard PD fluid is attenuated by AlaGln supplementation.
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20
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Dialysis access: issues related to conversion from peritoneal dialysis to hemodialysis and vice versa. J Vasc Access 2017; 18:41-46. [DOI: 10.5301/jva.5000695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2017] [Indexed: 11/20/2022] Open
Abstract
Hemodialysis (HD) and peritoneal dialysis (PD) represent two complementary modalities of renal replacement therapy (RRT) for end-stage renal disease patients. Conversion between the two modalities is frequent and more likely to happen from PD to HD. Every year, 10% of PD patients convert to HD, suggesting the need for recommendations on how to proceed with the creation of a vascular access in these patients. Criteria for selecting patients who would likely fail PD, and therefore take advantage of a backup access, are undefined. Creating backup fistulas at the time of PD treatment start to allow emergency access for HD has proved to be inefficient, but it may be considered in patients with progressive difficulty in achieving adequate depuration and/or peritoneal ultrafiltration. A big challenge is represented by patients switching from PD to HD for unexpected infectious complications. Those patients need to start HD with a central venous catheter (CVC), but an alternative approach might be using an early cannulation graft, provided that infection has been cleared by the circulation. An early cannulation graft might also be used to considerably shorten the time spent using a CVC. In patients who need a conversion from HD to PD, urgent-start PD is now an accepted and well-established approach.
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21
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Ito Y, Kinashi H, Katsuno T, Suzuki Y, Mizuno M. Peritonitis-induced peritoneal injury models for research in peritoneal dialysis review of infectious and non-infectious models. RENAL REPLACEMENT THERAPY 2017. [DOI: 10.1186/s41100-017-0100-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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22
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Piraino B. Innovations in Treatment Delivery, Risk of Peritonitis, and Patient Retention on Peritoneal Dialysis. Semin Dial 2017; 30:158-163. [PMID: 28066919 DOI: 10.1111/sdi.12571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Early innovations in the delivery of peritoneal dialysis (PD) markedly improved its acceptability and lowered peritonitis rates. The standard osmotic agent was, and continues to be dextrose, an agent that is not ideal as it is readily absorbed. The development of icodextrin-containing dialysis fluid has allowed a long dwell time to provide more effective ultrafiltration. The development of a smaller, more easily used automated cycler, led to an increase in the proportion of patients on the cycler as opposed to CAPD. Recently, new cyclers with better teaching tools and ease of use and communication with the training team have come on the market; data on outcomes using these cyclers are not yet available. Peritonitis continues to be a serious complication of PD although improvements in connectology and research on Staphylococcus aureus carriage have decreased peritonitis risk. Peritonitis rates continue to vary tremendously from one program to another, which may be in part due to failure to follow best demonstrated practices in training, care of the l catheter exit site, and prevention of peritonitis. Peritonitis rates should be expressed as episodes per year at risk and as organism-specific rates to allow comparisons from one program to another, from one period to another and from a program to the published literature. The term technique failure is misused in PD. Patients leave PD for a host of reasons including transplantation. Transfer from PD to hemodialysis can be planned and have an excellent outcome or can be delayed or done emergently and have a less optimal outcome. The life plan of the patient with ESRD needs to be not only considered but also periodically revised as circumstances and patient wishes change.
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Affiliation(s)
- Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Oliver MJ, Al-Jaishi AA, Dixon SN, Perl J, Jain AK, Lavoie SD, Nash DM, Paterson JM, Lok CE, Quinn RR. Hospitalization Rates for Patients on Assisted Peritoneal Dialysis Compared with In-Center Hemodialysis. Clin J Am Soc Nephrol 2016; 11:1606-1614. [PMID: 27464838 PMCID: PMC5012487 DOI: 10.2215/cjn.10130915] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 05/21/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Assisted peritoneal dialysis is a treatment option for individuals with barriers to self-care who wish to receive home dialysis, but previous research suggests that this treatment modality is associated with a higher rate of hospitalization. The objective of our study was to determine whether assisted peritoneal dialysis has a different rate of hospital days compared to in-center hemodialysis. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a multicenter, retrospective cohort study by linking a quality assurance dataset to administrative health data in Ontario, Canada. Subjects were accrued between January 1, 2004 and July 9, 2013. Individuals were grouped into assisted peritoneal dialysis (family or home care assisted) or in-center hemodialysis on the basis of their first outpatient dialysis modality. Inverse probability of treatment weighting using a propensity score was used to create a sample in which the baseline covariates were well balanced. RESULTS The study included 872 patients in the in-center hemodialysis group and 203 patients in the assisted peritoneal dialysis group. Using an intention to treat approach, patients on assisted peritoneal dialysis had a similar hospitalization rate of 11.1 d/yr (95% confidence interval, 9.4 to 13.0) compared with 12.9 d/yr (95% confidence interval, 10.3 to 16.1) in the hemodialysis group (P=0.19). Patients on assisted peritoneal dialysis were more likely to be hospitalized for dialysis-related reasons (admitted for 2.4 d/yr [95% confidence interval, 1.8 to 3.2] compared with 1.6 d/yr [95% confidence interval, 1.1 to 2.3] in the hemodialysis group; P=0.04). This difference was partly explained by more hospital days because of peritonitis. Modality switching was associated with high rates of hospital days per year. CONCLUSIONS Assisted peritoneal dialysis was associated with similar rates of all-cause hospitalization compared with in-center hemodialysis. Patients on assisted peritoneal dialysis who experienced peritonitis and technique failure had high rates of hospitalization.
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Affiliation(s)
- Matthew J. Oliver
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ahmed A. Al-Jaishi
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Stephanie N. Dixon
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Jeffrey Perl
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Arsh K. Jain
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Division of Nephrology, London Health Sciences Center, London, Ontario, Canada
| | - Susan D. Lavoie
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Danielle M. Nash
- Kidney, Dialysis and Transplantation Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | | | - Charmaine E. Lok
- Division of Nephrology, University Health Network–Toronto General Hospital, Toronto, Ontario, Canada; and
| | - Robert R. Quinn
- Departments of Medicine and
- Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Lee S, Kim H, Kim KH, Hann HJ, Ahn HS, Kim SJ, Kang DH, Choi KB, Ryu DR. Technique failure in Korean incident peritoneal dialysis patients: a national population-based study. Kidney Res Clin Pract 2016; 35:245-251. [PMID: 27957420 PMCID: PMC5142291 DOI: 10.1016/j.krcp.2016.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/16/2016] [Accepted: 08/04/2016] [Indexed: 11/24/2022] Open
Abstract
Background Technique failure is an important issue for peritoneal dialysis (PD) patients. In this study, we aimed to analyze technique failure rate in detail and to determine the predictors for technique failure in Korea. Methods We identified all patients who had started dialysis between January 1, 2005, and December 31, 2008, in Korea, using the Korean Health Insurance Review and Assessment Service database. A total of 7,614 PD patients were included, and the median follow-up was 24.9 months. Results The crude incidence rates of technique failure in PD patients were 54.1 per 1,000 patient-years. The cumulative 1-, 2-, and 3-year technique failure rates of PD patients were 4.9%, 10.3%, and 15.6%, respectively. However, those technique failure rates by Kaplan–Meier analysis were overestimated compared with the values by competing risks analysis, and the differences increased with the follow-up period. In multivariate analyses, diabetes mellitus and Medical Aid as a crude reflection of low socioeconomic status were independent risk factors in both the Cox proportional hazard model and Fine and Gray subdistribution model. In addition, cancer was independently associated with a lower risk of technique failure in the Fine and Gray model. Conclusion Technique failure was a major concern in patients initiating PD in Korea, especially in diabetic patients and Medical Aid beneficiaries. The results of our study offer a basis for risk stratification for technique failure.
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Affiliation(s)
- Shina Lee
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyunwook Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Korea
| | - Kyoung Hoon Kim
- Department of Public Health, Graduate School, Korea University, Seoul, Korea
| | - Hoo Jae Hann
- Ewha Medical Research Institute, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Seung-Jung Kim
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Duk-Hee Kang
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Kyu Bok Choi
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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Li PKT, Szeto CC, Piraino B, de Arteaga J, Fan S, Figueiredo AE, Fish DN, Goffin E, Kim YL, Salzer W, Struijk DG, Teitelbaum I, Johnson DW. ISPD Peritonitis Recommendations: 2016 Update on Prevention and Treatment. Perit Dial Int 2016; 36:481-508. [PMID: 27282851 PMCID: PMC5033625 DOI: 10.3747/pdi.2016.00078] [Citation(s) in RCA: 619] [Impact Index Per Article: 77.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk Chun Szeto
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Beth Piraino
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Javier de Arteaga
- Department of Nephrology, Hospital Privado and Catholic University, Cordoba, Argentina
| | - Stanley Fan
- Department of Renal Medicine and Transplantation, Barts Health NHS Trust, London, UK
| | - Ana E Figueiredo
- Nursing School-FAENFI, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas N Fish
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, CO, USA
| | - Eric Goffin
- Department of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain, Belgium
| | - Yong-Lim Kim
- Department of Internal Medicine, Kyungpook National University School of Medicine, Clinical Research Center for End Stage Renal Disease, Daegu, Korea
| | - William Salzer
- University of Missouri-Columbia School of Medicine, Department of Internal Medicine, Section of Infectious Disease, MI, USA
| | - Dirk G Struijk
- Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - David W Johnson
- Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
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Overcoming the Underutilisation of Peritoneal Dialysis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:431092. [PMID: 26640787 PMCID: PMC4658397 DOI: 10.1155/2015/431092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/20/2015] [Indexed: 11/23/2022]
Abstract
Peritoneal dialysis is troubled with declining utilisation as a form of renal replacement therapy in developed countries. We review key aspects of therapy evidenced to have a potential to increase its utilisation. The best evidence to repopulate PD programmes is provided for the positive impact of timely referral and systematic and motivational predialysis education: average odds ratio for instituting peritoneal dialysis versus haemodialysis was 2.6 across several retrospective studies on the impact of predialysis education. Utilisation of PD for unplanned acute dialysis starts facilitated by implantation of peritoneal catheters by interventional nephrologists may diminish the vast predominance of haemodialysis done by central venous catheters for unplanned dialysis start. Assisted peritoneal dialysis can improve accessibility of home based dialysis to elderly, frail, and dependant patients, whose quality of life on replacement therapy may benefit most from dialysis performed at home. Peritoneal dialysis providers should perform close monitoring, preventing measures, and timely prophylactic therapy in patients judged to be prone to EPS development. Each peritoneal dialysis programme should regularly monitor, report, and act on key quality indicators to manifest its ability of constant quality improvement and elevate the confidence of interested patients and financing bodies in the programme.
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Nadeau-Fredette AC, Hawley C, Pascoe E, Chan CT, Leblanc M, Clayton PA, Polkinghorne KR, Boudville N, Johnson DW. Predictors of Transfer to Home Hemodialysis after Peritoneal Dialysis Completion. Perit Dial Int 2015; 36:547-54. [PMID: 26526050 DOI: 10.3747/pdi.2015.00121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/09/2015] [Indexed: 11/15/2022] Open
Abstract
UNLABELLED ♦ BACKGROUND The aim of the present study was to evaluate the predictors of transfer to home hemodialysis (HHD) after peritoneal dialysis (PD) completion. ♦ METHODS All Australian and New Zealand patients treated with PD on day 90 after initiation of renal replacement therapy between 2000 and 2012 were included. Completion of PD was defined by death, transplantation, or hemodialysis (HD) for 180 days or more. Patients were categorized as "transferred to HHD" if they initiated HHD fewer than 180 days after PD had ended. Multivariable logistic regression was used to evaluate predictors of transfer to HHD in a restricted cohort experiencing PD technique failure; a competing-risks analysis was used in the unrestricted cohort. ♦ RESULTS Of 10 710 incident PD patients, 3752 died, 1549 underwent transplantation, and 2915 transferred to HD, among whom 156 (5.4%) started HHD. The positive predictors of transfer to HHD in the restricted cohort were male sex [odds ratio (OR): 2.81], obesity (OR: 2.20), and PD therapy duration (OR: 1.10 per year). Negative predictors included age (OR: 0.95 per year), infectious cause of technique failure (OR: 0.48), underweight (OR: 0.50), kidney disease resulting from hypertension (OR: 0.38) or diabetes (OR: 0.32), race being Maori (OR: 0.65) or Aboriginal and Torres Strait Islander (OR: 0.30). Comparable results were obtained with a competing-risks model. ♦ CONCLUSIONS Transfer to HHD after completion of PD is rare and predicted by patient characteristics at baseline and at the time of PD end. Transition to HHD should be considered more often in patients using PD, especially when they fulfill the identified characteristics.
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Affiliation(s)
- Annie-Claire Nadeau-Fredette
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Université de Montreal, Montreal, Quebec, Canada
| | - Carmel Hawley
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Elaine Pascoe
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Christopher T Chan
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Philip A Clayton
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Sydney Medical School, University of Sydney, Sydney
| | - Kevan R Polkinghorne
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, Monash Medical Centre Monash Health, Clayton Department of Medicine and of Epidemiology and Preventive Medicine, Monash University, Melbourne
| | - Neil Boudville
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - David W Johnson
- Australia and New Zealand Dialysis and Transplant Registry, Adelaide, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Department of Nephrology, University of Queensland at Princess Alexandra Hospital, Brisbane, Australia Centre for Kidney Disease Research, Translational Research Institute, University of Queensland, Brisbane, Australia
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Jiang N, Zhang Z, Fang W, Qian J, Mou S, Ni Z. High Peritoneal Glucose Exposure Is Associated with Increased Incidence of Relapsing and Recurrent Bacterial Peritonitis in Patients Undergoing Peritoneal Dialysis. Blood Purif 2015; 40:72-8. [DOI: 10.1159/000381663] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 03/16/2015] [Indexed: 11/19/2022]
Abstract
Aim: We investigated the association of peritoneal glucose exposure and dialysis exchange number with peritonitis outcome in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods: The first episodes of bacterial peritonitis were retrospectively analyzed in 187 CAPD patients. Peritoneal glucose exposure was calculated based on PD prescription at the onset of peritonitis. Results: Patients with peritoneal glucose exposure ≤140 g/day showed a higher and complete cure rate of peritonitis (66 vs. 51.7%, p = 0.047), lower occurrence of relapsing/recurrent peritonitis (10.0 vs. 21.8%, p = 0.026) and catheter removal (14.0 vs. 26.4%, p = 0.033). Patients who exchanged more than three times every day demonstrated marginally higher catheter removal rate (24.1 vs. 13.0%, p = 0.085). Logistic analysis indicated that peritoneal glucose exposure >140 g/day was an independent predictor for relapsing/recurrent peritonitis (RR: 1.959, p = 0.042). Conclusion: High peritoneal glucose exposure is associated with increased incidence of relapsing/recurrent peritonitis in CAPD patients.
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