The benefits of peritoneal dialysis (PD) solution with low-glucose degradation product in residual renal function and dialysis adequacy in PD patients: A meta-analysis / Beneficios de la solución de diálisis peritoneal (DP), con producto de degradación bajo en glucosa, en la función renal residual y la adecuación de la diálisis en pacientes en DP: un metanálisis

Abstract The peritoneal effects of low-glucose degradation product (GDP)-containing peritoneal dialysis (PD) solutions have been extensively described. To systematically evaluate the efficacy and safety of low GDP solution for PD patients, specifically the effect on residual renal function (RRF) and dialysis adequacy, we conducted a meta-analysis of the published randomized controlled trials (RCTs). Different databases were searched for RCTs that compared low GDP-PD solutions with conventional PD solutions in the treatment of PD patients with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). The outcomes of RCTs should include RRF and may include small solute clearance, peritoneal transport status, nutritional status, and all-cause mortality. Seven studies (632 patients) were included. Compared with the conventional solution, low-GDP solution preserved RRF in PD patients over time (MD 0.66 mL/min, 95% CI 0.34 to 0.99; p<0.0001), particularly in one year of treatment (p<0.01), and improved weekly Kt/V (MD 0.11, 95% CI 0.05 to 0.17; p=0.0007) without an increased 4-hour D/Pcr (MD 0.00, 95% CI -0.02 to 0.02; p=1.00). Notably, the MD of RRF and urine volume between the two groups tended to decrease as time on PD progressed up to 24 months. Patients using low GDP PD solutions did not have an increased risk of all-cause mortality (MD 0.97, 95% CI 0.50 to 1.88; p=0.93). Our meta-analysis confirms that the low GDP PD solution preserves RRF, improves the dialysis adequacy without increasing the peritoneal solute transport rate and all-cause mortality. Further trials are needed to determine whether this beneficial effect can affect long-term clinical outcomes.

Resumen Los efectos peritoneales de las soluciones de diálisis peritoneal (DP) que contienen productos de degradación bajos en glucosa (PIB) se han descrito ampliamente. Para evaluar sistemáticamente la eficacia y la seguridad de la solución de PIB bajo para pacientes en DP, específicamente el efecto sobre la función renal residual (RRF) y la adecuación de la diálisis, realizamos un metanálisis de los ensayos controlados aleatorios (ECA) publicados. Se realizaron búsquedas en diferentes bases de datos de ECA que compararan la solución de DP de bajo PIB con la solución de DP convencional en el tratamiento de pacientes con EP con CAPD y APD. Los resultados de los ECA deben incluir la RRF y pueden incluir la depuración de solutos pequeños, el estado nutricional, el estado del transporte peritoneal y la mortalidad por todas las causas. Se incluyeron siete estudios (632 pacientes). En comparación con la solución convencional, la solución de bajo PIB preservó la FRR en pacientes con EP a lo largo del tiempo (DM 0,66 mL/min, IC del 95%: 0,34 a 0,99; p<0,0001), particularmente en un año de tratamiento (p<0,01), y mejoró el Kt/V semanal (DM 0,11, IC del 95%: 0,05 a 0,17; p = 0,0007), sin un aumento de D/Pcr a las 4 horas (DM 0,00, IC del 95%: -0,02 a 0,02; p = 1,00). Los pacientes que usaron una solución para DP con bajo contenido de GDP no tuvieron un mayor riesgo de mortalidad por todas las causas (DM 0,97; IC del 95%: 0,50 a 1,88; p = 0,93). Nuestro metanálisis confirma que la solución de DP de bajo PIB preserva la FRR, mejora la adecuación de la diálisis sin aumentar la tasa de transporte peritoneal de solutos y la mortalidad por todas las causas. Se necesitan más ensayos para determinar si este efecto beneficioso puede afectar los resultados clínicos a largo plazo.

Investigation of the relation between symptoms seen in haemodialysis patients with dialysis adequacy and personality traits / Investigación sobre la relación entre síntomas observados en pacientes en hemodiálisis con la adecuación de diálisis y rasgos de personalidad

ABSTRACT Objectives: Investigate the relation between the symptoms seen in haemodialysis patients with haemodialysis adequacy and character traits. Background: Investigation of the factors affecting symptoms seen in haemodialysis patients would lead to better understanding of the causes behind the symptoms and enable efficient symptom control management. Design: This descriptive and analytical study was conducted between January and June 2019 at two dialysis centres in Turkey. Methods: The data was collected through Demographic Information Form, The Dialysis Symptom Index, the Big Five Inventory and by calculating Kt/V and URR (Urea Reduction Rate) values for dialysis adequacy. Results: It was found that 77.6% of the haemodialysis patients experience 6 or more symptoms and the most common symptoms are feeling tired or lack of energy (70.7%), and the most severe symptom is numbness or tingling in feet (3.13±3.12). While 70.9% of the participants' Kt/V value was calculated as above 1.4; no statistically significant relation was found between Kt/V value and psychological and physiological symptoms (p>0.05). It was determined that haemodialysis patients with high neuroticism trait experience increased symptoms of tiredness, irritability, sadness, worrying; and patients with extraversion trait experience these symptoms less severely (p<0.05). Conclusion: Although this study found a relation between experienced symptoms and personality traits (neuroticism, extraversion); no relation was observed with dialysis adequacy. Nurses need to plan nursing initiatives by considering not only the patients' biochemical parameters but also their personality traits in managing haemodialysis symptoms of the patients.

RESUMEN Objetivos: Se investigó la relación entre los síntomas detectados en pacientes en hemodiálisis con la adecuación de diálisis y rasgos de personalidad. Antecedentes: El estudio de los factores que afectan los síntomas observados en los pacientes en hemodiálisis ayudaría a entender mejor las causas detrás de dichos síntomas y permitiría un mejor manejo del control de estos. Diseño: El presente estudio descriptivo y analítico se desarrolló entre enero y junio de 2019 en dos centros de diálisis en Turquía. Material y métodos: Los datos se obtuvieron a través del formulario de información demográfica, índice de síntomas dialíticos, el modelo de los cinco grandes, y se calcularon los valores de Kt/V y tasa de reducción de urea (TRU) para la adecuación de diálisis. Resultados: Se encontró que el 77,6% de los pacientes de hemodiálisis experimentan 6 o más síntomas; los síntomas más comunes son cansancio o falta de energía (70,7%), y el síntoma más grave es entumecimiento u hormigueo en los pies (3,13 ± 3,12). Si bien se determinó que el cálculo del valor Kt/V del 70,9 % de los participantes fue superior a 1,4, no se encontró una relación estadísticamente significativa entre el valor de Kt/V y los síntomas psicológicos y fisiológicos (p> 0,05). Se observó que los pacientes de hemodiálisis con alto rasgo de neuroticismo experimentan síntomas aumentados de cansancio, irritabilidad, tristeza, preocupación; y los pacientes con rasgo de extraversión desarrollan estos síntomas con menos gravedad (p <0,05). Conclusión: Aunque este estudio halló una relación entre los síntomas experimentados y los rasgos de personalidad (neuroticismo, extraversión), no se observó relación con la adecuación de la diálisis. Es necesario que el personal de enfermería planifique iniciativas considerando no solo los parámetros bioquímicos de los pacientes, sino también sus rasgos de personalidad al lidiar con los síntomas de hemodiálisis.

Prevalence of chronic periodontitis in peritoneal dialysis patients and its correlation with dialysis adequacy / 上海交通大学学报（医学版）

Objective: To analyze the prevalence of chronic periodontitis (CP) in the peritoneal dialysis patients based on a single-center population, and explore the correlation between the severity of CP and the adequacy of peritoneal dialysis. Methods: A total of 57 patients undergoing peritoneal dialysis in the Department of Nephrology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine from December 2018 to December 2019 were included in the study. Baseline data, indicators of dialysis adequacy, including Kt/V, creatinine clearance rate, etc., and other related biochemical indicators were collected, and at the same time the CP-related indicators including clinical attachment loss, gingival index and probing depth were collected. The indicators of dialysis adequacy or their control rates of the patients with different severity of CP were compared. Pearson correlation analysis and linear regression analysis were used to explore the correlation between CP-related indexes and the indicators of dialysis adequacy. Results: All the patients undergoing peritoneal dialysis included in this study have moderate to severe CP. The prevalence of moderate CP was 24.6%, and the prevalence of severe CP was 75.4%. The proportion of moderate to severe anemia in the severe CP group was higher than that in the moderate CP group (28.0% vs 14.3%), but the difference was not statistically significant (P>0.05). Between the moderate and severe CP group, there was no statistical difference in the indicators of dialysis adequacy and their control rates (P>0.05). And there was no correlation between CP-related indexes and the indicators of dialysis adequacy as well (P>0.05). Conclusion: The prevalence of moderate to severe CP is very high in the peritoneal dialysis patients, in whom those with severe CP may have a tendency to develop moderate to severe anemia. There is no correlation between the severity of CP and dialysis adequacy.

Comparison of three PET methods to assess peritoneal membrane transport

The peritoneal equilibration test (PET) is the most widespread method for assessing water and solute transport across the peritoneal membrane. This study compared three methods: traditional PET (t-PET), mini-PET, and modified PET (mod-PET). Non-diabetic adults (n=21) who had been on peritoneal dialysis (PD) for at least three months underwent t-PET (glucose 2.5%-4 h), mini-PET (glucose 3.86%-1 h), and mod-PET (glucose 3.86%-4 h) to determine dialysate-to-plasma concentration ratio (D/P) for creatinine and dialysate-to-baseline dialysate concentration ratio (D/D0) for glucose. Agreement between methods regarding D/P creatinine and D/D0 glucose was assessed using analysis of variance (ANOVA), Pearson's correlation coefficient, and Bland-Altman analysis. D/P creatinine differed between t-PET and mini-PET (P<0.001) and between mod-PET and mini-PET (P<0.01) but not between t-PET and mod-PET (P=0.746). The correlation of D/P creatinine with t-PET vs mod-PET was significant (r=0.387, P=0.009) but not that of t-PET vs mini-PET (r=0.088, P=0.241). Estimated bias was −0.029 (P=0.201) between t-PET and mod-PET, and 0.206 (P<0.001) between t-PET and mini-PET. D/D0 glucose differed between t-PET and mod-PET (P=0.003) and between mod-PET and mini-PET (P=0.002) but not between t-PET and mini-PET (P=0.885). The correlations of D/D0 glucose in t-PET vs mod-PET (r=−0.017, P=0.421) or t-PET vs mini-PET (r=0.152, P=0.609) were not significant. Estimated bias was 0.122 (P=0.026) between t-PET and mod-PET, and 0.122 (P=0.026) between t-PET and mini-PET. The significant correlation of D/P creatinine between t-PET and mod-PET suggested that the latter is a good alternative to t-PET. There was no such correlation between t-PET and mini-PET.

Current characteristics of dialysis therapy in Korea: 2016 registry data focusing on diabetic patients

Diabetic nephropathy is the most frequent cause of end-stage renal disease worldwide. Dialysis patients with diabetes mellitus (DM) have more complications and shorter survival duration than non-DM dialysis patients, requiring more clinical attention and difficult management. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an on-line registry program and analyzed the characteristics of patients. A survey of dialysis patients in 2016 showed that 50.2% of new dialysis patients had DM nephropathy as the cause of end-stage renal disease. The proportion of patients receiving hemodialysis (HD) for more than 5 years was 38% in DM patients and 51% in non-DM patients. The mean pulse pressure in DM HD patients was 71.5 mmHg, compared with 62.6 mmHg in non-DM patients. The proportion of DM patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of non-DM patients (73% vs. 78%). Mean serum creatinine of DM and non-DM dialysis patients was 8.4 mg/dL and 9.5 mg/dL respectively. As vascular access of the DM HD patients was poor, the dialysis adequacy of DM patients was slightly lower than that of non-DM patients. The 5-year survival rate for DM HD patients was 53.9%, which was much lower than that of chronic glomerulonephritis patients (78.2%). The proportion of patients with a full-time job was 17% for DM patients and 28% for non-DM patients.

Veno-venous puncture: A new alternative method of vascular access on hemodialysis / 第二军医大学学报

Objective To investigate the feasibility of veno-venous puncture (VVP) as an alternative for temporary and long-term vascular access in hemodialysis patients. Methods A total of 84 hemodialysis patients were enrolled in this study in Fuzhou General Hospital, PLA Nanjing Military Area Command between June 2014 and June 2015. The priority order of vascular access is as follow: arteriovenous fistula (AVF)-, tunneled cuffed catheter (TCC), and VVP. Patients were divided into VVP group (n=28), TCC group (n=28) and AVF group (n=28). Dialysis adequacy, access recirculation rate and access complications were observed and compared among each group for a follow-up of 6 months. Results There were no significant differences in spKt/V. eKt/V or urea reduction ratio (URR) among the three groups at 0, 3 and 6 months after dialysis. After 6 months, the access recirculation rate in VVP group was significanlty lower than that in the other two groups (0 vs 14. 28%, 21. 43%; P<0. 05), and access dysfunction rate in VVP group was also significantly lower than that in TCC group (0 vs 21. 43%, P<0. 05), while the access-related infection rates were not significantly different among three groups. Conclusion VVP is easy to perform, with less complications and low access recirculation rate, and it might be an alternative choice for hemodialysis when AVF cannot be created or TCC cannot be placed.

The impact of blood flow rate during hemodialysis on all-cause mortality

BACKGROUND/AIMS: Inadequacy of dialysis is associated with morbidity and mortality in chronic hemodialysis (HD) patients. Blood flow rate (BFR) during HD is one of the important determinants of increasing dialysis dose. However, the optimal BFR is unclear. In this study, we investigated the impact of the BFR on all-cause mortality in chronic HD patients. METHODS: Prevalent HD patients were selected from Clinical Research Center registry for end-stage renal disease cohort in Korea. We categorized patients into two groups by BFR < 250 and ≥ 250 mL/min according to the median value of BFR 250 mL/min in this study. The primary outcome was all-cause mortality. RESULTS: A total of 1,129 prevalent HD patients were included. The number of patients in the BFR < 250 mL/min was 271 (24%) and in the BFR ≥ 250 mL/min was 858 (76%). The median follow-up period was 30 months. Kaplan-Meier analysis showed that the mortality rate was significantly higher in patients with BFR < 250 mL/min than those with BFR ≥ 250 mL/min (p = 0.042, log-rank). In the multivariate Cox regression analyses, patients with BFR < 250 mL/min had higher all-cause mortality than those with BFR ≥ 250 mL/min (hazard ratio, 1.66; 95% confidence interval, 1.00 to 2.73; p = 0.048). CONCLUSIONS: Our data showed that BFR < 250 mL/min during HD was associated with higher all-cause mortality in chronic HD patients.

Current characteristics of dialysis therapy in Korea: 2015 registry data focusing on elderly patients

Because of increases in the elderly population and diabetic patients, the proportion of elderly among dialysis patients has rapidly increased during the last decades. The mortality and morbidity of these elderly dialysis patients are obviously much higher than those of young patients, but large analytic studies about elderly dialysis patients' characteristics have rarely been published. The registry committee of the Korean Society of Nephrology has collected data about dialysis therapy in Korea through an Internet online registry program and analyzed the characteristics. A survey on elderly dialysis patients showed that more than 50% of elderly (65 years and older) patients had diabetic nephropathy as the cause of end-stage renal disease, and approximately 21% of elderly dialysis patients had hypertensive nephrosclerosis. The proportion of elderly hemodialysis (HD) patients with native vessel arteriovenous fistula as vascular access for HD was lower than that of young (under 65 years) HD patients (69% vs. 80%). Although the vascular access was poor and small surface area dialyzers were used for the elderly HD patients, the dialysis adequacy data of elderly patients were better than those of young patients. The laboratory data of elderly dialysis patients were not very different from those of young patients, but poor nutrition factors were observed in the elderly dialysis patients. Although small surface area dialyzers were used for elderly HD patients, the urea reduction ratio and Kt/V were higher in elderly HD patients than in young patients.

Effect of different puncture distances in internal arteriovenous fistula on dialysis adequacy in maintenance hemodialysis patient / 现代临床护理

Objective To investigate the effect of different puncture methods on dialysis adequacy in maintenance hemodialysis patients. Methods One hundred and twenty patients receiving maintenance hemodialysis were divided into the observation group and the control group according to the sequence of receiving the hemodialysis with 60 cases in each group. Patients in the observation group were treated with increasing distance arteriovenous fistula of more than 10 cm , while patients in the control group received normal dialysis care without changing the way of puncture. The difference of dialysis adequacy before and after intervention were compared between the two groups. Result The dialysis adequacy after intervention in the observation group was improved significantly compared with the control group (P<0.05). Conclusion The dialysis adequacy in patients with maintenance dialysis can be improved by increasing the puncture distance of internal arteriovenous fistula.

Study on alexithymia and its affecting factors in continuous ambulatory peritoneal dialysis patients / 中华行为医学与脑科学杂志

Objective To evaluate the alexithymia in the continuous ambulatory peritoneal dialysis (CAPD) patients in our peritoneal dialysis center,and determine the factors affecting alexithymia in CPAD patients.Methods The patients with end-stage renal disease treated by CAPD were divided into alexithymia group (total score≥61)and non-alexithymia group(total score≤51),according to the Toronto Alexithymia Scale(TAS-20).Risk factors for alexithymia were analyzed by Logistic regression statistical model.Results (1)The TAS-20 score was(55.8±9.2) in 86 cases of patients with CAPD.Among them,TAS-20 scores of 38 cases were ≥61 points with an average score (64.5 ±4.4),and the scores of 30 cases were ≤ 51 points with an average score (48.9±5.3),which had a significant difference(t=10.1,P＜0.01).(2) There were significant differences in the pay-way and the residual urine volume between the two groups(P＜0.01).There were significant correlations of alexithymia with the pay-way and the residual urine volume(P＜0.01).(3) The level of serum albumin was significantly lower in alexithymia groups than that in non-alexithymia(P＜0.01).The level of serum calcium,phosphorus and parathormone were significantly higher in alexithymia group than that in non-alexithymia group(P＜0.05).There were significant negative correlations of alexithymia with the level of serum albumin(P＜0.01) and positive correlations of alexithymia with the level of serum calcium,phosphorus and parathormone(P＜0.05).(4) There were significant differences score in SF-36 total score,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health (P＜ 0.01);There were significant negative correlations of alexithymia with SF-36,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health (P＜ 0.05).(5) The Kt/v was 1.65±0.47 in alexithymia group and 2.13±0.69 in non-alexithymia group.There were significant differences in the two groups(t=2.5,P=0.017).There were significant negative correlations of alexithymia with Kt/v(r=-0.417,P=0.007)by Pearson correlation analysis.Logistic regression analysis showed that the level of serun albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v were the risk factors for alexithymia.Conclusion The incidence rate of alexithymia is higher.The level of serum albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v are the risk factors for alexithymia.

Analysis of clinical characteristics of twice-weekly hemodialysis patients / 中华肾脏病杂志

Objective To investigate the clinical characteristics of twice-weekly hemodialysis patients.Methods Data were collected from Shanghai Renal Registry.A total of 1288 patients undergoing regular hemodialysis (HD) with dialysis adequacy index and other biochemical parameters in Shanghai in January 2007 were enrolled into the cohort study with 2 years follow-up.Clinical characteristics and outcome of twice-weekly HD patients were analyzed as compared with thrice-weekly HD patients.Results Compared with patients on thrice-weekly HD,the twice-weekly HD patients were significantly younger and had significantly shorter HD vintage,smaller body surface area,longer HD session time,higher single-pool Kt/V (spKt/V) and serum albumin but lower weekly Kt/V (P＜0.05).There was no statistical difference in ultrafiltration volume between two groups.Kaplan-Meier survival analysis indicated that both groups had similar two-year survival.Multivariate Cox regression analysis showed that age,body mass index,serum albumin and weekly Kt/V were predictors of patient mortality.Conclusion It is acceptable for some hemodialys patients with twice-weekly HD,and close monitor of dialysis adequacy and volume status is necessary for this therapy model.

Antibody response following Hepatitis B vaccination in peritoneal dialysis patients: does normalized urea clearance matter?

OBJECTIVES: Data on the factors that contribute to the antibody response to hepatitis B virus vaccination in peritoneal dialysis patients are scarce. The current study was conducted on a group of peritoneal dialysis patients to learn how the response to hepatitis B virus vaccination varies according to the patient's clearance of urea normalized to total body water (Kt/V). METHODS: A convenience sample of 33 peritoneal dialysis patients (13 women and 20 men, with a mean age of 49¡12 years) was administered double doses (20 μg IM in each deltoid muscle) of recombinant hepatitis B vaccine at 0, 1, 2, and 6 months. Response to immunization was measured at one to three months after the final dose of vaccine. The subjects were divided into groups according to the level of antibodies to hepatitis B surface antigen (anti-HBs), including non-responders ( < 10 IU/L), weak responders (10-100 IU/L), and good responders ( > 100 IU/L). RESULTS: Among non-responders, weak responders, and good responders, significant differences were found in age (54 ± 12 vs. 56 ± 9 vs. 45¡12 years, respectively; p = 0.049) and recombinant human erythropoietin use (20 vs. 29 vs. 76 percent, respectively; p = 0.016). No significant differences in weekly total Kt/V (p = 0.704), weekly peritoneal Kt/V (p = 0.064) and residual glomerular filtration rate (p = 0.355) were found across the three groups. CONCLUSIONS: Delivered clearance measured by weekly peritoneal Kt/V and total clearance measured by weekly total Kt/V did not predict the response to hepatitis B virus vaccination in patients on peritoneal dialysis.

Electrolyte changes and dialysis adequacy in patients underwent continued ambulatory peritoneal dialysis for 1 month / 中国综合临床

Objective To investigate the impact of continued ambulatory peritoneal dialysis (CAPD)for 1 month,thus to provide effective therapy to control the symptoms of uremia in early stage. Methods A total of 129 nephrotic patients in final stage were treated with CAPD ,dialysis adequacy were assessed after 1 month of CAPD. Complications and biochemical indicators were compared between before and after 1 month of CAPD. Results The dialysis adequacy was good at the end of 1 month of CAPD. Compared to before CAPD,The prevalence of edema after 1 month of CAPD significantly decreased compared to before CAPD (7.8%vs. 24.8% ,χ2 = 13.765, P ＜ 0.05 ). After CAPD gastrointestinal, symptom, such as nausea and vomit significantly decreased from 66.7% to 6. 2% ( χ2 = 101. 821, P ＜ 0. 05 ). Itch of skin significantly decreased from 22. 5% before CAPD to 6. 2% after CAPD(χ2 = 13.914,P ＜0. 05) . Hemoglobin increased significantly from (79. 10 ± 17.13 ) g/L to (96. 50 ± 18. 69 ) g/L after CAPD ( t = - 6. 333, P ＜ 0. 01 ), serum calcium was sisilar, ( 1.99 ± 0.30) mmol/L and (2.07 ± 0. 20) mmol/L at before and after CAPD respectively ( t = -1. 920,P ＞0. 05). Albumin was (30. 62 ±5.24) g/L before CAPD and after CAPD(31.84 ±5.64) g/L ,with no significant difference ( t= - 0.333, P ＞ 0. 05 ) . Serum inorganic phosphorus, kalemia, urea nitrogen and creatinine concentration significantly decreased from ( 2. 06 ± 0. 54 ) mmol/L, ( 4.30 ±: 0. 68 ) mmol/L, 22. 00( 15.87,30.03 ) mmol/L and 864. 00 ( 733.00,1046. 25 ) μmol/L to ( 1.72 ± 0. 52) mmol/L, ( 3.84 ± 0.47 )mmol/L , 17.00 ( 13.91,20. 91 ) mmol/L and 777. 50 ( 627.00, 1047.75 ) μnol/L, respectively ( t = 3.284,4. 669, Z = - 3.717 and - 2. 408, respectively,Ps ＜ 0. 01 or 0. 05 ).. The level of serum PTH increased slightly from [ 184. 80 ( 114. 21,369. 77) ng/L to 226. 26 ( 124. 22,335.92 ) ng/L, but the difference was not significant ( Z = - 0. 597, P ＞ 0. 05 ). Conclusion CAPD had significant effect in early stage of dialysis with good dialysis adequacy. Hypocalcemia and hyperphosphatemia can be improved. The levels of serum kalemia decreased. The iatients's quality of life significantly improved.

Role of peritoneal transport characteristics and nutritional status in evaluation of peritoneal dialysis adequacy / 中华临床营养杂志

Objective To evaluate the influence of peritoneal transport characteristics on nutritional status of peritoneal dialysis patients and estimate the role of peritoneal transport characteristics and nutritional status in evaluation of peritoneal dialysis adequacy. Methods Peritoneal transport properties (D/Pcr) were evaluated by Short Peritoneal Equilibration Test and then 53 cases were divided into high transport group (D/Pcr ≥0. 65) and low transport group (D/Pcr < 0. 65). Urea kinetics (Kt/v) and total clearance of creatinine (TCcr) were calcu- lated. Serum albumin (ALB), prealbumin, transferring (TF), hemoglobin (Hb), lean body mass (LBM) and LBM% were examined or calculated. Subjective global assessment (SGA) was used to evaluate the nutritional sta- tus of patients. Results There were 30 cases in high transport group and 23 cases in low transport group. D/Pcr (0. 82±0.15 vs. 0. 55±0. 08, P < 0. 01), TCcr (62. 93%±25. 98% vs. 49. 69%±16. 92% , P < 0. 05) and age were significantly higher in high transport group than those in low transport group, while ALB, TF, Hb, LBM% , and SGA were significantly lower than those in low transport group (P < 0.05). ALB was negatively cor-related with Kt/v (r= -0.2708, P<0. 05). Conclusions High peritoneal transport patients have better solute clearance but worse nourishment status compared with low transport ones. Nutritional status is one of the factors to evaluate dialysis adequacy. Nutrition management and guidance should be strengthened for the continuous ambula- tory peritoneal dialysis patients, especially for the elderly ones.

Outcomes of Chronic Peritoneal Dialysis by Various Modalities in Korean Children: A Single Center Study

PURPOSE: A single center cross sectional retrospective study was performed to compare the outcomes of different peritoneal dialysis(PD) modalities in Korean children. METHODS: Among children dialyzed with PD between the year 2004 and 2007, 35 children had reliable data on PD adequacy after 3 to 15 months of dialysis. Subjects were grouped by their modalities; 17, 13 and 5 children were on continuous ambulatory PD(CAPD), continuous cyclic PD(CCPD) and nightly intermittent PD(NIPD), respectively. Body weight and height, number of patients taking anti-hypertensives and laboratory data including biochemical and hemoglobin levels were compared. Dialysis adequacy including weekly Kt/Vurea, creatinine clearance (Ccr) and daily water removal were also compared. Patients were sub-grouped by their peritoneal permeability characteristics. RESULTS: The percentage of patients taking anti-hypertensives, monthly change in Z-scores of body weight and height and laboratory data did not differ among the groups. Patients on CAPD and CCPD showed similar dialysis adequacies. Weekly dialytic Ccr was significantly lower in the NIPD group compared to the others. But total Ccr was not different when residual renal function was added. Weekly dialytic Ccr by CAPD was significantly higher than that of CCPD in low and low-average transporters. CONCLUSION: We propose that modality can be selected flexibly according to the patients' preferences. And peritoneal permeability characteristics provide valuable information for adjusting PD prescriptions in ultrafiltration failure or in inadequate dialysis. Further study of other clinical performance measures should be performed to clarify the comparable outcomes in different PD modalities.

Effects of dialysis adequacy,microinflammation and residual renal function on nutritional status in hemodialysis patients / 中华肾脏病杂志

Objective To study the effect of dialysis adcquacy,microinflammation and residual renal function on nutritional status of hemodialysis patients.Methods One hundred and fourteen patients were enrolled in this study.Kt/V,?_2-MG and serum iPTH were measured as markers of hemodialysis adequacy.Nutritional evaluation included MQSGA,Alb,Hb,TF,IGF-1,IGFBP-3 and anthropometrics such as HGS,BSF,TSF,MAC,MAMC and AMA.Serum IL-6,TNF-?and CRP were detected to assess microinflammation.Urinary volume of 24 hours was measured to investigate the residual renal function (RRF).Results (1)There were different correlations and regressive associations of Kt/V,iPTH and?_2-MG with HGS,MAMC,AMA,Alb,Hb,nPCR,IGF-1 and MQSGA respectively.(2) There were significant correlations and regressive associations of RRF to HGS,TSF,MAMC,Alb,nPCR and IGF-1 within the first year of hemodialysis.(3) There were different correlations and regression relationships of IL-6,TNF-?and CRP with HGS、MAMC、AMA、Alb、TSF、Hb、nPCR、IGF-1 respectively.(4) Multivariate analysis showed that Kt/V,iPTH,IL-6, TNF-?,?_2-MG and RRF were influencing factors,among them,Kt/V,iPTH,IL-6 and TNF-?were independent predictors of nutritional status.Conclusions Hemodialysis adequacy and micruinflammation may impact on nutritional status.Residual renal function may be involved in nutritional status in the first year of hemodialysis.Kt/V,iPTH,IL-6 and TNF-?are independent factors affecting nutritional status.

Factors Associated with Anti-HBs Antibody Titers in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: The incidence and prevalence of Hepatitis B virus (HBV) infection had decreased significantly in longterm hemodialysis (HD) patients. However, Seroconversion rates in response to HBV vaccine are poor in the HD population compared with the general population (35-80% vs above 95%) and the duration of immunity is shorter. The purpose of this study was to determine the association between hepatitis B immunity with HBsAb titer and variable dialysis-related factors as well as inflammation in HD patients. METHODS: The clinically stable 65 patients maintained on thrice weekly HD were divided into two groups according to their previous vaccination (V+group) or others (V-group). In V+group (n=25), patients with HBsAb titer less than 50 IU/L were administered a single dose of 40 microgram of IM HBV vaccine as a booster dose. Patients who lost immunity (defined as Ab titer decreasing to or =10 IU/L, N=31) were followed over 12 months in our center. V-group without natural immunity (n=9) received three doses of IM HBV vaccination (40 microgram). RESULTS: Most (90%) of vaccinated patients at pre-dialysis period had persistent immunity. Booster at HBs Ab titer below 10 IU/L had significantly shorter duration of immunity. Increase of (delta)hsCRP between pre & post-booster was significantly related to the loss of immunity. Based on multivariate logistic analysis, the subset of variables best explaining seroconversion after booster was lower (delta)hsCRP and younger age. Seroconversion rate to ID vaccination was 66.7%. Non-diabetes, higher hematocrit & low rHuEpo dose were implicated as having a role in maintaining strong naturally acquired immunity (Ab titer> or =100 IU/L) (p<0.05). Patients with weak naturally acquired immunity had increased median hsCRP than patients with strong. Seroconversion rate to conventional IM vaccination was 66.7%. CONCLUSION: We suggest that tailored modification of strategies about hepatitis B is required to persist protective immunity in hemodialysis patients before too late until loss of immunity, HBsAb titers below 10 IU/L. Also, our study implicated patients with prolonged and strong immunity against HBV may be related to higher hematocrit, better adequacy of dialysis and low inflammatory state, which all associated with better cardiovascular outcome and survival in hemodialysis patients.

The Effect of Increasing Needle Size on Dialysis Adequacy in Hemodialysis Patients / 대한신장학회잡지

BACKGROUND: Kt/V is an important index of adequacy of dialysis in patients undergoing hemodialysis (HD). However, it is difficult to prolong dialysis time in practice because of its economic impact and poor patient compliance. This study was performed to investigate the effect of increasing dialysis needle size on dialysis adequacy in HD patients. METHODS: This study enrolled 70 patients who received HD thrice weekly for more than 3 months using arteriovenous fistula or graft. The patients were divided into three groups according to the blood flow rate (200, 250, 300 mL/min). We first performed HD using 16 gauge needle. And then we increased needle size up to 15 gauge without change of any other dialysis conditions such as blood and dialysate flow rates, dialysis time, distance between needle insertion sites. RESULTS: Mean Kt/V at HD method using 15 gauge needle was increased, compared with HD method using 16 gauge needle (1.31+/-0.18 vs. 1.23+/-0.18, p<0.001). When comparing Kt/V according to the blood flow rate, increasing needle size from 16 gauge to 15 gauge significantly increased Kt/V at 250 mL/min and 300 mL/min. But there was no difference in Kt/V at 200 mL/min of blood flow rate. VDP at HD method using 15 gauge needle was decreased, compared with HD method using 16 gauge needle (88+/-23 mmHg vs. 118+/-28 mmHg, p<0.001). CONCLUSION: This study suggests that increasing dialysis needle size is safe and effective method in improving dialysis adequacy without increasing blood flow rate or dialysis time.

The Effect of Increasing Blood Flow Rate on Dialysis Adequacy in Hemodialysis Patients with Low Kt/V / 대한신장학회잡지

BACKGROUND: Dialysis adequacy indexed by Kt/V in hemodialysis patients is recommended as a single-pool Kt/V of at least 1.2 per session thrice weekly. But many patients can not achieve this adequacy target. Although dialysis time is the most important as a factor influencing Kt/V, it is difficult to prolong dialysis time in practice because of its economic impact and poor patient compliance. The aim of this study is to investigate the effect of increasing blood flow rate on dialysis adequacy in hemodialysis patients with low Kt/V. METHODS: This study enrolled 36 hemodialysis patients with single-pool Kt/V less than 1.2 per session thrice weekly, which was measured in dialyzer blood flow rate of 200-230 mL/min. We increased 15% of blood flow rate in patients less than 65 kg of body weight and 20% in patients more than 65 kg. And then we compared Kt/V and urea reduction ratio (URR) between before and after increasing blood flow rate. RESULTS: The mean age was 48+/-11 years (23-73 years) and the number of male was 25. Of the total patients, 24 patients had dry weight less than 65 kg. Mean dialysis duration was 52+/-50 months (3-216 months). Mean Kt/V before increasing blood flow rate was 1.02+/-0.09. It increased to 1.14+/-0.12 after increasing blood flow rate (p or =1.2). Mean URR before increasing blood flow rate was 56.9+/-4.0%. It also increased to 60.8+/-4.1% (p<0.001). CONCLUSION: Our data suggest that increment of blood flow rate to 15-20% of previous flow rate is effective in achieving dialysis adequacy in patients with low Kt/V.

Long Term Effects of Dialysis Adequacy, Residual Renal Function, Nutritional Indices on CAPD Patient Outcome / 대한신장학회잡지

PURPOSE: Several factors including dialysis adequacy are now known to be related to clinical outcomes of CAPD patients. In our study, the long term effects of dialysis adequacy, residual renal function, nutritional indices, and peritoneal membrane transport characteristics on the outcomes of CAPD patients were evaluated. METHODS: Prevalent or incident 127 patients were enrolled from February 1998 to January 1999. Follow-up was terminated in January 2003. In 41 patients, parameters of adequacy were reevaluated, and the effects of parameter change over time on patient outcomes were analyzed. RESULTS: Seventy-two were male. Twenty-nine (23%) were diabetic. Mean age was 47+/-2.9 years, and the mean follow up period was 45+/-.8 months. The baseline serum albumin was 3.7+/-.5 g/dL. nPCR was 0.8+/-.2 g/kg/d, and %lean body mass was 68.4+/-4.3. Kt/V was 2.0+/-.7, and Ccr was 64.5+/-8.8 L/wk/1.73 m2. The estimated GFR was 1.1+/-.3 mL/min. The multivariated analysis demonstrated that diabetes, serum albumin, and the patent residual renal function were independent factors of the patient and technique survival. Membrane transport characteristic was a predictor of technique survival. Among patients for whom the parameters of adequacy were reevaluated, a more rapid decrease of serum albumin and a more rapid increase of membrane transport characteristics were associated with increased risk of either death or technique failure. CONCIUSION: Nutritional indices and presence of residual renal function have a significant impact on the clinical outcome. The decrease of serum albumin and the increase of membrane transport characteristic have negative impacts on patient and technique survival.