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Wan S, Hu Y, Cheng L, He D, Wang Z, Zhang Y. Prognostic value of transthoracic echocardiography score for the prognosis of continuous ambulatory peritoneal dialysis patients. BMC Nephrol 2024; 25:65. [PMID: 38395753 PMCID: PMC10893662 DOI: 10.1186/s12882-024-03493-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND We devoted ourselves to proving that the initial transthoracic echocardiography score (TTES) had predictive significance for patients with continuous ambulatory peritoneal dialysis (CAPD). METHODS In this retrospective analysis, 274 CAPD patients who had PD therapy were recruited sequentially. TTE exams were performed three months following the start of PD therapy. All patients were divided into two groups based on the strength of their TTES levels. TTES's predictive value for CAPD patients was then determined using LASSO regression and Cox regression. RESULTS During a median of 52 months, 46 patients (16.8%) died from all causes, and 32 patients (11.7%) died from cardiovascular disease (CV). The TTES was computed as follows: 0.109 × aortic root diameter (ARD, mm) - 0.976 × LVEF (> 55%, yes or no) + 0.010 × left ventricular max index, (LVMI, g/m2) + 0.035 × E/e' ratio. The higher TTES value (≥ 3.7) had a higher risk of all-cause death (hazard ratio, HR, 3.70, 95% confidence index, 95%CI, 1.45-9.46, P = 0.006) as well as CV mortality (HR, 2.74, 95%CI 1.15-19.17, P = 0.042). Moreover, the TTES had an attractive predictive efficiency for all-cause mortality (AUC = 0.762, 95%CI 0.645-0.849) and CV mortality (AUC = 0.746, 95%CI 0.640-0.852). The introduced nomogram, which was based on TTES and clinical variables, exhibited a high predictive value for all-cause and CV mortality in CAPD patients. CONCLUSION TTES is a pretty good predictor of clinical outcomes, and the introduced TTES-based nomogram yields an accurate prediction value for CAPD patients.
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Affiliation(s)
- Sheng Wan
- Department of Nephropathy, Wuhan No.1 Hospital, No. 215 of Zhongshan Avenue, 430030, Wuhan, China
| | - Yanglin Hu
- Department of Nephropathy, Wuhan No.1 Hospital, No. 215 of Zhongshan Avenue, 430030, Wuhan, China
| | - Li Cheng
- Department of Nephropathy, Wuhan No.1 Hospital, No. 215 of Zhongshan Avenue, 430030, Wuhan, China
| | - Da He
- Department of Nephropathy, Wuhan No.1 Hospital, No. 215 of Zhongshan Avenue, 430030, Wuhan, China
| | - Zengsi Wang
- Department of Nephropathy, Wuhan No.1 Hospital, No. 215 of Zhongshan Avenue, 430030, Wuhan, China
| | - Yanmin Zhang
- Department of Nephropathy, Wuhan No.1 Hospital, No. 215 of Zhongshan Avenue, 430030, Wuhan, China.
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Hu S, Ren T, Yang B, Pei M, Gao X, Yang H, Chen H. In-Center Automated Peritoneal Dialysis: Clinical Features, Practice Patterns, and Patient Survival from a 6-Year Cohort Study in China. Kidney Blood Press Res 2023; 49:91-99. [PMID: 38061343 DOI: 10.1159/000535566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/20/2023] [Indexed: 04/26/2024] Open
Abstract
INTRODUCTION In-center automated peritoneal dialysis (APD) has been more frequently adopted in clinical practice for maintenance PD patients in China. For a better understanding of its clinical uptake, this retrospective study reviewed incident PD patients for a period of 6 years, investigating the practice pattern of in-center APD, factors associated with the use of in-center APD, and report on the patient survival compared to the nonusers of APD among hospitalized PD patients. METHODS This was a cohort study of all incident PD patients who met the inclusion criteria from January 1, 2013 to September 30, 2018, and were followed until death, cessation of PD, loss to follow-up, or December 31, 2018. Clinical characteristics, patient outcomes, and detailed data on APD sessions were recorded. We used time-dependent Cox model to estimate the variables associated with the initiation of in-center APD, and marginal structural model through inverse probability weighting to adjust for time-varying APD use on the causal pathway to all-cause mortality. RESULTS A total of 651 subjects over 17,501 patient-months were enrolled. Of these, 633 (97.2%) PD patients were hospitalized at least once during follow-up, and 369 (56.7%) received in-center APD at a certain point, and the timing of APD use during the first 3 months, first year, and first 2 years since PD inception were 14.8%, 45.4%, and 74.8%, respectively. A total of 12,553 in-center APD sessions were recorded, where 85.9% used 4 bags of 5L-exchanges per prescription. Time-dependent Cox model showed that diabetes (hazard ratio (HR), 1.39, 95% confidence interval (CI), 1.09-1.76), urine output (HR 0.80, 95% CI: 0.70-0.92), serum albumin (HR 0.84, 95% CI: 0.72-0.99), hemoglobin (HR 0.88, 95% CI: 0.77-0.99), and Ca × P (HR 1.19, 95% CI: 1.06-1.35) were significantly associated with in-center APD use. Among all hospitalized PD patients, the estimated HR corresponding to the marginal causal effect of in-center APD use on all-cause mortality was 0.13 (95% CI: 0.05-0.31, p < 0.001). Starting APD after the first PD year was associated with a significantly lower risk of all-cause mortality (adjusted-HR 0.56, 95% CI: 0.33-0.95). CONCLUSIONS In-center APD is used intensively during the first 2 years of PD and is associated with certain clinical features. Overall, in-center APD use was associated with a lower risk of all-cause death when compared with non-use.
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Affiliation(s)
- Shouci Hu
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Tong Ren
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Bo Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Ming Pei
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Xiangfu Gao
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Hongtao Yang
- Department of Nephrology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Hongbo Chen
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
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Hu J, Tang L, Zhan X, Peng F, Wang X, Wen Y, Feng X, Wu X, Gao X, Zhou Q, Zheng W, Su N, Tang X. Serum uric acid to creatinine ratio as a risk factor for mortality among patients on continuous ambulatory peritoneal dialysis: a multi-center retrospective study. Ren Fail 2023; 45:2273979. [PMID: 37905944 PMCID: PMC10653642 DOI: 10.1080/0886022x.2023.2273979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/17/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Serum uric acid to serum creatinine ratio (SUA/Scr) has emerged as a new biomarker, which is significantly associated with several metabolic diseases. However, no study has investigated the association between SUA/Scr and mortality among patients on continuous ambulatory peritoneal dialysis (CAPD). METHODS In this multicenter retrospective cohort study, we enrolled CAPD patients in eight tertiary hospitals in China from 1 January 2005 to 31 May 2021. Cox proportional hazard models were used to determine the relationship between SUA/Scr and mortality. RESULTS A total of 2480 patients were included; the mean age was 48.9 ± 13.9 years and 56.2% were males. During 12648.0 person-years of follow-up, 527 (21.3%) patients died, of which 267 (50.7%) deaths were caused by cardiovascular disease. After multivariable adjustment for covariates, per unit increase in SUA/Scr was associated with a 62.9% (HR, 1.629 (95% confidence interval (CI) 1.420-1.867)) and 73.0% (HR, 1.730 (95% CI 1.467-2.041)) higher risk of all-cause and cardiovascular mortality. Results were similar when categorized individuals by SUA/Scr quartiles. Compared with the lowest quartile of SUA/Scr, the highest and the second highest quartile of SUA/Scr had a 2.361-fold (95% CI 1.810-3.080) and 1.325-fold (95% CI 1.003-1.749) higher risk of all-cause mortality, as well as a 3.701-fold (95% CI 2.496-5.489) and 2.074-fold (95% CI 1.387-3.100) higher risk of cardiovascular mortality. Multivariable-adjusted spline regression models showed nonlinear association of SUA/Scr with mortality in CAPD patients. CONCLUSIONS Higher levels of SUA/Scr were associated with higher risk of all-cause and cardiovascular mortality in CAPD patients.
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Affiliation(s)
- Jieping Hu
- Department of Nephrology, Dongguan Tungwah Hospital, Dongguan, China
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Liwen Tang
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Yueqiang Wen
- Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiujiang, China
| | - Xianfeng Wu
- Department of Nephrology, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Xingcui Gao
- Department of Cardiology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Zheng
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
| | - Ning Su
- Department of Hematology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xingming Tang
- Department of Nephrology, Dongguan Songshan Lake Tungwah Hospital, Dongguan, China
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Miñana G, González-Rico M, de la Espriella R, González-Sánchez D, Montomoli M, Núñez E, Fernández-Cisnal A, Villar S, Górriz JL, Núñez J. Peritoneal and Urinary Sodium Removal in Refractory Congestive Heart Failure Patients Included in an Ambulatory Peritoneal Dialysis Program: Valuable for Monitoring the Course of the Disease. Cardiorenal Med 2023; 13:211-220. [PMID: 37586337 PMCID: PMC10664341 DOI: 10.1159/000531631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/24/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Spot urinary sodium emerged as a useful parameter for assessing decongestion in patients with congestive heart failure (CHF). Growing evidence endorses the therapeutic role of continuous ambulatory peritoneal dialysis (CAPD) in patients with refractory CHF and kidney disease. We aimed to examine the long-term trajectory of urinary, peritoneal, and total (urinary plus peritoneal) sodium removal in a cohort of patients with refractory CHF enrolled in a CAPD program. Additionally, we explored whether sodium removal was associated with the risk of long-term mortality and episodes of worsening heart failure (WHF). METHODS We included 66 ambulatory patients with refractory CHF enrolled in a CAPD program in a single teaching center. 24-h peritoneal, urinary, and total sodium elimination were analyzed at baseline and after CAPD initiation. Its trajectories over time were calculated using joint modeling of longitudinal and survival data. Within the framework of joint frailty models for recurrent and terminal events, we estimated its prognostic effect on recurrent episodes of WHF. RESULTS At the time of enrollment, the mean age and estimated glomerular filtration rate were 72.8 ± 8.4 years and 28.5 ± 14.3 mL/min/1.73 m2, respectively. The median urinary sodium at baseline was 2.34 g/day (1.40-3.55). At a median (p25%-p75%) follow-up of 2.93 (1.93-3.72) years, we registered 0.28 deaths and 0.24 episodes of WHF per 1 person-year. Compared to baseline (urinary), CAPD led to increased sodium excretion (urinary plus dialyzed) since the first follow-up visit (p < 0.001). Over the follow-up, repeated measurements of total sodium removal were associated with a lower risk of death and episodes of WHF. CONCLUSIONS CAPD increased sodium removal in patients with refractory CHF. Elevated sodium removal identified those patients with a lower risk of death and episodes of WHF.
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Affiliation(s)
- Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
- Universitat de València, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
| | - Miguel González-Rico
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Marco Montomoli
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Eduardo Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | | | - Sandra Villar
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Universitat de València, Valencia, Spain
- Nephrology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, INCLIVA, Valencia, Spain
- Universitat de València, Valencia, Spain
- CIBER Cardiovascular, Madrid, Spain
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Solin RSC, Kumalawati J, Yusra Y, Indrasari ND. Microbial Profile, Peritoneal Fluid White Blood Cell Count, and Outcome of Peritoneal Dialysis-Related Peritonitis at Indonesian Tertiary Hospital. J Glob Infect Dis 2023; 15:108-112. [PMID: 37800088 PMCID: PMC10549902 DOI: 10.4103/jgid.jgid_16_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Peritonitis caused by peritoneal dialysis (PD) remains a common complication of continuous ambulatory PD (CAPD). The purpose of this study is to determine the microbial profile in CAPD-related peritonitis, the optimal cutoff of white blood cell (WBC) count, and the percentage of polymorphonuclear (PMN) in CAPD fluid in the prediction of CAPD-related peritonitis, together with the outcome of CAPD-related peritonitis at an Indonesian tertiary hospital. This is a retrospective cohort study of CAPD-related peritonitis patients at Indonesian tertiary hospitals from November 2020 to October 2022. Methods Patients with suspected CAPD-related peritonitis who were tested for CAPD fluid culture and WBC count in CAPD fluid were eligible for this study. Patient's diagnosis and outcome obtained from medical records. Differences in clinical outcomes by category of microorganisms were analyzed with Fisher exact test. The Mann-Whitney test and receiver operating characteristic curve were used to determine optimal WBC and PMN cutoff. Results This study included 58 patients and 102 episodes of CAPD-related peritonitis. CAPD-related peritonitis was caused by 29.4% Gram-negative bacteria, 21.5% Gram-positive bacteria, 7.8% fungi, and 6.9% polymicrobial bacteria. CAPD fluid WBC count >79 cells/μL and PMN percentage >50% had a sensitivity of 76.4% and a specificity of 92.9% in predicting CAPD-related peritonitis. There was a significant difference in outcome between Gram-negative and Gram-positive bacterial peritonitis. Conclusions It is critical to understand the microbial profile in CAPD-related peritonitis. Lower WBC count cutoff points in CAPD fluids may improve sensitivity in predicting CAPD-related peritonitis.
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Affiliation(s)
- Ro Shinta Christina Solin
- Department of Clinical Pathology, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - July Kumalawati
- Department of Clinical Pathology, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Yusra Yusra
- Department of Clinical Pathology, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
| | - Nuri Dyah Indrasari
- Department of Clinical Pathology, Faculty of Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia
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Silva LBB, Brunaldi MO, Martinez R, Costa JACD. Peritonitis caused by paracoccidioides spp. in a patient on continuous ambulatory peritoneal dialysis - A case report. Braz J Infect Dis 2023; 27:102792. [PMID: 37488046 PMCID: PMC10412859 DOI: 10.1016/j.bjid.2023.102792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
Paracoccidioidomycosis is a systemic mycosis found mainly in South America and is the most prevalent endemic and systemic mycosis in Brazil. The purpose of this paper was to report the case of a male patient who developed peritonitis caused by Paracoccidioides spp. Forty-eight-year-old, male patient, with type I Diabetes mellitus and chronic kidney disease who was undergoing a Continuous Ambulatory Peritoneal Dialysis (CAPD) program. After eighteen months of peritoneal dialysis, the patient developed turbidity of the peritoneal fluid and was diagnosed with peritonitis. Direct mycological examination of the peritoneal fluid revealed yeasts with morphology suggestive of Paracoccidioides spp. The patient was treated with sulfamethoxazole-trimethoprim (1,600 mg/320 mg dose/day) for 61 days, but he died because a bacterial septic shock. The diagnosis of opportunistic PCM peritonitis was later confirmed by autopsy and Paracoccidioides spp. isolation. This is the first reported case of a patient on CAPD who experienced complications due peritonitis caused by opportunistic PCM.
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Affiliation(s)
- Lázaro Bruno Borges Silva
- Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Divisão de Nefrologia, Ribeirão Preto, SP, Brazil
| | - Mariângela Ottoboni Brunaldi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Patologia, Ribeirão Preto, SP, Brazil
| | - Roberto Martinez
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Doenças Infecciosas e Tropicais, Ribeirão Preto, SP, Brazil
| | - José Abrão Cardeal da Costa
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Clínica Médica, Divisão de Nefrologia, Ribeirão Preto, SP, Brazil.
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Duarsa GWK, Duarsa MDVI, Tirtayasa PMW, Mahakrishna BN, Kandarini Y, Nilawati GAP. Vagino-peritoneal fistula in pediatric patient with continuous ambulatory peritoneal dialysis and lupus nephropathy: An unusual case report. Int J Surg Case Rep 2023; 106:108167. [PMID: 37068455 PMCID: PMC10130203 DOI: 10.1016/j.ijscr.2023.108167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 04/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Continuous Ambulatory Peritoneal Dialysis (CAPD) is one of the major renal replacement therapies that is widely used, especially in children. Although CAPD patients do not need to visit the hospital on a regular basis, it is frequently followed by complications such as peritonitis, hernia, pain, and, rarely, vagino-peritoneal fistula. CASE PRESENTATION A 13-year-old female was diagnosed with end-stage renal disease due to lupus nephritis and treated with Continuous Ambulatory Peritoneal Dialysis (CAPD) for three months. She underwent a laparoscopic diagnostic procedure and removal of CAPD after being diagnosed with vagino-peritoneal fistula with signs of recurrent peritonitis. During this time, patient has no symptoms regarding the SLE condition. CLINICAL DISCUSSION Vagino-peritoneal fistula is one of the complications in CAPD patients that cause a decrease in patient's quality of life. The vaginal discharge might be an alarm sign for the possibility of a vagino-peritoneal fistula. The aggravation of inflammation due to the SLE condition may facilitate the perforation. Vagino-peritoneal fistula should be treated as soon as possible to prevent peritonitis. CONCLUSION A rare finding of vagino-peritoneal fistula as a result of peritonitis due to CAPD could be aggravated by severe inflammation in SLE patients.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Department of Urology, Sanglah General Hospital, Faculty of Medicine of Udayana University, Denpasar, Bali, Indonesia
| | | | - Pande Made Wisnu Tirtayasa
- Department of Urology, Sanglah General Hospital, Faculty of Medicine of Udayana University, Denpasar, Bali, Indonesia
| | | | - Yenny Kandarini
- Department of Internal Medicine, Sanglah General Hospital, Denpasar, Bali, Indonesia
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Hu S, Ji Y, Pei M, Yang B, Chen H, Gao X, He Q, Yang H, Ye L. The impact of long-term exposure to ambient air pollution in patients undergoing peritoneal dialysis: A cohort study in China. Chemosphere 2023; 316:137871. [PMID: 36646184 DOI: 10.1016/j.chemosphere.2023.137871] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/04/2022] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
There is increasing evidence for an association of air pollutants and the incidence of chronic kidney disease, and the progression to end stage kidney disease (ESKD). Despite the global expansion of peritoneal dialysis (PD), the impact of environmental and climatic factors in PD patients has not been studied in detail. We aimed to assess the association of long-term residential exposure to air pollutants, with patient survival and incidence of hospitalizations. This was a cohort study of all prevalent ESKD patients who were stable on PD therapy for more than 90 days in our PD center from 2013/01/01 to 2018/12/31. The enrolled patients were followed until death, cessation of PD, loss to follow-up, or 2018/12/31. Time-varying pollutant exposures were modeled as the key time-dependent variables. We used time-dependent Cox model to evaluate the risk of mortality and hospitalizations associated with air pollutant exposures adjusted for potential confounders. A total of 886 subjects who meets inclusion criteria with 27,024 patient-months were modeled. Over a mean follow-up of 30.5 ± 21.3 months, we ascertained 246 cases of death and 2611 cases of hospital admission. Significant hazard ratios (HRs) were observed for all four air pollutants including PM2.5 (hazard ratio [HR] 1.27, 95% confidence interval [95%CI] 1.05-1.54), PM10 (HR 1.31, 95%CI 1.04-1.65), NO2 (HR 1.45, 95%CI 1.02-2.06), and SO2 (HR 1.20, 95%CI 1.10-1.32) in fully adjusted model, corresponding to per interquartile range μg/m3 increase of air pollutant concentrations for mortality, and non-significant HRs for incidence of hospitalization. Non-linear associations with respect to different air pollutants were observed in models for all-cause mortality and recurrent hospitalization. The estimates for mortality were significantly higher in certain groups of patients. Our findings suggest long-term exposure to ambient air pollution was associated with higher risk of all-cause mortality in PD patients, but the association with incidence of hospitalizations was less clear.
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Affiliation(s)
- Shouci Hu
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Yue Ji
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ming Pei
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bo Yang
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Hongbo Chen
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Xiangfu Gao
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Qiang He
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China
| | - Hongtao Yang
- Division of Nephrology, First Affiliated Teaching Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, China.
| | - Liqing Ye
- Department of Nephrology, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), Hangzhou, China.
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Yan C, Zeng C, Ma Y, Zhan X, Min Y. Prevalence and risk factors of poor sleep quality in continuous ambulatory peritoneal dialysis patients in Nanchang, Southeast China. Ren Fail 2022; 44:1144-1149. [PMID: 35816167 PMCID: PMC9275507 DOI: 10.1080/0886022x.2022.2097406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to explore the prevalence and risk factors of poor sleep quality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) at the peritoneal dialysis center of the First Affiliated Hospital of Nanchang University. This cross-sectional study was conducted from March 2019 to December 2019. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the sleep quality of patients undergoing CAPD. A PSQI score of ≥5 was defined as poor sleep quality, whereas a PSQI of <5 was defined as good sleep quality. Logistic regression analysis was used to analyze risk factors for poor sleep quality. In total, 456 patients undergoing CAPD were investigated. The average PSQI score was 5.0 ± 2.9. Among the participants, 46.3% had poor sleep quality, and 45.6% were female patients. The average age was 49.4 ± 13.3 years. Compared with good sleepers, poor sleepers included a higher proportion of females and calcium–phosphorus (Ca × P) product, longer dialysis durations, lower total endogenous creatinine clearance rates, less residual renal function, and lower albumin levels. Multivariate logistic regression analysis showed that a long dialysis duration, low albumin level, and high Ca × P product were independent risk factors for poor sleep quality in patients undergoing CAPD. Odds ratios (95% confidence interval) for these risk factors were 1.01 (1.00–1.02), 0.95 (0.91–1.00), and 1.02 (1.00–1.03), respectively. Interventions aimed at improving albumin and Ca × P product levels may improve quality of life for CAPD patients.
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Affiliation(s)
- Caixia Yan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chuanfei Zeng
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yujiao Ma
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaojiang Zhan
- Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yan Min
- Department of Nursing, First Affiliated Hospital of Nanchang University, Nanchang, China
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10
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Sun H, Zhuang Y, Gao L, Xu N, Xiong Y, Yuan M, Lu J, Ye J. Impact of dialysis modality conversion on the health-related quality of life of peritoneal dialysis patients: a retrospective cohort study in China. PeerJ 2022; 10:e12793. [PMID: 35111408 PMCID: PMC8772444 DOI: 10.7717/peerj.12793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND To analyze the health-related quality of life associated with the conversion of dialysis modality among end-stage renal disease patients in China. METHODS Patients were recruited from hospitals and a dialysis center in Kunshan, China. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis were recruited as the observation group (n = 64), and patients continuing with continuous ambulatory peritoneal dialysis treatment were included in the control group (n = 64) after matching in this retrospective cohort study. Their health-related quality of life was measured using the kidney disease quality of life instrument in 2019 and 2020, respectively. Baseline socio-demographic characteristics and clinical data were collected in 2019. The before-and-after cross-group comparisons of subscale scores of two groups were conducted using a Student's t-test. Multiple linear regression models were fitted to identify the factors associated with the change of each scale. RESULTS The health-related quality of life scores of the two groups was comparable in baseline, while the observation group had higher scores in Physical Component Summary (51.92 ± 7.50), Kidney Disease Component Summary (81.21 ± 8.41), Symptoms (90.76 ± 6.30), Effects (82.86 ± 11.42), and Burden (69.04 ± 15.69) subscales after one year. In multivariate regression analysis, the change of Physical Component Summary was significantly associated with conversion to APD (β = 11.54, 95% CI [7.26-15.82]); the change of Mental Component Summary with higher education (β = - 5.96, 95% CI [-10.18--1.74]) and CCI (>2) (β = 5.39, 95% CI [1.05-9.73]); the change of Kidney Disease Component Summary with conversion to APD (β = 15.95, 95% CI [10.19-21.7]) and age (>60 years) (β = - 7.36, 95% CI [-14.11--0.61]); the change of Symptoms with CCI (>2) (β = 7.96, 95% CI [1.49-14.44]); the change of Effects with conversion to APD (β = 19.23, 95% CI [11.57-26.88]); and the change of Burden with conversion to APD (β = 22.40, 95% CI [13.46-31.34]), age (>60 years) (β = - 12.12, 95% CI [-22.59--1.65]), and higher education (β = - 10.38, 95% CI [-19.79--0.98]). CONCLUSIONS The conversion of dialysis modality had a significant impact on the scores of most subscales. Patients converting from continuous ambulatory peritoneal dialysis to automated peritoneal dialysis generally had improved health-related quality of life scores.
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Affiliation(s)
- Heqi Sun
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Ye Zhuang
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Lanying Gao
- Department of Nephrology, The First People’s Hospital of Kunshan, Suzhou, China
| | - Ningze Xu
- School of Public Health, Fudan University, Shanghai, China
| | - Yan Xiong
- Department of Nephrology, The First People’s Hospital of Kunshan, Suzhou, China
| | - Min Yuan
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China
| | - Jianming Ye
- Department of Nephrology, The First People’s Hospital of Kunshan, Suzhou, China
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11
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Hiruy AF, Opoku S, Xiong Q, Jin Q, Zhao J, Lin X, He S, Zuo X, Ying C. Nutritional predictors associated with malnutrition in continuous ambulatory peritoneal dialysis patients. Clin Nutr ESPEN 2021; 45:454-461. [PMID: 34620355 DOI: 10.1016/j.clnesp.2021.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/15/2021] [Accepted: 06/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Currently in China, out of the total dialysis population, approximately 20% represents continuous ambulatory peritoneal dialysis (CAPD) and almost half of CAPD patients was affected by malnutrition. This study aimed to investigate the association between nutritional predictors and malnutrition with 5.1 years of dialysis according to the subjective global assessment (SGA) in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS A cross-sectional study was conducted from April 2013 to May 2018 and included 70 CAPD patients. The relationship between anthropometric and biochemical parameters with malnutrition was assessed by multiple logistic regression analysis. RESULTS The prevalence of malnutrition in CAPD patients was 52.9%. Our result revealed a 7.05-fold increased odds of malnutrition for patients with protein equivalent of total nitrogen appearance normalized to body weight (nPNA) < 1.0 g/kg per day (d) versus patients with normal nPNA (confidence interval (CI) 1.33-37.34; p < 0.05). Patients whose normalized protein catabolic rate (nPCR) was <1.2 g/(kg/d) had a significant positive association with malnutrition versus patients with normal nPCR (adjusted odds ratio (OR) 7.99; p < 0.05). Patients with dietary protein intake (DPI) < 1.0 g/(kg/d) had a higher likelihood of malnutrition than those with normal DPI (OR 12.73; p < 0.05). CAPD patients with upper arm circumference (UAC) < 23.2 cm had a high risk of malnutrition versus patients with normal UAC (OR 12.99; p < 0.05). CONCLUSIONS Our study suggested a close association between nPNA, DPI, nPCR, and UAC and malnutrition in CAPD patients. Further studies can be warranted the use of these variables as predictors and a malnutrition consequence among Chinese CAPD patients.
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Affiliation(s)
- Aschalew Fikru Hiruy
- 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, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Sampson Opoku
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, 430030, 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, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Qiman Jin
- 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, 13 Hangkong Road, Wuhan, 430030, 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, 13 Hangkong Road, Wuhan, 430030, 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, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Shuiqing 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, 13 Hangkong Road, Wuhan, 430030, Hubei, China.
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, 430030, 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, 13 Hangkong Road, Wuhan, 430030, Hubei, China; Ministry of Education Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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12
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Duarsa GWK, Kandarini Y, Winarta GK, Santosa KB, Yudiana IW, Tirtayasa PMW, Pramana IBP, Oka AAG, Pradhana AP. A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis. J Sex Med 2021; 18:920-925. [PMID: 33814356 DOI: 10.1016/j.jsxm.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Erectile dysfunction (ED) is one of the sexual dysfunctions that are often encountered as a complication of male patients with stage 5 chronic kidney disease (stage 5 CKD). ED can be caused by psychological factors in patients with regular dialysis therapy. Currently, Hemodialysis (HD) therapy is the first choice in dialysis therapy and only 2% of stage 5 CKD patients are using Continuous Ambulatory Peritoneal Dialysis (CAPD) as a dialysis therapy. ED in stage 5 CKD patients should become a part of the treatment of patients with dialysis, which hopefully will improve the quality of life of patients. This study aims to compare the improvement in ED degree in patients with HD and CAPD. METHOD This study is an observational analytic comparative study involving 44 male patients with stage 5 CKD; 22 of whom underwent HD and the remaining 22 patients underwent CAPD. The differences evaluated were changes in the ED degree before and after dialysis, which were assessed using the International Index of Erectile Function-5 (IIEF-5). RESULT There were significant differences in the improvement in ED degree and IIEF-5 scores in CAPD group. In the HD group, no significant difference was obtained in the improvement in ED degree and IIEF-5 score. A significant difference was obtained in the improvement in ED degree between the HD and CAPD groups by comparing the improvement in IIEF-5 score. CONCLUSION Patients with CAPD have a better improvement in ED degree than patients with HD. Duarsa GWK, Kandarini Y, Winarta GK, et al. A Comparison of Erectile Dysfunction Improvement Between Patients With Regular Hemodialysis and Patients With Continuous Ambulatory Peritoneal Dialysis. J Sex Med Rev 2021;18:920-925.
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Affiliation(s)
- Gede Wirya Kusuma Duarsa
- Urology Division, General Surgery Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | - Yenny Kandarini
- Nephrology Division, Internal Medicine Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | - Gede Kesuma Winarta
- General Surgery Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | - Kadek Budi Santosa
- Urology Division, General Surgery Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | - I Wayan Yudiana
- Urology Division, General Surgery Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | | | - Ida Bagus Putra Pramana
- Urology Division, General Surgery Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | - Anak Agung Gde Oka
- Urology Division, General Surgery Department, Faculty of Medicine, Udayana University, Bali - Indonesia
| | - Adinda Putra Pradhana
- Anesthesiology and Intensive Care Department, Faculty of Medicine, Udayana University, Bali - Indonesia.
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13
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Dao Bui Quy Q, Pham Ngoc Huy T, Nguyen Duc L, Pham Van M, Nguyen Huu D, Nguyen Duy T, Tran Viet T, Do Q, Le Viet T. Overhydration and low serum prealbumin predict peritoneal dialysis-related peritonitis in continuous ambulatory peritoneal dialysis patients. BMC Nephrol 2020; 21:512. [PMID: 33238904 PMCID: PMC7690099 DOI: 10.1186/s12882-020-02178-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/19/2020] [Indexed: 11/11/2022] Open
Abstract
Background In this study, we focused on the role of overhydration (OH) and low serum prealbumin concentration in predicting peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients over a 3-year period. Methods We measured serum prealbumin concentration and OH by body composition monitor in 278 CAPD patients (159 males and 119 females) with a mean age of 46 years and a median peritoneal dialysis (PD) duration of 21 months. Cases of PD-related peritonitis were collected over 3 years. Results After the 3-year follow-up, 44 patients were diagnosed with PD-related peritonitis (15.8%). Low education, serum glucose, prealbumin, and OH were independent risk factors for predicting peritonitis over 36 months in CAPD patients. Based on the ROC curve model and Kaplan-Meier analysis, we realized that low prealbumin and high OH were independent predictors of 3-year peritonitis in CAPD patients (Prealbumin: AUC = 0.838, cut-off value = 32.5 mg/dL, Se = 90.9%, Sp = 32.9%; OH: AUC = 0.851, cut-off value = 1.33 L, Se = 79.5%, Sp = 85.5%; and log-rank test p < 0.001, respectively). Conclusion Overhydration and low serum prealbumin were the independent predictors of PD-related peritonitis in CAPD patients.
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Affiliation(s)
| | | | | | - My Pham Van
- University of Medicine Pham Ngoc Thach, Ho Chi Minh, Viet Nam
| | | | - Toan Nguyen Duy
- Military Hospital 103, Ha Noi, Viet Nam.,Vietnam Military Medical University, Ha Noi, Viet Nam
| | - Tien Tran Viet
- Military Hospital 103, Ha Noi, Viet Nam.,Vietnam Military Medical University, Ha Noi, Viet Nam
| | - Quyet Do
- Vietnam Military Medical University, Ha Noi, Viet Nam
| | - Thang Le Viet
- Military Hospital 103, Ha Noi, Viet Nam. .,Vietnam Military Medical University, Ha Noi, Viet Nam.
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Ounsinman T, Chongtrakool P, Angkasekwinai N. Continuous ambulatory peritoneal dialysis-associated Histoplasma capsulatum peritonitis: a case report and literature review. BMC Infect Dis 2020; 20:717. [PMID: 32993529 PMCID: PMC7526214 DOI: 10.1186/s12879-020-05441-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Case presentation An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable. Conclusion H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.
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Affiliation(s)
- Thanat Ounsinman
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nasikarn Angkasekwinai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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15
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You X, Zhou Y, Zhang J, Zhou Q, Shi Y, Su Z, Chen C, Shao R, Zhang J. Effects of parathyroid hormone and vitamin D supplementation on stroke among patients receiving peritoneal dialysis. BMC Nephrol 2020; 21:183. [PMID: 32423377 PMCID: PMC7236177 DOI: 10.1186/s12882-020-01817-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuous ambulatory peritoneal dialysis (CAPD) patients have a high incidence of stroke and commonly have increased parathyroid hormone levels and vitamin D insufficiency. We seek to investigate the incidence of stroke and the role of parathyroid hormone and vitamin D supplementation in stroke risk among CAPD patients. METHODS This study employed a retrospective design. We enrolled a Chinese cohort of 980 CAPD patients who were routinely followed in our department. The demographic and clinical data were recorded at the time of initial CAPD and during follow-up. The included patients were separated into non-stroke and stroke groups. The effects of parathyroid hormone and vitamin D supplementation on stroke in CAPD patients was evaluated. The primary endpoint is defined as the first occurrence of stroke, and composite endpoint events are defined as death or switch to hemodialysis during follow-up. RESULTS A total of 757 eligible CAPD patients with a mean follow-up time of 54.7 (standard deviation, 33) months were included in the study. The median incidence of stroke among our CAPD patients was 18.9 (interquartile range, 15.7-22.1) per 1000 person-years. A significant nonlinear correlation between baseline iPTH and hazard of stroke (p-value of linear association = 0.2 and nonlinear association = 0.002) was observed in our univariate Cox regression analysis, and low baseline iPTH levels (≤150 pg/ml) were associated with an increased cumulative hazard of stroke. Multivariate Cox regression analysis indicated a significant interaction effect between age and iPTH after adjusting for other confounders. Vitamin D supplementation during follow-up was a predictive factor for stroke in our cohort. CONCLUSIONS CAPD patients suffered a high risk of stroke, and lower iPTH levels were significantly correlated with an increased risk of stroke. Nevertheless, vitamin D supplementation may reduce the risk of stroke in these patients.
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Affiliation(s)
- Xiaohan You
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Ying Zhou
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Jianna Zhang
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Qiongxiu Zhou
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Yanling Shi
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Zhen Su
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Chaoshen Chen
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Rongrong Shao
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China
| | - Ji Zhang
- Department of Nephrology, the First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang, Ouhai District, Wenzhou, 325000, Zhejiang, P. R. China.
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16
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Usta M, Ersoy A, Ayar Y, Budak F. The relationship between lymphocyte subsets, nutritional status and tuberculin reactivity in continuous ambulatory peritoneal dialysis and hemodialysis patients. Int Urol Nephrol 2020; 52:1167-1172. [PMID: 32323130 PMCID: PMC7271018 DOI: 10.1007/s11255-020-02467-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022]
Abstract
Aim Skin test anergy is common in patients with uremia and during maintenance hemodialysis treatment. However, up to date only one study concerning skin test in peritoneal dialysis patients has focused on the issue. Our cross-sectional controlled study was conducted to analyze the correlation of purified protein derivative (PPD) test response with demographical features, nutritional parameters and the distribution of peripheral blood lymphocyte subsets in peritoneal dialysis and hemodialysis patients Patients and methods Stable 30 hemodialysis (HD) patients (16 men, 14 women) and 30 continuous ambulatory peritoneal dialysis (PD) patients (17 men, 13 women) were included. Thirty healthy cases (15 men, 15 women) with a mean age of 32.4 ± 9.4 constituted the control group. Results In the HD group, 14 patients (46.6%) were PPD positive, and ın the PD group 16 patients (53.3%) were PPD positive. In the PPD-positive HD patients 64.2% (9/14), and in the PPD-positive PD patients 62.4% (10/16) had an induration of 10 mm or greater. In the control group, 21 of 30 patients (70%) were PPD positive. Comparison of both HD and PD groups with the control group showed significant differences in PPD reactivity (p < 0.01). Albumin levels were significantly high in the control groups (p < 0.01), and cholesterol levels were significantly high in the PD and the control groups (p < 0.05). Transferrin levels were significantly high in the PD (p < 0.01). The lymphocyte counts were significantly high in the control group compared to the HD patients (p < 0.05). The lymphocyte subset percentages CD19 were high in the control groups (p < 0.05), and CD16/56 was significantly high in the PD groups (p < 0.05). All the parameters were also similar between PPD-positive and -negative same groups. Conclusion The prevalence of PPD positivity was lower in the PD and HD groups. The PPD test responses were not related to the peripheral lymphocyte counts, subsets and malnutrition parameters.
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Affiliation(s)
- Mehmet Usta
- Department of Nephrology, Bursa City Hospital, Nilüfer, 16010, Bursa, Turkey
| | - Alpaslan Ersoy
- Department of Nephrology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Yavuz Ayar
- Department of Nephrology, Bursa City Hospital, Nilüfer, 16010, Bursa, Turkey.
| | - Ferrah Budak
- Department of Microbiology and Immunology, Faculty of Medicine, Uludag University, Bursa, Turkey
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17
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Chen T, Yang M. Platelet-to-lymphocyte ratio is associated with cardiovascular disease in continuous ambulatory peritoneal dialysis patients. Int Immunopharmacol 2019; 78:106063. [PMID: 31835088 DOI: 10.1016/j.intimp.2019.106063] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/15/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) patients have a high incidence of cardiovascular disease (CVD) events, which is related to the inflammatory status of this population. Platelet-to-lymphocyte ratio (PLR) is a relatively new indicator of inflammation. The aim of this study was to investigate the relationship between PLR and the CVD events in continuous ambulatory peritoneal dialysis (CAPD) patients. METHODS A total of 70 stable CAPD patients were included in this study from February 2014 to March 2017, and complete demographic characteristics and clinical laboratory baseline data were collected at enrollment. The primary endpoint was defined as the experienced of CVD events during the follow-up period. Binary logistic regression was used to assess the association between PLR and CVD events in CAPD patients. RESULTS During a median follow-up period of 22 months, 28 (40%) CAPD patients experienced CVD events. Patients in the CVD event group had a high level of platelets (P < 0.01), C-reactive protein (P < 0.01), PLR (P < 0.01) and neutrophil-to-lymphocyte ratio (NLR) (P < 0.01). However, lymphocyte counts (P < 0.01) were significantly lower than patients without CVD events. Following adjusted binary regression analysis revealed no relationship between high NLR and CVD events (OR, 1.21; 95% CI, 0.52-2.85; p = 0.44). However, the correlation between high PLR and CVD events was significant (OR, 1.05; 95% CI, 1.02-1.08; p < 0.01). High PLR was confirmed as an independent predictor of CVD events. CONCLUSION Our results demonstrated that PLR was independently associated with CVD events. High PLR can be used to predict the risk of CVD events in CAPD patients. PLR was easy to obtain and can be considered as a routine test to serve the clinic.
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Affiliation(s)
- Tianlei Chen
- Department of Nephrology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, PR China
| | - Min Yang
- Department of Nephrology, The First People's Hospital of Changzhou, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu 213000, PR China.
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18
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Gweon TG, Jung SH, Kim SW, Lee KM, Cheung DY, Lee BI, Choi H. Risk factors for peritonitis in patients on continuous ambulatory peritoneal dialysis who undergo colonoscopy: a retrospective multicentre study. BMC Gastroenterol 2019; 19:175. [PMID: 31694579 PMCID: PMC6836509 DOI: 10.1186/s12876-019-1081-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colonoscopy is associated with a risk of peritonitis in patients on peritoneal dialysis. However, no study has yet described the risk factors in play. METHODS This was a retrospective multicentre study. The medical records of patients on continuous ambulatory peritoneal dialysis (CAPD) who underwent colonoscopy from January 2003 to December 2012 were analysed. We recorded demographic characteristics, colonoscopic factors, use of prophylactic antibiotics, and development of peritonitis. Colonoscopy-related peritonitis was defined as peritonitis developing within 1 week after colonoscopy. Demographic and clinical characteristics were compared between patients who did and those who did not develop peritonitis. RESULTS During the study period, 236 patients on CAPD underwent colonoscopy, of whom 9 (3.8%) developed peritonitis. The rates of polypectomy/endoscopic mucosal resection were significantly higher in the peritonitis group than in the no peritonitis group (66.7 vs. 23.4%, p = 0.009). Prophylactic antibiotics were prescribed before colonoscopy in 65 patients; none developed peritonitis. No patient who developed peritonitis received prophylactic antibiotics (p = 0.067). CONCLUSIONS Advanced procedures including polypectomy or endoscopic mucosal resection increase colonoscopy-related peritonitis in patients on CAPD. Randomized controlled trials to investigate whether prophylactic antibiotics are needed to prevent peritonitis in all CAPD patients are warranted.
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Affiliation(s)
- Tae-Geun Gweon
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Hoon Jung
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. .,Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Sang Woo Kim
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kang-Moon Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Young Cheung
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Bo-In Lee
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hwang Choi
- Division of Gastroenterology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Prasad N, Rangaswamy D, Patel M, Gulati S, Bhadauria D, Kaul A, Gupta A. Long-term outcomes in children on chronic continuous ambulatory peritoneal dialysis: a retrospective cohort study from a developing country. Pediatr Nephrol 2019; 34:2389-2397. [PMID: 31468143 DOI: 10.1007/s00467-019-04311-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Peritoneal dialysis (PD) is the preferred modality of dialysis among children with end-stage renal disease. METHODS To study the incidence of technique failure and survival among children with end-stage renal disease on continuous ambulatory peritoneal dialysis (CAPD), we included children younger than 18 years of age who commenced and continued PD for more than 3 months as their primary form of dialysis between 1st January 2005 and 31st December 2016. Kaplan-Meier survival analysis was applied to analyze the CAPD outcomes. RESULTS A total of 68 Tenckhoff (58 double cuffs, and ten single cuffs) catheters were inserted in 66 patients (mean age 12.3 ± 3.91 years) during the study period. Of the 66 children, 31 (47%) experienced 45 episodes of peritonitis. The total duration on CAPD was 107.58 years with a peritonitis rate of 0.42 episodes per year. Overall, the mean patient survival was 41 (95% confidence interval (CI) 29-54) months, with mean patient survival of 72% at 12 months, declining to 30% at 36 months and then remaining stable until the end of follow-up (106 months). The overall mean technique survival was 55 (95% CI 40-69) months, with mean technique survival of 69% at 12 months, declining to 44% at 36 months and then remaining stable until the end of follow-up (106 months). CONCLUSION CAPD is a viable option for end-stage renal disease in children from developing countries with a lack of access to automated PD and pediatric hemodialysis centers.
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Affiliation(s)
- Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
| | - Dharshan Rangaswamy
- Department of Nephrology (Pediatric), Kasturba Medical College and Hospital, Manipal Academy of Higher Education, Manipal (Udupi), 576104, India
| | - Manas Patel
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Sanjeev Gulati
- Pediatric Nephrology, Fortis Group of Hospitals, New Delhi, India
| | - Dharmendra Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
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Lingappa L, Ichikawa S, Gray AK, Acton D, Evans MJ, Madarasu RC, Kekunnaya R, Siddaiahagari S. An Unusual Combination of Neurological Manifestations and Sudden Vision Loss in a Child with Familial Hyperphosphatemic Tumoral Calcinosis. Ann Indian Acad Neurol 2019; 22:327-331. [PMID: 31359949 PMCID: PMC6613414 DOI: 10.4103/aian.aian_191_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hyperphosphatemia in the absence of renal failure is an unusual occurrence, particularly in children, but is a common primary feature of familial hyperphosphatemic tumor calcinosis. We report a child with hyperphosphatemia who presented with multiple episodes of neurologic dysfunction involving lower motor neuron facial nerve palsy along with sequential visual loss. He also had an episode of stroke. There was an extensive metastatic calcification of soft tissue and vasculature. Hyperphosphatemia with normal serum alkaline phosphatase, calcium, parathyroid hormone, and renal function was noted. He was managed with hemodialysis and sevelamer (3 months) without much success in reducing serum phosphate level, requiring continuous ambulatory peritoneal dialysis (3 years). Intact fibroblast growth factor 23 (FGF23) was undetectable, with C-terminal FGF23 fragments significantly elevated (2575 RU/ml, normal <180 RU/ml). Sequencing demonstrated homozygous c.486C >A (p.N162K) mutation in FGF23 exon 3, confirming the diagnoses of primary FGF23 deficiency, the first case to be reported from India.
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Affiliation(s)
- Lokesh Lingappa
- Department of Neurology and Hemato-Oncology, Rainbow Children's Hospital and Birthright, Hyderabad, Telangana, India
| | - Shoji Ichikawa
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amie K Gray
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dena Acton
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael J Evans
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Ramesh Kekunnaya
- Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisharani Siddaiahagari
- Department of Neurology and Hemato-Oncology, Rainbow Children's Hospital and Birthright, Hyderabad, Telangana, India
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Wang Y, Liu C, Wei W, Chen W. Predictive value of circulating coagulation related microRNAs expressions for major adverse cardiac and cerebral event risk in patients undergoing continuous ambulatory peritoneal dialysis: a cohort study. J Nephrol 2020; 33:157-65. [PMID: 31359371 DOI: 10.1007/s40620-019-00626-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/20/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND We aimed to investigate the correlation of coagulation related microRNAs (miRNAs) expressions with major adverse cardiac and cerebral event (MACCE) risk in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS 198 end-stage renal disease (ESRD) patients underwent CAPD were consecutively recruited in this study. Clinical characteristics as well as physiological and biochemical indexes were recorded. Peripheral blood was collected after enrollment to separate plasma, and 13 blood coagulation related miRNAs were detected by the real-time quantitative polymerase chain reaction. All patents were followed up for 48 months, and the last follow-up date was 2018/12/31. MACCEs occurred during the follow up were documented, and MACCE-free survival was calculated. RESULTS MACCE incidence at 1 year, 2 year, 3 year and 4 year was 2.5, 6.1, 9.1 and 13.1% respectively, and mean MACCE-free survival was 45.2 (95% CI 44.0-46.4) months. Kaplan-Meier curves showed that miR-30e-5p, miR-92a-3p, miR-106a-5p and miR-126-5p high expressions were associated with longer MACCE-survival, while miR-423-5p high expression correlated with shorter MACCE-free survival. Multivariate Cox's regression analysis disclosed that miR-92a-3p, miR-126-5p and miR-652-3p independently predicted longer MACCE-free survival, while miR-423-5p independently predicted reduced MACCE-free survival in CAPD patients. CONCLUSION Circulating miR-92a-3p, miR-126-5p, miR-652-3p and miR-423-5p exhibit potential to serve as novel biomarkers for MACCE risk in patients undergoing CAPD.
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Vural A, Kara İ, Şan F, Şahin Mİ, Eroğlu E, Zararsız G, Ketenci İ, Ünlü Y, Koçyiğit İ. Mucociliary clearance in patients with continuous ambulatory peritoneal dialysis. Nefrologia 2019; 39:545-551. [PMID: 31164245 DOI: 10.1016/j.nefro.2019.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 01/14/2019] [Accepted: 02/01/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Mucociliary clearance (MC) is a critical defense mechanism for the protection of the entire respiratory system. Nasal colonization of some pathogens and chronical nasal infections are important risk factors for peritonitis. Any disturbance in the MC causes stasis of secretions and secondary infections. OBJECTIVE The aim of the study was to evaluate the patients with chronic kidney disease (CKD) receiving continuous ambulatory peritoneal dialysis (CAPD) in terms of nasal MC. More specifically, the goal is to investigate the possible correlation between the nasal MC and peritonitis. METHODS Forty CAPD patients and 39 healthy volunteers were involved in the study. The nasal MC was evaluated with the saccharin test, in which a 1mm diameter saccharin particle was carefully placed on the antero-medial surface of inferior nasal concha. The time taken by the subjects from the placement of particle to the perception of the sweet taste was taken as mucociliary clearance time (MCT). The groups were compared in terms of MCT. The patient group was evaluated in terms of a peritonitis history, and the correlations with MC were analyzed. RESULTS Patient group with CKD consisted of 16 females and 24 males with a mean age of 32.4 years; healthy individuals in the control group consisted of 17 women and 22 men with a mean age of 33.3 years. There was not a significant difference in terms of mean MC time in patients with CKD when compared with the individuals in the control group. The comparison between the mean MCT in the patients who had a history of peritonitis and patients without peritonitis was statistically significant (p<0.05). CONCLUSIONS Unique for being conducted with patients in continuous ambulatory peritoneal dialysis, the current study shows that although the MC of CKD patients and healthy individuals is similar, patients with low rates of MC appear to present an increased incidence of peritoneal infection. Considering the small sample investigated, an invitation to future confirmatory studies would be appropriate.
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Affiliation(s)
- Alperen Vural
- Erciyes University, Department of Otorhinolaryngology, Kayseri, Turkey; University of Brescia, Department of Otorhinolaryngology, Brescia, Italy.
| | - İrfan Kara
- Erciyes University, Department of Otorhinolaryngology, Kayseri, Turkey
| | - Furkan Şan
- Erciyes University, Department of Otorhinolaryngology, Kayseri, Turkey
| | | | - Eray Eroğlu
- Erciyes University, Department of Internal Medicine, Division of Nephrology, Kayseri, Turkey
| | - Gökmen Zararsız
- Erciyes University, Department of Biostatistics, Kayseri, Turkey
| | - İbrahim Ketenci
- Erciyes University, Department of Otorhinolaryngology, Kayseri, Turkey
| | - Yaşar Ünlü
- Erciyes University, Department of Otorhinolaryngology, Kayseri, Turkey
| | - İsmail Koçyiğit
- Erciyes University, Department of Internal Medicine, Division of Nephrology, Kayseri, Turkey
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Surendra NK, Abdul Manaf MR, Hooi LS, Bavanandan S, Mohamad Nor FS, Shah Firdaus Khan S, Ong LM, Abdul Gafor AH. Health related quality of life of dialysis patients in Malaysia: Haemodialysis versus continuous ambulatory peritoneal dialysis. BMC Nephrol 2019; 20:151. [PMID: 31039745 PMCID: PMC6492391 DOI: 10.1186/s12882-019-1326-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 04/02/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQOL) is an important predictor of clinical outcomes for End Stage Renal Disease (ESRD) patients and to establish quality adjusted life years (QALYs) for economic evaluation studies. This study aims to measure the health utilities and to identify socio-demographic and clinical factors associated with HRQOL for haemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) in Malaysia. METHODS A total of 141 patients (77 HD and 64 CAPD) from 1 federal and four state hospitals participated in this cross-sectional study. Patients were randomly selected from the National Renal Registry (NRR) using a stratified random sampling. The EQ-5D-3 L questionnaire was used to measure HRQOL. Variables investigated include dialysis modalities, sociodemographic characteristics, co-morbidities and biochemical markers. Utilities are measured on an ordinal scale of 0-1, where 1 indicates full health and 0 indicates death. RESULTS The mean utility scores were 0.854 ± 0.181 and 0.905 ± 0.124 (p > 0.05) and the mean Visual Analogue Scale (VAS) scores were 76.2 ± 12.90 and 77.1 ± 10.26 (p > 0.05) for HD and CAPD patients respectively. There was a significant difference in problems reported between HD (35.1%) and CAPD (15.6%) on usual activities dimension (p = 0.009). The proportion of patients having problems in the pain/discomfort domain in both modalities was high (34.0%). Haemoglobin (< 10 g/dL) (p = 0.003), number of co-morbidities ≥3 (p = 0.004) and wheelchair-bound status (p < 0.001) were significant predictors of poor HRQOL. CONCLUSIONS The present cross-sectional study shows that CAPD patients have a higher utility index score than HD patients but this was not statistically significant. The utilities index score may be used to calculate QALYs.
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Affiliation(s)
- Naren Kumar Surendra
- Department of Community Health, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Cheras Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Cheras Malaysia
| | - Lai Seong Hooi
- Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, 80100 Johor Bahru, Johor Malaysia
| | | | | | | | - Loke Meng Ong
- Hospital Pulau Pinang, Residency Road, 10990 Penang, Malaysia
| | - Abdul Halim Abdul Gafor
- Nephrology Unit, Faculty of Medicine, Pusat Perubatan Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000 Kuala Lumpur, Malaysia
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Xiang S, Jin Q, Xu F, Yao Y, Liang W, Zuo X, Ye T, Ying C. High serum arsenic and cardiovascular risk factors in patients undergoing continuous ambulatory peritoneal dialysis. J Trace Elem Med Biol 2019; 52:1-5. [PMID: 30732868 DOI: 10.1016/j.jtemb.2018.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 09/13/2018] [Accepted: 11/01/2018] [Indexed: 12/12/2022]
Abstract
The present study aims to assess arsenic accumulation and explore its association with renal function and biomarkers of CVD risk in chronic kidney disease patients receiving continuous ambulatory peritoneal dialysis (CAPD). The serum was collected from 87 CAPD patients and 26 healthy subjects between 2015 and 2016. The arsenic concentration was measured by inductively coupled plasma mass spectrometer. Clinical variables related to CVD risk were determined with automatic biochemical analyzer. Serum arsenic was higher in CAPD patients as compared to healthy volunteers. Moreover, significant differences of BMI, serum phosphorus, eGFR and Ccr were observed among groups. Positive correlation between serum arsenic and serum phosphorus was found (r = 0.453, p < 0.001). While serum arsenic was negatively associated with Ccr (r = -0.328, p = 0.002) and eGFR (r = -0.248, p = 0.020). The logistic regression models revealed that high serum arsenic was related to hyperphosphatemia (ORs, 1.827; 95%CI, 1.145-2.913) after adjusted for the potential confounding factors. Overall, our findings inferred the accumulation of arsenic in CAPD patients. In addition, high serum arsenic was independently associated with the occurrence of hyperphosphatemia, which was a special and ubiquitous CVD risk factor in CAPD patients. This study provided a clue for the association between arsenic and CVD burden in CKD patients. At the same time, it suggested that prevention of arsenic accumulation should be taken into consideration clinically.
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Affiliation(s)
- Siyun Xiang
- 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, 430030, Hubei, China
| | - Qiman Jin
- 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, 430030, Hubei, China
| | - Fangyi Xu
- 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, 430030, Hubei, China
| | - Ying Yao
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China; Department of Nephrology, Tongji Hospital, Huazhong University of Science and Technology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Wangqun Liang
- Department of Nephrology, Tongji Hospital, Huazhong University of Science and Technology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xuezhi Zuo
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Ting Ye
- Department of Clinical Nutrition, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, 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, 430030, Hubei, China.
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Salgaonkar HP, Behera RR, Sharma PC, Katara A, Bhandarkar DS. Minimally invasive surgery for salvage of malfunctioning peritoneal dialysis catheters. J Minim Access Surg 2019; 15:19-24. [PMID: 29483375 PMCID: PMC6293686 DOI: 10.4103/jmas.jmas_184_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Malfunction of continuous ambulatory peritoneal dialysis (CAPD) catheters is a frequent complication and has traditionally been treated with a laparotomy. We present our experience with minimally invasive surgical (laparoscopic and thoracoscopic) salvage of CAPD catheters. Materials and Methods: Between October 2003 and June 2013, 19 patients (13 males and 6 females with a mean age of 37 years [range 28–64]) underwent minimally invasive laparoscopic salvage of malfunctioning CAPD catheters. These catheters had been placed with either a percutaneous or open technique and had been in place for a mean of 4.5 months (range 2–18 months). All the salvage procedures were performed under general anaesthesia using one 10 mm and two or three 5 mm ports. The various manoeuvres undertaken to re-establish catheter function included correct positioning the catheter and anchoring it to the pelvic peritoneum, clearing the fibrin clot/sheath, freeing up the omentum/bowel/taenia coli. In addition, all patients underwent an omentopexy. Results: Laparoscopic salvage could be completed in 18 patients with good catheter inflow and outflow established at the end of the surgery and one patient underwent thoracoscopic salvage. The median operative time was 63 min (range 45–96 min) and median post-operative hospital stay was 2 days (range 2–5 days). Low volume dialysis was commenced the day after surgery and full volume dialysis by the 10th day. There were no intra- or post-operative complications. All the catheters were functioning at the end of 6-month follow-up. Conclusions: Minimally invasive surgery is a valid, safe and efficacious way of salvaging malfunctioning CAPD catheters. This modality reduces the chances of re-formation of adhesions, ensures rapid recovery, reduced wound-related complications and allows for early institution of peritoneal dialysis.
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Affiliation(s)
| | - Ramya Ranjan Behera
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | | | - Avinash Katara
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Deepraj S Bhandarkar
- Department of Minimal Access Surgery, Hinduja Hospital, Mumbai, Maharashtra, India
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Xu L, Hu X, Chen W. Fibroblast growth factor-23 correlates with advanced disease conditions and predicts high risk of major adverse cardiac and cerebral events in end-stage renal disease patients undergoing continuous ambulatory peritoneal dialysis. J Nephrol 2018; 32:307-314. [PMID: 30465136 DOI: 10.1007/s40620-018-0557-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/12/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study aimed to investigate the correlation of serum fibroblast growth factor-23 (FGF-23) level with clinical indexes, in particular to explore the value of FGF-23 in predicting major adverse cardiac and cerebral event (MACCE) risk in end-stage renal disease (ESRD) patients undergoing continuous ambulatory peritoneal dialysis (CAPD). METHODS In 270 ESRD patients undergoing CAPD consecutively enrolled in this prospective cohort study, we collected serum samples and performed enzyme-linked immunosorbent assay to detect FGF-23 expression. MACCE-free survival was defined as the date from enrollment to the date of MACCE occurrence. RESULTS High levels of FGF-23 correlated with longer duration of dialysis (p = 0.002), elevated levels of calcium (p < 0.001), phosphorus (p = 0.037) and low density lipoprotein cholesterol (p = 0.027). MACCE occurrence rate was higher in the FGF-23 high-expression than low-expression group at 2 years (p = 0.028), 3 years (p = 0.001) and 4 years (p = 0.004). Kaplan-Meier curves revealed that MACCE-free survival was shorter in the FGF-23 high-expression than low-expression group (p = 0.004). Multivariate Cox's analysis showed that high FGF-23 expression (p = 0.011) as well as the duration of dialysis (p = 0.017), C-reactive protein (p = 0.011) and fasting blood glucose (p = 0.038) were independent predictive factors for reduced MACCE-free survival in ESRD patients undergoing CAPD. CONCLUSION High FGF-23 expression correlates with advanced disease conditions as well as increased MACCE risk, and is an independent factor predicting worse MACCE-free survival in ESRD patients undergoing CAPD.
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Affiliation(s)
- Li Xu
- Department of Nephrology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, 26 Shengli Street, Wuhan, 430000, China.
| | - Xiaosong Hu
- Department of Nephrology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, 26 Shengli Street, Wuhan, 430000, China
| | - Wenli Chen
- Department of Nephrology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, 26 Shengli Street, Wuhan, 430000, China
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Cai L, Yu J, Yu J, Peng Y, Ullah H, Yi C, Lin J, Yang X, Yu X. Prognostic value of inflammation-based prognostic scores on outcome in patients undergoing continuous ambulatory peritoneal dialysis. BMC Nephrol 2018; 19:297. [PMID: 30367618 PMCID: PMC6204053 DOI: 10.1186/s12882-018-1092-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 10/09/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inflammation-based prognostic scores have been used as outcome predictors in patients with cancer or on hemodialysis. However, their role in patients on continuous ambulatory peritoneal dialysis (CAPD) remains unclear. This study aimed to examine the prognostic value of inflammation-based composite scores for mortality in CAPD patients. METHODS This study was conducted in CAPD patients enrolled from January 1, 2006 to December 31, 2014 and followed until December 31, 2016. Three inflammation-based prognostic scores, including Glasgow prognostic score (GPS), prognostic nutritional index (PNI), and prognostic index (PI), were conducted in this study. The associations between these scores and all-cause or cardiovascular mortality were evaluated by Kaplan-Meier method and Cox proportional hazards models. The areas under the curve (AUC) of receiver-operating characteristic (ROC) analysis were used to determine the predictive values of mortality. RESULTS A total of 1501 patients were included. During a median follow-up of 38.7 (range, 21.6-62.3) months, 346 (23.1%) patients died, of which 168 (48.6%) were due to cardiovascular diseases (CVD). After adjustment for confounders, the results showed that elevated GPS, PNI, and PI scores were all independently associated with all-cause [GPS: Score 1: hazard ratio(HR) 3.94, 95% confidence interval(CI) 2.90-5.35; Score 2: HR 7.56, 95% CI 5.35-10.67; PNI: HR 1.82, 95% CI 1.36-2.43; PI: Score 1: HR 2.08, 95% CI 1.63-2.65; Score 2: HR 3.03, 95% CI 2.00-4.60)] and CVD mortality(GPS: Score 1: HR 4.41, 95% CI 2.76-7.03; Score 2: HR 9.64, 95% CI 5.72-16.26; PNI: HR 1.63, 95% CI 1.06-2.51; PI: Score 1: HR 2.57, 95% CI 1.81-3.66, Score 2: HR 3.85, 95% CI 1.99-7.46).The AUC values of GPS score were 0.798 (95% CI0.770-0.826) for all-cause mortality and 0.781 (95% CI 0.744-0.817) for CVD mortality, both of which significantly higher than those of PNI and PI scores (P < 0.001, respectively). CONCLUSIONS All elevated GPS, PNI, and PI scores were independently associated with all-cause and CVD mortality. The GPS score showed better predictive value than PNI and PI scores in CAPD patients.
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Affiliation(s)
- Lu Cai
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jianwen Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Yuan Peng
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Habib Ullah
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Chunyan Yi
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xiao Yang
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080 China
- Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, China
- Institute of Nephrology, Guangdong Medical University, Zhanjiang, China
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Baldolli A, Daurel C, Verdon R, de La Blanchardière A. High mortality in peritonitis due to Mycobacterium avium complex: retrospective study and systematic literature review. Infect Dis (Lond) 2018; 51:81-90. [PMID: 30318980 DOI: 10.1080/23744235.2018.1519639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Mycobacterium avium complex (MAC) infection is often disseminated and mainly involves lymph nodes, spleen, liver or bone marrow. Peritonitis due to MAC infection (PMAC) is a very uncommon manifestation. METHODS In this report, after describing the case of the only PMAC infection in our 10-year retrospective study, which occurred in an AIDS patient who was non-adherent to highly active antiretroviral therapy (HAART), we performed a systematic literature review of documented bacteriological PMAC. RESULTS Including our patient, 51 cases of PMAC have been reported. Patients were most often male (sex ratio 2.14), with a median age of 41 years (2.8-72) and an immunodeficiency in all cases, most often AIDS (57%), cirrhosis (20%) and continuous ambulatory peritoneal dialysis (CAPD) (18%). Ascites was more often chylous (54%) than exudative (46%) and, in this case, lymphocytic (60%), with an inconstantly positive acid-fast bacilli smear (54%). Non-disseminated PMAC patients were more likely to have peritoneal dialysis (39% versus 6.5%, p < .01) or cancer with immunosuppressive therapy (39% versus 0%, p < .0001), while AIDS was the leading underlying disease in disseminated-PMAC patients (83% versus 11%, p < .001). Mortality was high (50%), with no difference between disseminated and non-disseminated PMAC. CONCLUSIONS This report highlights the need to be aware of an atypical presentation of PMAC infection, which is associated with a high rate of mortality even for non-disseminated infection.
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Affiliation(s)
- Aurélie Baldolli
- a Infectious Diseases Department , CHU de Caen , Caen , France.,b Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie University , Caen , France
| | - Claire Daurel
- c Microbiology Department, CHU de Caen , Caen , France
| | - Renaud Verdon
- a Infectious Diseases Department , CHU de Caen , Caen , France.,b Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Normandie University , Caen , France
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Liu S, Zhuang X, Zhang M, Wu Y, Liu M, Guan S, Liu S, Miao L, Cui W. Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period. Int Urol Nephrol 2018; 50:541-549. [PMID: 29340842 PMCID: PMC5845069 DOI: 10.1007/s11255-018-1785-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 01/02/2018] [Indexed: 12/13/2022]
Abstract
Objective Whether automated peritoneal dialysis (APD) is a feasible strategy for urgent-start peritoneal dialysis (PD) therapy during the break-in period remains unclear. This study was conducted to compare the efficacy as well as complications among three PD modes during the break-in period. Methods Ninety-six patients treated with urgent-start PD after catheterization were retrospectively analyzed. Patients were divided into three groups, incremental continuous ambulatory PD (CAPD) group (n = 26); APD group (n = 42); and APD–CAPD group (n = 28). Clinical parameters at the end of the break-in period and 1 month after the initiation of PD treatment were collected and analyzed. Results Compared with the traditional incremental CAPD, APD and APD–CAPD were superior as they could effectively remove small-molecule uremic toxins and correct electrolyte imbalance (P < 0.05), while did not increase the incidence of early complications during the break-in period (P > 0.05). However, APD led to a significant decline in albumin and pre-albumin, as compared with APD–CAPD and CAPD (P < 0.05). A PD strategy consisting 6 days of APD and 3 days of CAPD showed a great advantage in preventing excessive protein loss. There were no significant differences in all tested biochemical parameters among the three groups at 1 month after treatment (all P > 0.05). Conclusion Application of APD for urgent-start PD during the break-in period is feasible. A combination of APD and CAPD regimens seems to be a more reasonable mode.
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Affiliation(s)
- Shengmao Liu
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Xiaohua Zhuang
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Min Zhang
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Yanfeng Wu
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Min Liu
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Sibo Guan
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Shujun Liu
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Lining Miao
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China
| | - Wenpeng Cui
- Department of Nephrology, Second Hospital, Jilin University, 218 Ziqiang Street, Changchun, 130041, Jilin, China.
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30
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Dogra PM, Hooda AK, Shanmugraj G, Pramanik SK. Continuous Ambulatory Peritoneal Dialysis Catheter Insertion Technique: A Comparative Study of Percutaneous versus Surgical Insertion. Indian J Nephrol 2018; 28:291-297. [PMID: 30158748 PMCID: PMC6094842 DOI: 10.4103/ijn.ijn_144_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Continuous ambulatory peritoneal dialysis (CAPD) is a standard renal replacement therapy, but there is a lack of consensus for catheter insertion method and type of catheter used. We retrospectively analyzed 140 peritoneal dialysis catheters (PDC) inserted in 139 CAPD patients by two methods; percutaneous (Group “P,” n = 47) and surgical mini laparotomy (Group “S,” n = 93) technique over a 39-month period, with cumulative experience of 2415 catheter-months: 745 catheter-months for Group “P” and 1670 catheter-months for Group “S.” Break-in period was shorter in Group “P” (P = 0.002) whereas primary nonfunction rate was comparable (P = 0.9). The mean catheter survival was better in Group “S” (17.95 ± 10.96 months vs. 15.85 ± 9.41 months in “P” group, P = 0.05) whereas the death-censored and overall catheter survival was comparable in both groups. PDC removal due to refractory peritonitis was also comparable. Mechanical complications were more in “P” group (P = 0.049), leading to higher catheter removal (P = 0.033). The peritonitis rates were higher in “P” group (1 episode per 24.8 catheter-months vs. 1 episode per 34.8 catheter-months in “S” group, P = 0.026) and related to a higher number of rural patients in the group (P = 0.04). Patient survival was comparable. There was no effect on episodes of peritonitis in those CAPD patients who had diabetic etiology or prior hemodialysis catheter-related sepsis, age, and PDC insertion method.
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Affiliation(s)
- P M Dogra
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - A K Hooda
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - G Shanmugraj
- Department of Nephrology, Command Hospital, Kolkata, West Bengal, India
| | - S K Pramanik
- Department of Medicine, Command Hospital, Kolkata, West Bengal, India
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31
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Lahiji AP, Mortazavi M, Tirani SA, Moeinzadeh F, Bidaki EZ, Naini AE, Faghihi G, Toghyani A, Farajzadegan Z. Omega-3 Supplementation Improves Pruritus in Continuous Ambulatory Peritoneal Dialysis Patients: A Crossover Randomized Pilot Clinical Trial. J Res Pharm Pract 2018; 7:195-199. [PMID: 30622987 PMCID: PMC6298140 DOI: 10.4103/jrpp.jrpp_18_64] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: Pruritus is a prevalent skin condition in end-stage renal disease patients. Omega-3 fatty acids have been shown to reduce pruritus in hemodialysis patients. Our objective was to assess the effect of 3 g/day omega-3 supplementation on pruritus among continuous ambulatory peritoneal dialysis (CAPD) patients. Methods: In this two-period, two-sequence crossover randomized clinical trial, 40 eligible subjects (CAPD patients who complained of pruritus for more than 8 weeks) were randomized to 3 g of omega-3 (n = 20) or identical placebo capsules (n = 20) for 4 weeks. After a wash-out period of 6 weeks, patients were crossed over to the alternate treatment option. Pruritus intensity was assessed using the visual analog scale (VAS) at baseline, 2-and 4-weeks post-intervention in each study period. Both patients and investigators were blinded to the study protocol. Findings: No significant carry-over effect was detected. The mean pruritus score (VAS) in the omega-3 group compared with placebo group after the first (−3.02 vs. −0.48, P < 0.001) and second (−4.09 vs. −0.43, P < 0.001) intervention periods showed higher significant decrease. Conclusion: In summary, omega-3 supplementation is an effective treatment for pruritus alleviation in CAPD patients. Further studies are needed to determine the mechanisms underlying antipruritic effects of omega-3.
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Affiliation(s)
- Arian Pourmehdi Lahiji
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, USA
| | - Mojgan Mortazavi
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shahnaz Amani Tirani
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firouzeh Moeinzadeh
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Zarea Bidaki
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Afsoon Emami Naini
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Isfahan Kidney Diseases Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gita Faghihi
- Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arash Toghyani
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ziba Farajzadegan
- Department of Community and Family Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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32
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Liu XY, Gao XM, Zhang N, Chen R, Wu F, Tao XC, Li CJ, Zhang P, Yu P. Oral Bicarbonate Slows Decline of Residual Renal Function in Peritoneal Dialysis Patients. Kidney Blood Press Res 2017; 42:565-574. [PMID: 29032379 DOI: 10.1159/000479641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/07/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Metabolic acidosis is a common consequence of end-stage renal disease (ESRD) which may result in a substantial adverse outcome. The effect of oral bicarbonate on the preservation of residual renal function (RRF) in peritoneal dialysis (PD) patients has been rarely reported. METHODS We randomly assigned 40 continuous ambulatory peritoneal dialysis (CAPD) patients to the oral bicarbonate group or placebo group at a 1: 1 ratio. All enrollments were followed for a duration of 104 weeks. We took residual creatinine clearance (CCr), a measure of residual renal function (RRF), as the primary outcome. Residual CCr was calculated as the average of urea and creatinine clearance from a 24-hour urine collection. RESULTS Thirteen patients in the placebo group and 15 patients in the treatment group completed the 104 weeks of follow-up with a comparable dropout rate (placebo group: 35% vs treatment group: 25%). Compared with the placebo group, serum bicarbonate in treatment group was significantly increased at each time point, and oral bicarbonate resulted in a slower declining rate of residual CCr (F=5.113, p=0.031). Baseline residual CCr at enrollment also had a significant effect on residual CCr (F=168.779, P<0.001). Charlson Comorbidity Index which was adopted to calculate a comorbidity score had no significant effect on residual CCr loss (F=0.168, P=0.685). CONCLUSION Oral bicarbonate may have a RRF preserving effect in CAPD patients, and a normal to high level of serum bicarbonate (≥24mmol/L) may be appropriate for RRF preservation.
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Affiliation(s)
- Xiang-Yang Liu
- Department of Diabetic Nephropathy Hemodialysis, Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Xiu-Mei Gao
- Department of Nephrology, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Ning Zhang
- Department of Endocrinology, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Rui Chen
- Department of Diabetic Nephropathy Hemodialysis, Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
| | - Feng Wu
- Department of Endocrinology, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Xin-Chao Tao
- Department of Nephrology, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Chun-Jun Li
- Department of Endocrinology, Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical Universtiy, Tianjin, China
| | - Ping Zhang
- Department of Nephrology, Chinese PLA No. 254 Hospital, Tianjin, China
| | - Pei Yu
- Department of Diabetic Nephropathy Hemodialysis, Key Laboratory of Hormones and Development (Ministry of Health), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Metabolic Diseases Hospital & Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, China
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33
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Long B, Koyfman A, Lee CM. Emergency medicine evaluation and management of the end stage renal disease patient. Am J Emerg Med 2017; 35:1946-1955. [PMID: 28893450 DOI: 10.1016/j.ajem.2017.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 09/02/2017] [Accepted: 09/03/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population. DISCUSSION ESRD incidence is rapidly increasing, and patients commonly require renal replacement therapy including hemodialysis (HDS) or peritoneal dialysis (PD), each type with specific features. These patients possess greater risk of neurologic complications, cardiopulmonary pathology, infection, and access site complications. Focused history and physical examination are essential. Neurologic issues include uremic encephalopathy, cerebrovascular pathology, and several others. Cardiopulmonary complications include pericarditis, pericardial effusion/tamponade, acute coronary syndrome, sudden cardiac death, electrolyte abnormalities, pulmonary edema, and air embolism. Infections are common, with patients more commonly presenting in atypical fashion. Access site infections and metastatic infections must be treated aggressively. Access site complications include bleeding, aneurysm/pseudoaneurysm, thrombosis/stenosis, and arterial steal syndrome. Specific medication considerations are required for analgesics, sedatives, neuromuscular blocking agents, antimicrobials, and anticoagulants. CONCLUSIONS Consideration of renal physiology with complications in ESRD can assist emergency providers in the evaluation and management of these patients. ESRD affects many organ systems, and specific pharmacologic considerations are required.
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Affiliation(s)
- Brit Long
- San Antonio Military Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Courtney M Lee
- Joint Base Elmendorf Richardson Medical Center, Department of Emergency Medicine, 5955 Zeamer Ave, JBER, AK, 99506, United States
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Li W, Xiong L, Fan L, Wang Y, Peng X, Rong R, Qiu Y, Shen J, Lin J, Yu X, Mao H. Association of baseline, longitudinal serum high-sensitive C-reactive protein and its change with mortality in peritoneal dialysis patients. BMC Nephrol 2017; 18:211. [PMID: 28676043 PMCID: PMC5496342 DOI: 10.1186/s12882-017-0624-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/19/2017] [Indexed: 02/04/2023] Open
Abstract
Background The prognostic values of baseline, longitudinal high-sensitivity C-reactive protein (hs-CRP) and its change over time on mortality in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) remain uncertain. Methods We retrospectively studied 1228 consecutive CAPD patients from 2007 to 2012, and followed up through December 2014. Cox regression models were performed to assess the association of hs-CRP on outcomes using serum hs-CRP levels as: (1) stratified by tertile of baseline or longitudinal hs-CRP levels; (2) baseline or longitudinal hs-CRP levels as continuous variables; and (3) categorized by tertile of slopes of hs-CRP change per year for each subject. Results Higher baseline hs-CRP levels were not associated with clinical outcomes after adjustment for potential confounders. However, patients with the upper tertile of longitudinal hs-CRP had a nearly twice-fold increased risk of both all-cause and cardiovascular mortality [adjusted hazard ratio (HR) 1.77; (95% CI 1.16–2.70) and 2.08 (1.17–3.71), respectively], as compared with those with lower tertile. Results were similar when baseline or longitudinal hs-CRP was assessed as continuous variable. Additionally, the risk of all-cause and cardiovascular mortality in patients with increased trend in serum hs-CRP levels over time (tertile 3) was significantly higher [adjusted HR 2.48 (1.58–3.87) and 1.99 (1.11–3.56), respectively] when compared to those with relatively stable hs-CRP levels during follow-up period. These associations persisted after excluding subjects with less than 1-year follow up. Conclusions Higher longitudinal serum hs-CRP levels and its elevated trend over time, but not baseline levels were predictive of worse prognosis among CAPD patients.
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Affiliation(s)
- Wei Li
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Liping Xiong
- Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Li Fan
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Yating Wang
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Xuan Peng
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Rong Rong
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Yagui Qiu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jiani Shen
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jianxiong Lin
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Xueqing Yu
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Haiping Mao
- Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Key Laboratory of Nephrology, Ministry of Health of China, 58 Zhongshan Road II, Guangzhou, 510080, China.
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35
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Uzunoglu E, Sahin AM. Paecilomyces variotii peritonitis in a patient on continuous ambulatory peritoneal dialysis. J Mycol Med 2017; 27:277-280. [PMID: 28363816 DOI: 10.1016/j.mycmed.2017.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 01/26/2017] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Abstract
Paecilomyces variotii (P. variotii) is an extremely rare cause of continuous ambulatory peritoneal dialysis (CAPD) peritonitis. When diagnosed, it usually portends poor prognosis. Patient's survival depends on early laboratory diagnosis and proper treatment. We herein report a P. variotii peritonitis in a patient on CAPD which is a quite rare clinical entity. Laboratory diagnosis was confirmed via both morphological analysis and DNA sequencing. Antifungal susceptibility tests were performed and interpreted according to the Clinical Laboratory Standards Institute M38-A2 guidelines. After laboratory diagnosis, the patient was treated succesfully with liposomal amphotericin B and itraconazole combination and the peritoneal catheter was removed. This case is worthy of reporting since P. variotii is an uncommon cause of peritonitis and leads to dilemmas in both laboratory diagnosis and treatment strategies.
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Affiliation(s)
- E Uzunoglu
- Giresun University, Medical Faculty, Medical Microbiology Department, 28100 Giresun, Turkey.
| | - A M Sahin
- Ozdemir State Hospital, Infectious Disease and Clinical Microbiology Clinic, Giresun, Turkey
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36
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Taheri S, Ahmadnia M, Mortazavi M, Karimi S, Reihani H, Seirafian S. Comparing the Effect of Dressing Versus No-dressing on Exit Site Infection and Peritonitis in Chronic Ambulatory Peritoneal Dialysis Patients. Adv Biomed Res 2017; 6:5. [PMID: 28217650 PMCID: PMC5309448 DOI: 10.4103/2277-9175.199263] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Bachground: Peritonitis and exit site (ES) infection are two main complications of peritoneal dialysis. There are some controversies regard to preventive strategies for ES care. In this study we compared peritonitis and ES infection rates in patients with and without dressing. Materials and Methods: This historical cohort study carried out on 72 patients under continuous ambulatory peritoneal dialysis treatment, 54 with dressing versus 18 patients without dressing, followed from October 1, 2010 to March 31, 2011 for peritonitis and ES infection. Results: A total of 17 episodes of ES infection occurred in 12 patients in dressing group, but no case was seen in no-dressing group (P = 0.02). Twenty-one episodes of peritonitis occurred in 15 patients in both groups (one episode every 20.6 patient-months). In no-dressing group two episodes occurred in only one patient (one episode every 54 patient-months), and in dressing group, 19 episode in 14 patients (one episode every 17.1 patient-months) (P = 0.03). Peritonitis was significantly more frequent in male versus female in overall patients (38% vs. 14%, P = 0.025) and in dressing group (52% vs. 15%, P = 0.003). In dressing group, peritonitis was more frequent in diabetics versus non-diabetics (48% vs. 11%, P = 0.01). Odds ratio for developing peritonitis was 9.4 in dressing group (95% confidence interval [CI] =1.05 − 84.4; P = 0.045), and 4.4 in men (95% CI = 1.26 − 15.19; P = 0.02). Conclusion: In this study, chronic ES care without dressing was associated with lower risk of peritonitis and ES infection.
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Affiliation(s)
- Shahram Taheri
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdieh Ahmadnia
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirin Karimi
- Isfahan Kidney Diseases Research Center, Peritoneal Dialysis Ward, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homa Reihani
- Isfahan Kidney Diseases Research Center, Peritoneal Dialysis Ward, Al-Zahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Seirafian
- Isfahan Kidney Diseases Research Center, Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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37
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Ndlovu KCZ, Assounga A. Continuous Ambulatory Peritoneal Dialysis in Patients with HIV and End-Stage Renal Failure. Perit Dial Int 2016; 37:321-330. [PMID: 27935535 DOI: 10.3747/pdi.2016.00165] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 09/20/2016] [Indexed: 12/21/2022] Open
Abstract
♦ BACKGROUND: This study aimed to evaluate the differences in continuous ambulatory peritoneal dialysis (CAPD)-related outcomes according to human immunodeficiency virus (HIV) status of end-stage renal failure patients. ♦ METHODS: This prospective cohort study included 70 HIV-negative and 70 HIV-positive consecutive patients with renal failure who underwent dialysis with newly inserted Tenckhoff catheters between September 2012 and February 2015. Patients were followed up monthly at a central renal clinic for 1 year or until the primary endpoints of technique failure or death. ♦ RESULTS: Technique failure rates were similar (HIV-negative: 0.270 episodes/person-year; HIV-positive: 0.298 episodes/person-year; hazard ratio [HR], 1.09; 95% confidence interval [CI], 0.51 - 2.32; p = 0.822). However, there were fewer HIV-positive patients with complete 1-year follow-up with a patent catheter (42.9% vs 58.6% in the HIV-negative cohort; p = 0.063) owing to their higher all-cause mortality rate (0.55 vs 0.25 deaths/person-year, respectively; HR, 2.11; CI, 1.07 - 4.14; p = 0.031). Cluster of differentiation 4 count (CD4) < 200/μL (HR, 5.39; CI, 2.20 - 13.21; p < 0.001) and unsuppressed viral load (HR, 3.63; CI 1.72 - 7.67; p = 0.001) were associated with increased mortality hazards. Rates of first peritonitis were 0.616 (HIV-negative) and 1.668 (HIV-positive) episodes/person-year (HR, 2.38; CI, 1.46 - 3.89; p = 0.001). All-cause admission rates were 1.52 (HIV-negative) and 2.97 (HIV-positive) hospital admissions/person-year (HR, 1.66; CI, 1.12 - 2.48; p = 0.013). ♦ CONCLUSION: Although HIV-seropositive status of patients on CAPD did not adversely influence technique failure rates or patency at 1 year, uncontrolled HIV infection may be associated with increased relative risk of mortality and morbidity.
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Affiliation(s)
- Kwazi C Z Ndlovu
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa .,Department of Nephrology, University of KwaZulu-Natal, Durban, South Africa
| | - Alain Assounga
- Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Nephrology, University of KwaZulu-Natal, Durban, South Africa
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Naini AE, Karbalaie A, Abedini M, Askari G, Moeinzadeh F. Comparison of malnutrition in hemodialysis and peritoneal dialysis patients and its relationship with echocardiographic findings. J Res Med Sci 2016; 21:78. [PMID: 27904623 PMCID: PMC5122224 DOI: 10.4103/1735-1995.189695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 08/29/2015] [Accepted: 05/09/2016] [Indexed: 12/11/2022]
Abstract
Background: Malnutrition is common in patients with end-stage renal disease (ESRD) who on peritoneal dialysis (PD) or hemodialysis (HD). This study aimed to compare the frequency distribution of malnutrition in HD and PD patients and its relationship with echocardiographic findings. Materials and Methods: This is a case–control study. Using the simple random sampling, 109 patients were selected among HD and PD patients based on the inclusion criteria. HD and PD groups included 55 and 54 patients, respectively. The malnutrition-inflammation score (MIS) index was used to assess malnutrition. Echocardiography was performed by a cardiologist. All the data were analyzed by SPSS version 18. Results: In this study, 79.6% (43 patients) were in the PD group with MIS <9 (no malnutrition to mild malnutrition) and 20.4% (11 patients) with 9 ≤ MIS ≤ 18 suffered from moderate malnutrition. In the HD group, 72.7% (forty patients) had MIS < 9, 25.5% (14) had 9 ≤ MIS ≤ 18, and 1.8% (one patient) with MIS > 18 suffered from severe malnutrition (P = 0.74). There was no significant relationship between MIS and echocardiographic findings in PD patients (P > 0.05). In the HD group, there was no significant relationship between MIS and echocardiographic findings (P > 0.05), except for aortic and mitral valve insufficiencies (P < 0.05). Conclusion: The findings of this study show 27.3% of HD patients had moderate to severe malnutrition. There was a statistically significant relationship between MIS index and aortic and mitral valve insufficiencies in HD patients.
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Affiliation(s)
- Afsoon Emami Naini
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Karbalaie
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mokhtar Abedini
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Firouzeh Moeinzadeh
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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39
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Schindler R. [Renal replacement therapy in the elderly]. Z Gerontol Geriatr 2016; 49:483-7. [PMID: 27444435 DOI: 10.1007/s00391-016-1110-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/19/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
Renal function in humans declines with old age. Currently, the normal range for renal function is not differentiated by age but uniformly given, which has evoked criticism. The symptoms of high-grade impairment of renal function are nonspecific. The current data situation does not support early initiation of dialysis: on the contrary, initiation of dialysis should be decided from clinical aspects and not according to the values for the glomerular filtration rate (GFR). Elderly patients should be offered peritoneal dialysis (PD) as well as hemodialysis (HD), which can be performed either at home (PD) or at a dialysis center (HD or PD). Patients and their relatives should be presented with all available information on both therapy options but there are also conservative, palliative therapy options for the very old or for those with a high number of comorbidities. The decision for therapy should be individualized and tailored for each patient. The planning of kidney replacement therapy should be carried out well in advance. A multidisciplinary team should discuss possible barriers to one or the other treatment option and provide assistance for implementation of the individual optimal therapy. In some cases a home-based assisted PD can be a sensible option.
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Affiliation(s)
- H Nakamura
- Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
| | - M Anayama
- Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
| | - Y Makino
- Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
| | - K Tamura
- Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
| | - M Nagasawa
- Department of Nephrology, Shinonoi General Hospital, Nagano, Japan
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Abstract
Background and Objectives: Continuous ambulatory peritoneal dialysis has become an increasingly popular modality of renal replacement therapy. Laparoscopic placement of peritoneal dialysis catheters may help overcome previous barriers to peritoneal dialysis, such as previous abdominal surgical procedures or the presence of hernias, without incurring substantially greater risks. Methods: We performed a retrospective review of 120 consecutive patients who underwent attempted laparoscopic peritoneal dialysis catheter placement between July 2009 and June 2014 by a single surgeon. Patient and catheter characteristics and outcomes were compared between patients with and without complications, as well as between patients with a history of major abdominal surgery and those without such a history. Results: Laparoscopic peritoneal dialysis catheter placement was aborted in 4 patients because of an inability to safely achieve sufficient access to the abdominal cavity through dissection; these patients were excluded from subsequent analysis. The mean follow-up period was 18.8 ± 12.9 months. Fifty-five patients had a history of major abdominal surgery compared with 61 without such a history. No significant difference was observed with respect to age, race, sex, or body mass index between groups. Notably, more adjunctive procedures were required in patients with previous abdominal surgery, including adhesiolysis (60.0% vs 4.9%, P < .0001) and hernia repair (12.7% vs 1.6%, P = .026). Postoperative catheter complications were not significantly different between patients with and patients without a history of abdominal surgery (29.1% vs 32.8%, P = .667). Both unassisted (56.8% vs 65.0%, P = .397) and overall (72.7% vs 76.7%, P = .647) 1-year catheter survival rates were similar between patients with and patients without previous surgery, and the overall 1-year survival rate improved to 83.9% on exclusion of patients who stopped peritoneal dialysis for nonsurgical reasons. Conclusions: Laparoscopic peritoneal dialysis catheter placement offers a chance to establish peritoneal dialysis access in patients traditionally viewed as noncandidates for this modality. Despite the potential risks incurred because of additional procedures at the time of catheter placement in these complicated cases, these patients can achieve good long-term peritoneal dialysis access with an aggressive surgical approach.
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Affiliation(s)
- Adam T Hauch
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Peter W Lundberg
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Anil S Paramesh
- Department of General Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Zhang P, Wu HM, Shen QY, Liu RY, Qi XM. Associations of pulmonary function with serum biomarkers and dialysis adequacy in patients undergoing peritoneal dialysis. Clin Exp Nephrol 2016; 20:951-959. [PMID: 26868146 DOI: 10.1007/s10157-016-1244-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 02/02/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND As lung impairment is an indicator of increased morbidity and mortality in patients receiving continuous ambulatory peritoneal dialysis (CAPD), the risk factors associated with impaired lung function are of great significance. The aim of this study is to elucidate the effects of inflammatory biomarkers and dialysis adequacy on pulmonary function, in CAPD patients. METHODS 101 patients undergoing CAPD, 30 CKD5 patients and 30 healthy subjects were enrolled. Spirometry and serum biomarkers were evaluated in each subject. Pulmonary function was compared among patients and control groups. Pearson analysis was used to analyze the correlation between serum biomarkers, dialysis adequacy and pulmonary function. RESULTS Lower vital capacity, maximal voluntary ventilation (MVV), forced vital capacity (FVC), peak expiratory flow (PEF), maximal mid-expiratory flow rate (MMEF), and diffusing capacity of the lung for carbon monoxide (DLCO) were observed in the CAPD group (all P < 0.05) when compared with control subjects. DLCO % was negatively correlated with CRP (r = -0.349, P = 0.007) and positively correlated with albumin (r = 0.401, P = 0.002). Total Kt/V was associated positively with MMEF % (r = 0.316, P = 0.019), and MVV % (r = 0.362, P = 0.007). nPNA was positively correlated with FVC % (r = 0.295, P = 0.049) and MMEF % (r = 0.381, P = 0.010). CONCLUSION The results suggest that lung function decline was directly related to higher CRP level, hypoalbuminemia, and dialysis inadequacy. These findings provide the evidence that inflammation and dialysis adequacy play a role in predicting outcomes of CAPD patients with pulmonary impairment.
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Affiliation(s)
- Pei Zhang
- Department of Pulmonary, Anhui Geriatric Institute, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, Anhui, 230022, People's Republic of China.,Department of Nephrology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Hui-Mei Wu
- Department of Pulmonary, Anhui Geriatric Institute, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, Anhui, 230022, People's Republic of China.,Institute of Respiratory Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Qi-Ying Shen
- Department of Pulmonary, Anhui Geriatric Institute, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, Anhui, 230022, People's Republic of China.,Institute of Respiratory Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
| | - Rong-Yu Liu
- Department of Pulmonary, Anhui Geriatric Institute, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei, Anhui, 230022, People's Republic of China. .,Institute of Respiratory Diseases, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China.
| | - Xiang-Ming Qi
- Department of Nephrology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, People's Republic of China
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Liu Y, Huang R, Guo Q, Yang Q, Yi C, Lin J, Yu X, Yang X. Baseline higher peritoneal transport had been associated with worse nutritional status of incident continuous ambulatory peritoneal dialysis patients in Southern China: a 1-year prospective study. Br J Nutr 2015; 114:398-405. [PMID: 26244901 DOI: 10.1017/S0007114515001804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of the present study was to investigate the relationship between baseline peritoneal transport types and nutritional status in Chinese continuous ambulatory peritoneal dialysis (CAPD) patients. In the present single-centre, prospective study, incident CAPD patients were included from 15 April 2010 to 31 December 2011 and were followed up for 12 months. According to the results of baseline peritoneal equilibration test, patients were divided into lower peritoneal transport group (lower transporters) and higher peritoneal transport group (higher transporters). Nutritional status was evaluated by both subjective global assessment (SGA) and protein-energy wasting (PEW) score. The body composition parameters were assessed by body impedance analysis. A total of 283 CAPD patients were included in the study, of which 171 (60.4 %) were males with a mean age of 47.0 (sd 14.9) years. Compared with lower transporters (n 92), higher transporters (n 181) had lower levels of serum albumin (37.1 (sd 4.3) v. 39.6 (sd 4.3) g/l, P< 0.001), serum pre-albumin (356 (sd 99) v. 384 (sd 90) mg/l, P= 0.035), phase angle (6.15 (sd 0.39) v. 6.27 (sd 0.47)°, P< 0.05) and higher rate of malnutrition defined by SGA (52.5 v. 25.0%, P< 0.001) and PEW score (37.0 v. 14.1 %, P< 0.001) at 1-year of follow-up. Baseline higher peritoneal transport, analysed by multivariate binary logistic regressions, was independently associated with malnutrition (SGA mild to moderate and severe malnutrition: OR 3.43, 95% CI 1.69, 6.96, P< 0.01; PEW: OR 2.40, 95% CI 1.08, 5.31, P= 0.03). It was concluded that baseline higher peritoneal transport was independently associated with worse nutritional status of CAPD patients in Southern China.
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Xu Y, Gao C, Xu J, Chen N. Successful Treatment of Idiopathic Eosinophilic Peritonitis by Oral Corticosteroid Therapy in a Continuous Ambulatory Peritoneal Dialysis Patient. Case Rep Nephrol Dial 2015; 5:130-4. [PMID: 26266243 PMCID: PMC4519605 DOI: 10.1159/000431085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Eosinophilic peritonitis is a well-described complication of peritoneal dialysis and is often associated with either a reaction to the dialysis system constituent (tubing, sterilant or solution) or an underlying bacterial or fungal reaction. We report a case of eosinophilic peritonitis, which is treated by oral prednisone acetate therapy. A 43-year-old female patient developed end-stage renal disease and underwent continuous ambulatory peritoneal dialysis for 2.5 years. The patient received 2,000 ml of 1.5% dialysis solution (PD2) with three exchanges daily and 2,000 ml of 2.5% PDF overnight (PD2). She went to the consultation because of a constant turbid peritoneal dialysis effluent for 3 months without abdominal pain. Repeated peritoneal effluent samples showed an elevated white blood cell count of 500 cells/mm3, with 87% eosinophils. The peripheral blood test revealed a white blood cell count of 3.8 × 109/l, with 32.2% eosinophils. Etiology like bacterial and fungal infection was excluded by peritoneal fluid culture. Turbidness persisted in spite of diagnostic antibiotic treatment. Given the fact that we found a significant elevation of eosinophils in the peripheral blood and an absolute increase in the eosinophil count of >30/mm3 in dialysis fluid (up to 400/mm3 in our patient), obvious dialysate effluent turbidness, negative results of repeated peritoneal fluid cultures, inefficacy of antibiotic therapy, and negativity of serum tumor and immunological markers, we drew the conclusion that the patient had idiopathic eosinophilic peritonitis. Oral corticosteroid was administered at once (20 mg prednisone acetate daily), which was gradually weaned off and stopped over an 8-week period. Afterwards, the dialysis effluent became clear, and the cytological analysis showed that the white blood cell count decreased to 1 × 106/l, with no eosinophils. This case reminds us that the diagnosis of eosinophilic peritonitis should be considered when repeated cultures are always negative and the turbidness of peritoneal dialysis effluent persists in spite of an antibiotic therapy.
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Affiliation(s)
- Yaowen Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenni Gao
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Xu
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Kim BG, Cho AY, Kim SS, Lee SH, Shin HS, Yoon HJ, Kim JG, Sun IO, Lee KY. A case of peritoneal dialysis-associated peritonitis by Rothia mucilaginosa. Kidney Res Clin Pract 2015; 34:185-7. [PMID: 26484045 PMCID: PMC4608873 DOI: 10.1016/j.krcp.2015.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/21/2015] [Accepted: 02/27/2015] [Indexed: 11/30/2022] Open
Abstract
Rothia muciliaginosa (R. mucilaginosa) is a facultative, Gram-positive coccus that is considered to be part of the normal flora of the mouth and respiratory tract. There are sporadic reports of the organism causing endocarditis in patients with heart valve abnormalities, as well as meningitis, septicemia, and pneumonia associated with intravenous drug abuse. However, it is an unusual pathogen in cases of peritoneal dialysis (PD)-associated peritonitis. Although R. mucilaginosa is generally susceptible to penicillin, ampicillin, cefotaxime, imipenem, rifampicin, and glycopeptides, there are no guidelines for the treatment of PD-associated peritonitis. Herein, we report a case of PD-associated peritonitis due to R. mucilaginosa that was resolved with intraperitoneal antibiotic treatment.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Kwang Young Lee
- Corresponding author. Department of Internal Medicine, Presbyterian Medical Center, 300 Junghwasan-dong, Wansan-gu, 560-750 Jeonju, Korea.
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Abstract
PURPOSE The conventional trocar and cannula method in peritoneal dialysis (PD) catheter insertion has its limitation in clinical setting. The aim of this study was to compare a modified method for percutaneous PD catheter insertion with the conventional method, and demonstrate advantages of the modified method. MATERIALS AND METHODS Patients at a single center who had percutaneous PD catheters inserted by nephrologists from January 2006 until September 2012, using either a modified method (group M) or the conventional trocar and cannula method (group C), were retrospectively analyzed, in terms of baseline characteristics, complications experienced up to 3 months after the procedure, and the suitability of the procedure for patients. RESULTS Group M included 82 subjects, while group C included 66 cases. The overall early complication rate in group M (1.2%) was significantly lower than that in group C (19.7%) (p<0.001). The catheter revision rate during timeframe for early complications was significantly lower in group M (0%) than in group C (6.1%) (p=0.024). When comparing Procedure time (1 h 3 min±16 min vs. 1 h 36 min±19 min, p<0.01), immediate post-procedural pain (2.43±1.80 vs. 3.14±2.07, p<0.05), and post-procedure days until ambulation (3.95±1.13 days vs. 6.17±1.34 days, p<0.01), group M was significantly lower than group C. There was no significant difference in total hospitalization period (14.71±7.05 days vs. 13.86±3.7 days). CONCLUSION Our modified PD catheter insertion method shows its advantages in early complication rate, early complications revision rate, and the patients' conveniences.
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Affiliation(s)
- Yong Kyu Lee
- Department of Internal Medicine, NHIC, Ilsan Hospital, Goyang, Korea
| | - Pil-Sung Yang
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Kyoung Sook Park
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Kyu Hun Choi
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Beom Seok Kim
- Division of Nephrology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
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Jin H, Shin JY, Lee SH, Song JH, Kim MJ, Lee SW. Abdominal Obesity and Mortality in Continuous Ambulatory Peritoneal Dialysis Patients. Electrolyte Blood Press 2015; 13:22-9. [PMID: 26240597 PMCID: PMC4520884 DOI: 10.5049/ebp.2015.13.1.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/09/2015] [Indexed: 12/21/2022] Open
Abstract
Background The relationship between abdominal obesity (AO) and mortality in peritoneal dialysis (PD) patients is controversial. Methods The prevalence of AO in 84 PD patients was assessed in a cross-section manner and followed up for 9 years at a single center. AO was defined as a waist circumference (WC) of more than 90 cm in males or more than 80 cm in females. The patients were classified as either with AO(AO group) or without AO(nAO group). Results The AO group was older, contained more diabetics, more females, and had higher Charlson comorbidity index (aCCI) scores, BMI, and triglyceride and lower serum creatinine than the non-AO subjects. The follow-up duration was 53.2±34.4 months. At the end of the follow-up, eighteen patients (21.4%) were dead; 9 died of cardiovascular causes. The five year survival rate was 40.8%. Kaplan-Meier analysis revealed that both all-cause and cardiovascular-cause mortalities were similar in the AO and nAO groups. Multivariate analysis revealed the presence of AO not to be an independent risk factor of all-cause and cardiovascular-cause mortality. Conclusion AO itself might not be a risk factor for mortality in PD patients. Nevertheless, further prospective studies with a large number of patients will be needed to prove this.
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Affiliation(s)
- Haifeng Jin
- Division of Nephrology, Department of Internal Medicine, Yanbian University Hospital, Yanji, Jilin Province, China
| | - Jun Young Shin
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seung Ho Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Joon Ho Song
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Moon-Jae Kim
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Seoung Woo Lee
- Division of Nephrology and Hypertension, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
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Kim SW, Kim JE, Hong YA, Ko GJ, Pyo HJ, Kwon YJ. Raoultella planticola peritonitis in a patient on continuous ambulatory peritoneal dialysis. Infection 2015; 43:771-5. [PMID: 25958102 DOI: 10.1007/s15010-015-0788-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/25/2015] [Indexed: 11/28/2022]
Abstract
A 65-year-old man on continuous ambulatory peritoneal dialysis was admitted with peritonitis. Empirical antibiotic therapy was initiated, and Raoultella planticola was identified in the peritoneal fluid culture. We treated the patient with intraperitoneally administered ciprofloxacin and ceftazidime according to the antibiotic susceptibility. His condition improved, and he was well treated with a 2-week antibiotic course.
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Affiliation(s)
- Sun Woo Kim
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, South Korea
| | - Ji Eun Kim
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, South Korea
| | - Yu Ah Hong
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, South Korea
| | - Gang Jee Ko
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, South Korea
| | - Heui Jung Pyo
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, South Korea
| | - Young Joo Kwon
- Division of Nephrology, Department of Internal Medicine, Korea University, Seoul, South Korea.
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Yamaguchi T, Isogai S, Okamura T, Uozu S, Mieno Y, Hoshino T, Goto Y, Hayashi M, Nakanishi T, Imaizumi K. Pharmacokinetics of gefitinib in a patient with non-small cell lung cancer undergoing continuous ambulatory peritoneal dialysis. Case Rep Oncol 2015; 8:78-82. [PMID: 25848356 PMCID: PMC4361913 DOI: 10.1159/000375485] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 72-year-old man undergoing continuous ambulatory peritoneal dialysis (CAPD) for chronic renal failure and who had undergone right upper lobectomy for lung adenocarcinoma (pT2aN0M0) 2 years ago was admitted for recurrence of lung cancer presenting as multiple brain metastases. An epidermal growth factor receptor mutation analysis of his lung cancer revealed a deletion of 15 nucleotides (E746-A750) in exon 19. After whole-brain radiotherapy, we started daily administration of 250 mg gefitinib under the continuation of CAPD and performed a pharmacokinetic analysis. We speculated that the plasma concentration of gefitinib reached the steady state at least by day 16 after the start of gefitinib (626.6 ng/ml at trough level). On day 46, the plasma concentration was 538.4 ng/ml at trough level and the concentration in the peritoneal dialysis fluid was 34.6 ng/ml, suggesting that CAPD appeared to have little effect on the pharmacokinetics of gefitinib. During gefitinib therapy, there were no significant adverse events except for grade 2 diarrhea. Gefitinib could be safely administered to a patient undergoing CAPD.
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Affiliation(s)
- Teppei Yamaguchi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Sumito Isogai
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Takuya Okamura
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Sakurako Uozu
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Yuki Mieno
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Tami Hoshino
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Yasuhiro Goto
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Masamichi Hayashi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Toru Nakanishi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
| | - Kazuyoshi Imaizumi
- Division of Respiratory Medicine and Clinical Allergy, Department of Internal Medicine, Fujita Health University, Toyoake, Japan
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Liu Y, Zhang H, Zhang K, Liu J, Zhou L, Liao X, Cheng J, Deng X, Xia Z. Metabolic status and personality affect the prognosis of patients with continuous ambulatory peritoneal dialysis. Int J Clin Exp Med 2015; 8:440-447. [PMID: 25785015 PMCID: PMC4358470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 12/05/2014] [Indexed: 06/04/2023]
Abstract
Continuous ambulatory peritoneal dialysis (CAPD) is recognized as an effective and economical therapy for end-stage renal disease (ESRD). However, the drop-out and mortality rates of this treatment remain high. The aim of the present study was to investigate the potential effects of metabolic status and personality on the prognosis of ESRD patients receiving CAPD. A total of 835 patients (455 men and 380 women) were enrolled in the cross-sectional survey. Analysis of variance and Spearman correlations were used to analyze variables in two groups of ESRD patients: group L (dialysis duration < 3 years) and group H (dialysis duration ≥ 3 years). The variables included gender, age, duration of dialysis, primary diseases, blood pressure, body mass index (BMI), hemoglobin (Hb), serum albumin, Subjective Global Assessment (SGA), blood lipids, fasting blood glucose, renal function, immunoreactive parathyroid hormone (iPTH), serum phosphorus and calcium, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Kt/V, and Life Orientation Test-Revised (LOT-R) scores. Levels of DBP, BUN, glucose, CRP, SBP, SGA, TG, LDL, creatinine, iPTH, ESR, and LOT-R scores were significantly higher in group H than in Group L, whereas Hb and Kt/V were significantly lower in group H. The dialysis duration was positively correlated with the blood pressure, SGA scores, TG, LDL, PTH, CRP, and LOT-R scores, but negatively correlated with Kt/V. Our results suggest that hypertension, anemia, hypoproteinemia, SGA, TG, LDL, iPTH, CRP, Kt/V, and personalities are potentially important factors affecting the prognosis of ERSD patients with CAPD.
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Affiliation(s)
- Yan Liu
- Department of Nephropath, The Third Xiangya Hospital of Central South UniversityChangsha 410000, Hunan, China
| | - Hao Zhang
- Department of Nephropath, The Third Xiangya Hospital of Central South UniversityChangsha 410000, Hunan, China
| | - Ke Zhang
- Department of Nephropath, The Third Xiangya Hospital of Central South UniversityChangsha 410000, Hunan, China
| | - Jun Liu
- Department of Nephropath, The Third Xiangya Hospital of Central South UniversityChangsha 410000, Hunan, China
| | - Liuchan Zhou
- Department of Nephropath, Shaoyang Central HospitalShaoyang 422000, Hunan, China
| | - Xiangping Liao
- Department of Nephropath, The First Hospital in ChenzhouChenzhou 423000, Hunan, China
| | - Jianzhao Cheng
- Department of Nephropath, Xiangtan Central HospitalXiangtan 411100, Hunan, China
| | - Xiaohua Deng
- Department of Nephropath, The First Hospital in YiyangYiyang 413000, Hunan, China
| | - Zhiming Xia
- Department of Nephropath, The First Hospital in HuaihuaHuaihua 418000, Hunan, China
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