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Lu JC, Lee P, Ierino F, MacIsaac RJ, Ekinci E, O'Neal D. Challenges of Glycemic Control in People With Diabetes and Advanced Kidney Disease and the Potential of Automated Insulin Delivery. J Diabetes Sci Technol 2023:19322968231174040. [PMID: 37162092 DOI: 10.1177/19322968231174040] [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: 05/11/2023]
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD) and end-stage kidney disease in the world. It is known that maintaining optimal glycemic control can slow the progression of CKD. However, the failing kidney impacts glucose and insulin metabolism and contributes to increased glucose variability. Conventional methods of insulin delivery are not well equipped to adapt to this increased glycemic lability. Automated insulin delivery (AID) has been established as an effective treatment in patients with type 1 diabetes mellitus, and there is emerging evidence for their use in type 2 diabetes mellitus. However, few studies have examined their role in diabetes with concurrent advanced CKD. We discuss the potential benefits and challenges of AID use in patients with diabetes and advanced CKD, including those on dialysis.
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Affiliation(s)
- Jean C Lu
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
| | - Petrova Lee
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Francesco Ierino
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Nephrology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- St Vincent's Institute of Medical Research, Fitzroy, VIC, Australia
| | - Richard J MacIsaac
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
| | - Elif Ekinci
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
- Department of Endocrinology and Diabetes, Austin Health, Heidelberg, VIC, Australia
- Department of Medicine, Austin Hospital, The University of Melbourne, Heidelberg, VIC, Australia
| | - David O'Neal
- Department of Medicine, St Vincent's Hospital Melbourne, The University of Melbourne, Fitzroy, VIC, Australia
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
- Australian Centre for Accelerating Diabetes Innovations, The University of Melbourne, Parkville, VIC, Australia
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Tanriover C, Ucku D, Basile C, Tuttle KR, Kanbay M. On the importance of the interplay of residual renal function with clinical outcomes in end-stage kidney disease. J Nephrol 2022; 35:2191-2204. [PMID: 35819749 DOI: 10.1007/s40620-022-01388-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
Chronic kidney disease (CKD) is one of the most important public health concerns of the century, and is associated with high rates of morbidity, mortality and social costs. CKD evolving towards end-stage kidney disease (ESKD) is on the rise resulting in a greater number of patients requiring peritoneal dialysis (PD) and hemodialysis (HD). The aim of this manuscript is to review the current literature on the interplay of residual renal function (RRF) with clinical outcomes in ESKD. The persistence of RRF is one of the most important predictors of decreased morbidity, mortality, and better quality of life in both PD and HD patients. RRF contributes to the well-being of ESKD patients through various mechanisms including higher clearance of solutes, maintenance of fluid balance, removal of uremic toxins and control of electrolytes. Furthermore, RRF has beneficial effects on inflammation, anemia, malnutrition, diabetes mellitus, obesity, changes in the microbiota, and cardiac diseases. Several strategies have been proposed to preserve RRF, such as blockade of the renin-angiotensin-aldosterone system, better blood pressure control, incremental PD and HD. Several clinical trials investigating the issue of preservation of RRF are ongoing. They are needed to broaden our understanding of the interplay of RRF with clinical outcomes in ESKD.
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Affiliation(s)
- Cem Tanriover
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carlo Basile
- Associazione Nefrologica Gabriella Sebastio, Martina Franca, Italy.
| | - Katherine R Tuttle
- Division of Nephrology, University of Washington, Seattle, WA, USA.,Providence Medical Research Center, Providence Health Care, Washington, USA
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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3
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Blaine E, Tumlinson R, Colvin M, Haynes T, Whitley HP. Systematic literature review of insulin dose adjustments when initiating hemodialysis or peritoneal dialysis. Pharmacotherapy 2022; 42:177-187. [DOI: 10.1002/phar.2659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022]
Affiliation(s)
- Emily Blaine
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Robin Tumlinson
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Marion Colvin
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Tyler Haynes
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
| | - Heather P. Whitley
- Auburn University Harrison School of Pharmacy Auburn Alabama USA
- Baptist Family Medicine Baptist Health System Montgomery Alabama USA
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Jeon Y, Kim HD, Hong YA, Kim HW, Yang CW, Chang YK, Kim YK. Clinical outcomes of infection-related hospitalization in incident peritoneal dialysis patients. Kidney Res Clin Pract 2020; 39:460-468. [PMID: 33184240 PMCID: PMC7770989 DOI: 10.23876/j.krcp.20.069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/23/2022] Open
Abstract
Background Infection is the second leading cause of death in patients undergoing long-term dialysis. Peritoneal dialysis (PD) is associated with an increased risk of infection-related hospitalization (IRH) when compared with hemodialysis. In this study, we investigated the influence of IRH on clinical outcomes in incident PD patients. Methods In total, 583 incident PD patients were selected from the Clinical Research Center Registry for End-Stage Renal Disease, a nationwide multicenter prospective observational cohort study in Korea. Incident PD patients who had been hospitalized for infection-related diseases were defined as the IRH group. The primary outcome was all-cause mortality and the secondary outcome was technical failure. The median follow-up period was 29 months. Results Seventy-three PD patients (12.5%) were categorized in the IRH group. Multivariable logistic regression analysis showed that diabetes mellitus was a significant independent predictor for IRH (odds ratio, 2.43; 95% confidence interval [CI], 1.12 to 5.29; P = 0.007). The most common causes of IRH were peritonitis (63.0%) and respiratory tract infection (9.6%). Multivariable Cox proportional hazard model analysis showed that IRH was a significant independent risk factor for all-cause mortality (hazard ratio [HR], 2.51; 95% CI, 1.12 to 5.62; P = 0.026) and for the technical failure of PD (HR, 3.23; 95% CI, 1.90 to 5.51; P < 0.001). Conclusion Our data showed that after initiation of PD, IRH was significantly associated with higher risk of all-cause mortality and technical failure.
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Affiliation(s)
- Youngdong Jeon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Duk Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yu Ah Hong
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chul Woo Yang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoon-Kyung Chang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Kyun Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Cell Death Disease Research Center, The Catholic University of Korea, Seoul, Republic of Korea
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5
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Eroglu E, Heimbürger O, Lindholm B. Peritoneal dialysis patient selection from a comorbidity perspective. Semin Dial 2020; 35:25-39. [PMID: 33094512 DOI: 10.1111/sdi.12927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/27/2020] [Accepted: 09/30/2020] [Indexed: 12/17/2022]
Abstract
Despite many medical and socioeconomic advantages, peritoneal dialysis (PD) is an underutilized dialysis modality that in most countries is used by only 5%-20% of dialysis patients, while the vast majority are treated with in-center hemodialysis. Several factors may explain this paradox, such as lack of experience and infrastructure for training and monitoring of PD patients, organizational issues, overcapacity of hemodialysis facilities, and lack of economic incentives for dialysis centers to use PD instead of HD. In addition, medical conditions that are perceived (rightly or wrongly) as contraindications to PD represent barriers for the use of PD because of their purported potential negative impact on clinical outcomes in patients starting PD. While there are few absolute contraindications to PD, high age, comorbidities such as diabetes mellitus, obesity, polycystic kidney disease, heart failure, and previous history of abdominal surgery and renal allograft failure, may be seen (rightly or wrongly) as relative contraindications and thus barriers to initiation of PD. In this brief review, we discuss how the presence of these conditions may influence the strategy of selecting patients for PD, focusing on measures that can be taken to overcome potential problems.
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Affiliation(s)
- Eray Eroglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University School of Medicine, Kayseri, Turkey.,Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Olof Heimbürger
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Lindholm
- Division of Renal Medicine and Baxter Novum, Department of Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
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Marcacuzco A, Jiménez-Romero C, Manrique A, Calvo J, Cambra F, Caso Ó, García-Sesma Á, Nutu A, Justo I. Outcome of patients with hemodialysis or peritoneal dialysis undergoing simultaneous pancreas-kidney transplantation. Comparative study. Clin Transplant 2018; 32:e13268. [DOI: 10.1111/ctr.13268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2018] [Indexed: 12/11/2022]
Affiliation(s)
- Alberto Marcacuzco
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Carlos Jiménez-Romero
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Alejandro Manrique
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Jorge Calvo
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Félix Cambra
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Óscar Caso
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Álvaro García-Sesma
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Anisa Nutu
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
| | - Iago Justo
- Faculty of Medicine; Department of Surgery; Unit of HPB Surgery and Abdominal Organ Transplantation; University Hospital “Doce de Octubre”; Complutense University (UCM); Madrid Spain
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Cao L, Mou S, Fang W, Gu L, Huang J, Gu A, Qian J, Ni Z. Hyperleptinaemia, insulin resistance and survival in peritoneal dialysis patients. Nephrology (Carlton) 2015; 20:617-24. [PMID: 25907108 DOI: 10.1111/nep.12491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Liou Cao
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Shan Mou
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Wei Fang
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Leyi Gu
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Jiaying Huang
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Aiping Gu
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Jiaqi Qian
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
| | - Zhaohui Ni
- Department of Nephrology; Molecular Cell Laboratory for Kidney Disease; Shanghai Center for Peritoneal Dialysis Research; Ren Ji Hospital; School of Medicine; Shanghai Jiao Tong University; Shanghai China
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Vega-Diaz N, Gonzalez-Cabrera F, Marrero-Robayna S, Santana-Estupiñan R, Gallego-Samper R, Henriquez-Palop F, Perez-Borges P, Rodriguez-Perez JC. Renal Replacement Therapy: Purifying Efficiency of Automated Peritoneal Dialysis in Diabetic versus Non-Diabetic Patients. J Clin Med 2015; 4:1518-35. [PMID: 26239689 PMCID: PMC4519803 DOI: 10.3390/jcm4071518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/14/2015] [Accepted: 07/14/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In order to reduce the cardiovascular risk, morbidity and mortality of peritoneal dialysis (PD), a minimal level of small-solute clearances as well as a sodium and water balance are needed. The peritoneal dialysis solutions used in combination have reduced the complications and allow for a long-time function of the peritoneal membrane, and the preservation of residual renal function (RRF) in patients on peritoneal dialysis (PD) is crucial for the maintenance of life quality and long-term survival. This retrospective cohort study reviews our experience in automatic peritoneal dialysis (APD) patients, with end-stage renal disease (ESRD) secondary to diabetic nephropathy (DN) in comparison to non-diabetic nephropathy (NDN), using different PD solutions in combination. DESIGN Fifty-two patients, 29 diabetic and 23 non-diabetic, were included. The follow-up period was 24 months, thus serving as their own control. RESULTS The fraction of renal urea clearance (Kt) relative to distribution volume (V) (or total body water) (Kt/V), or creatinine clearance relative to the total Kt/V or creatinine clearance (CrCl) decreases according to loss of RRF. The loss of the slope of RRF is more pronounced in DN than in NDN patients, especially at baseline time interval to 12 months (loss of 0.29 mL/month vs. 0.13 mL/month, respectively), and is attenuated in the range from 12 to 24 months (loss of 0.13 mL/month vs. 0.09 mL/month, respectively). Diabetic patients also experienced a greater decrease in urine output compared to non-diabetic, starting from a higher baseline urine output. The net water balance was adequate in both groups during the follow up period. Regarding the balance sodium, no inter-group differences in sodium excretion over follow up period was observed. In addition, the removal of sodium in the urine output decreases with loss of renal function. The average concentration of glucose increase in the cycler in both groups (DN: baseline 1.44 ± 0.22, 12 months 1.63 ± 0.39, 24 months 1.73 ± 0.47; NDN: baseline 1.59 ± 0.40, 12 months 1.76 ± 0.47, 24 months 1.80 ± 0.46), in order to maintain the net water balance. The daytime dwell contribution, the fraction of day and the renal fraction of studies parameters provide sustained benefit in the follow-up time, above 30%. CONCLUSIONS The wet day and residual renal function are determinants in the achievement of the objective dose of dialysis, as well as in the water and sodium balance. The cause of chronic kidney disease (CKD) does not seem to influence the cleansing effectiveness of the technique.
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Affiliation(s)
- Nicanor Vega-Diaz
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Fayna Gonzalez-Cabrera
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Silvia Marrero-Robayna
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Raquel Santana-Estupiñan
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Roberto Gallego-Samper
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Fernando Henriquez-Palop
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - Patricia Perez-Borges
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
| | - José Carlos Rodriguez-Perez
- Nephrology Service, Hospital Universitario de Gran Canaria Dr. Negrin, Universidad de Las Palmas de Gran Canaria, 35019 Las Palmas de Gran Canaria, Spain.
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Coelho S, Rodrigues A. Hemoglobin A1c in Patients on Peritoneal Dialysis: How Should We Interpret It? Ther Apher Dial 2014; 18:375-82. [DOI: 10.1111/1744-9987.12166] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Silvia Coelho
- Nephrology Department; Hospital Fernando da Fonseca; Amadora Portugal
| | - Anabela Rodrigues
- Nephrology Department; Centro Hospitalar do Porto- Hospital de Santo António; Porto Portugal
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Nierenersatztherapie bei Typ-I- und Typ-II-Diabetes-Patienten. DIABETOLOGE 2013. [DOI: 10.1007/s11428-013-1091-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Xu R, Han Q, Zhu T, Ren Y, Chen J, Zhao H, Chen M, Dong J, Wang Y, Hao C, Zhang R, Zhang X, Wang M, Tian N, Wang H. Diabetic patients could do as well as non-diabetic patients without inflammation on peritoneal dialysis. PLoS One 2013; 8:e80486. [PMID: 24260402 PMCID: PMC3832492 DOI: 10.1371/journal.pone.0080486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/12/2013] [Indexed: 12/12/2022] Open
Abstract
Background Diabetic patients on peritoneal dialysis (PD) have lower survival and are more likely complicated with inflammation than their non-diabetic counterparts. Here, we explored the interaction effects between diabetes and inflammation on the survival of PD patients. Methods Overall, 2,264 incident patients were enrolled from a retrospective cohort study in China. Patients were grouped according to the baseline levels of high-sensitive C-reactive protein (hsCRP, ≤3 mg/L or >3 mg/L) or serum albumin (SA, ≥38 g/L or <38 g/L). Then, several multivariable adjusted stratified Cox regression models were constructed for these groups to explore the predicted role of diabetes on all-cause or cardiovascular death under inflammatory or non-inflammatory conditions. Results Diabetics on PD were more likely to have inflammation than non-diabetics on PD, and they presented with elevated hsCRP (52.7% vs. 47.3%, P = 0.03) or decreased SA (77.9% vs. 62.7%, P < 0.001) levels. After stratification by size of center and controlling for confounding factors, diabetes was found to predict all-cause death in patients with hsCRP >3 mg/L or SA <38 g/L but not in patients with hsCRP ≤3 mg/L or SA ≥38 g/L. Similarly, the presence of diabetes was an indication of cardiovascular death in patients with hsCRP >3 mg/L or SA <38 g/L. However, if further adjusted by baseline cardiovascular disease, the predicted role of diabetes on death related to cardiovascular disease in patients with SA <38 g/L disappeared. Conclusion Diabetic patients could do as well as non-diabetic patients without inflammation on peritoneal dialysis. Active strategies should be implemented to improve inflammation status in diabetic patients on PD.
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Affiliation(s)
- Rong Xu
- Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health, Key Laboratory of Renal Disease, Ministry of Education, Beijing, China
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Puttinger H. [Peritoneal dialysis--an ideal initial dialysis mode]. Wien Med Wochenschr 2013; 163:271-9. [PMID: 23817731 DOI: 10.1007/s10354-013-0200-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 03/26/2013] [Indexed: 11/25/2022]
Abstract
Peritoneal dialysis (PD) has become an established dialysis modality besides hemodialysis (HD). Although PD is an equal form of dialysis compared to HD, patients numbers on PD remain low worldwide. There are several reasons for this fact. The medical staff in some centers is not used to PD, so there is not enough information about the different dialysis methods available for the patients and the staff doesn't get the training that would be necessary to get familiar with PD. There are some concerns about offering PD to certain groups of patients despite excellent results as to quality of dialysis, good preservation of residual renal function, low costs compared to HD and better quality of life than on HD. However, PD should be offered to all patients requiring dialysis with very few exeptions as an ideal initial dialysis method. This includes patients with diabetes, patients with kidney transplant failure, patients with congestive heart failure and older patients.
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Affiliation(s)
- Heidi Puttinger
- Klinische Abteilung für Nephrologie und Dialyse, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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