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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.
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La función renal (FR) es medida por varios métodos. La más utilizada es el aclaramiento de creatinina (ClCr), que reflejaría, el filtrado glomerular (FG). Para su medición se recurre a la recolección de orina durante 24 horas o a la utilización de fórmulas, siendo la más utilizada, la ecuación CKD-EPI (Chronic kidney disease Epidemiology Collaboration). La disfunción renal se clasifica en 5 estadios. El estadio 5 (cuando el ClCr es igual o inferior a 15 ml/min), es cuando los pacientes están prontos a recibir tratamiento sustitutivo renal (TSR). La hemodiálisis (HD), es una técnica muy utilizada como TSR y normalmente es llevada a cabo 3 veces a la semana, por 4 horas cada una. Un paciente de 59 años, quién debido a la distancia entre su domicilio y el Centro de diálisis decide (consentimiento firmado), someterse a solo 2 sesiones de HD por semana. Al inicio del tratamiento, el paciente presentaba todos los datos clínicos y bioquímicos de la Enfermedad renal Crónica Avanzada, estadio 5 y un volumen diurético (VD) ≥ 1 litro/día. En caso de empeoramiento clínico y/o bioquímico, las sesiones de HD serían 3 veces por semana. Al año, los parámetros clínicos, bioquímicos y la función renal residual (FRR), permanecen óptimos. Si FRR (medido por el aclaramiento de urea (Kru) y el VD), declina serán necesarias 3 sesiones de HD, semanales. El mantenimiento de la FRR, está relacionado con la mortalidad y la HD incremental, al preservar mejor la FRR, mejora la sobrevida del paciente.
Several methods are useful to measure renal function (RF). In clinical practice, the creatinina cleareance (CrCl), is widely used, which approximately reflects the glomerular filtration rate (GFR). The 24 hs urine volume collection is required to measure CrCl, however, thanks different formulas we can have a precise CrCl value. The CKD-EPI (chronic kidney disease epidemiology collaboration), is the equation frequently used. According to glomerular filtration rate (GFR), the renal function has been classified in 5 stages. At advances stages (stage 5), (CrCl: 15 ml/min), the patient is faced to receive renal replacement therapy (RRT). Hemodialysis (HD) method is often used. It is carry out 3 times per week (4 hours each). A 59 years old male, due to the distance between the Capital City and his home, decided to receive HD only two times per week (signed consent). At the beginning of the treatment the patient presents all the clinical and biochemical data corresponding to Chronic Renal Failure stage 5. His diuretic volume (DV), ≥ 1 lt/day. In the case of RF deterioration reflected clinical and/or biochemically, the HD session would be 3 times a week. At year, presents adequate residual renal function (RRF) and clinics, biochemical parameters as well. If the RRF (measured by urea clareance (Kru) and the DV) decline, 3 sessions per week will be necessary. The RRF maintenance is related to mortality, therefore, its preservation thanks incremental HD, improve the patient survival.
Subject(s)
Renal Dialysis , Creatinine , Dialysis , Renal Insufficiency, Chronic , Kidney Failure, Chronic , Residence Characteristics , Epidemiology , MortalityABSTRACT
Objective:To discuss influence of addition and subtraction therapy of Zhenwutang to residual renal function （RRF）， nutritional status， dialysis adequacy and quality of life of patients with maintenance hemodialysis （MHD）. Method:One hundred and thirty-six patients were randomly divided into control group （68 cases） and observation group （68 cases） by random number table. Patients in two group got MHD， 3 times/week， 4 h/time， levocarnitine injection （1 g dissolved in 5-10 mL water for injection） after the dialysis， 2-3 min/time， recombinant human erythropoietin injection with subcutaneous injection for 4 weeks， 3 000 U， 3 times/day， valsartan capsules for 3 months， 80 mg/time， 1 time/day. The control group took Manshenning mixture， 35 mL / time， 3 times / day.Patients in observation group added addition and subtraction therapy of Zhenwutang for 3 months， 1 dose/day. Before and after treatment， urea nitrogen （BUN）， creatinine （CR） and 24 hours' urine volume were recorded. And RRF， rate of decrease of RRF and rate of decrease in urine volume were also calculated. Levels of hemoglobin （HB）， albumin （ALB）， prealbumin （PA） and transferrin （TRF） were detected. After treatment， standardized protein metabolism rate （nPCR）， urea clearance index （Kt / V） and glomerular filtration rate （EGFR） were discussed. And improved subjective comprehensive nutrition assessment （SGA）， dialysis related quality of life （kdta） and health survey summary （SF-36） were graded. Six months' follow-up， primary end point event （24 h urine volume ≤ 400 mL） and no residual renal function （24 h urine volume ≤ 400 mL） were recorded. Result:Levels of RRF， Kt/V， nPCR， eGFR， Hb， Alb， PA， TRF and total scores of KDTA and SF-36 in observation group were higher than those in control group （P<0.01）. And score of SGA， rate of decrease of RRF and rate of decrease in urine volume were less than those in control group （P<0.01）.Incidence rate of primary end point event was 27.94%（19/68） lower than 47.06%（32/68） in control group （χ2=5.302， P<0.05）， incidence rate of no residual renal functionwas 17.65%（11/68） lower than 36.76%（25/68） in control group （χ2=6.274， P<0.05）. And BUN and Cr were lower than those in control group （P<0.01）， 24 h urine volume was more than that in control group （P<0.01）. Conclusion:Addition and subtraction therapy of Zhenwutang can maintenance of RRF， improvement of nutritional status， improvement of dialysis adequacy and quality of life of patients .
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OBJECTIVE@#To explore the impact of dietary sodium-intake on residual renal function in patients undergoing peritoneal dialysis (PD).@*METHODS@#Thirty-three patients on PD with stable dialysis were regularly followed up for 12 months. The daily sodium intake of the patients was calculated based on the 3-day dietary record. Based on the mean daily sodium intake, the patients enrolled were divided into low-salt group (sodium intake≤3.0 g/day, 19 patients) and high-salt group (sodium intake>3.0 g/day, 14 patients). The baseline data of the patients were recorded, and the indicators of residual renal function and peritoneal function were regularly tested. The patients were followed-up at 3-month intervals, and their urine volume, peritoneal ultrafiltration volume and other clinical indicators were recorded and the biochemical indexes were detected to evaluate the changes in the residual renal function and peritoneal function.@*RESULTS@#There was a positive correlation between the total sodium excretion and dietary sodium intake in these patients (=0.536, =0.0013), and sodium excretion by dialysis was positively correlated with their sodium intake (=0.901, =0.000). Regression analysis suggested that the total sodium excretion was correlated with dietary sodium intake (β=0.416, 95% : 0.170-0.666; < 0.0018); sodium excretion by dialysis was associated with dietary sodium intake (β=0.489, 95% : 0.395-0.582; < 0.001). The residual renal function was reduced by 17.48±11.22 L /(w·1.73 m) in the low-salt group, as compared to 30.20±18.30 L /(w·1.73 m) in the high-salt group (=0.032). The reduction in the residual renal function was correlated with sodium intake in the PD patients (=0.409, =0.018). Multivariate regression analysis showed that sodium intake was an independent factor contributing to the reduction of residual renal function (β=14.646, 95% CI 7.426-21.866, < 0.001).@*CONCLUSIONS@#Sodium excretion by PD in patients with continuous ambulatory PD is positively correlated with their dietary sodium intake, which contribute to the decrease of residual renal function. A high dietary sodium intake may accelerate the reduction of residual renal function in these patients.
Subject(s)
Humans , Kidney , Peritoneal Dialysis , Prospective Studies , Sodium, DietaryABSTRACT
Objective: To observe the protective effect of Xiao Chaihutang and Wulingsan on residual renal function in patients with maintenance peritoneal dialysis (PD) and investigate its effect on peritoneal fibrosis and microinflammation.Method: The 65 patients with PD who were admitted to our hospital from June 2016 to June 2017 were enrolled in the study, and divided into control group (32 cases) and study group (33 cases) according to the random number table. The control group received routine treatment. The study group received routine treatment+Xiao Chaihutang and Wulingsan. The fasting venous blood was taken before treatment and 3 months after treatment to measure serum creatinine (SCr) and urea nitrogen (BUN). Urine was collected; 24 hour urine volume was recorded; 24 h urine protein (24 h UP) was measured by colorimetry; glomerular filtration rate (eGFR) was calculated; residual renal function (RRF) was expressed with residual renal creatinine clearance. Inflammatory factors were detected by using chemiluminescence, including interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α) levels. Serum Janus Kinase (JAK) 2 as well as signal transducer and activator of transcription (STAT) 3 levels were determined by double antibody sandwich enzyme-linked immunosorbent assay (ELISA). E-cadherin and α-smooth muscle actin (α-SMA) levels were determined by Western blot.Result: Before treatment, there was no significant difference in the residual renal function between two groups. After treatment, the residual renal function of the study group was significantly better than that of control group (PPα in study group were lower than those in control group (PPPα-SMA protein was significantly increased after treatment (Pα-SMA protein after treatment.Conclusion: Xiao Chaihutang and Wulingsan can protect the residual renal function of PD patients, and the mechanism may be related to the improvement of peritoneal fibrosis and the reduction of micro-inflammation of the body, showing a high application value.
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Objective · To investigate the clinical characteristics of initial peritoneal dialysis (PD) patients with different peritoneal transport status, and analyze risk factors of high peritoneal transport status in PD patients. Methods · A total of 455 consecutive PD patients newly starting PD between January 2007 to October 2015 were retrospectively analyzed. According to the results of the first sPET, patients were divided into H/HA (4h D/Pcr ≥ 0.65) and L/ LA (4h D/Pcr<0.65) groups. Clinical and biochemical characteristics between the two groups were compared. Multivariate logistic regression model was established to investigate risk factors of higher peritoneal transport status of incident PD patients. Results · The study included 372 incident PD patients. The L/LA group and H/HA group had 264 cases (71.2%) and 108 cases (28.8%) respectively. The H/HA group had higher proportion of male patients (63.0% vs 50.8%, P=0.03), lower residual renal function [RRF, (4.26±2.77) mL/min vs (5.79±4.53) mL/min, P<0.01], lower serum albumin level [(29.34±6.89) g/L vs (32.08±5.86) g/L, P=0.00], and more frequent diabetic nephropathy (19.4% vs 9.5%, P=0.00), compared with L/LA group. Univariate and multivariate logistic regression analysis showed that higher peritoneal transport status was associated with lower serum albumin level (OR=0.96, 95% CI 0.28-0.99; P=0.02), male (OR=1.92, 95% CI 1.19-3.12; P=0.00), presence of diabetic nephropathy (OR=2.52, 95% CI 1.26-5.05; P=0.00) and lower residual renal function (OR=0.90,95% CI 0.83-0.96; P=0.00). The level of hsCRP in patients with hypoalbuminemia was higher than that in patients with normal albumin level (1.69 mg/L vs 0.69 mg/L, P=0.00). Conclusion · Low and low average peritoneal transport status accounted for the majority of the patients in this study. Low serum albumin levels, male, diabetic nephropathy, RRF were risk factors of initial high peritoneal solute transport status. Chronic inflammatory status might partially explain for the correlation between hypoalbuminemia and high peritoneal solute transport status in PD patients.
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Objective To investigate the association of residual renal function with intradialysis dialysis hypotension among maintenance hemodialysis patients. Methods Fifty-six patients who had underwent maintenance hemodialysis from March 2014 to November 2015 were enrolled according to researching protocol in this study. Data of baseline and clinical parameter of every hemodialysis session were collected. The patients were divided into two groups by 24 h urine output:urine group (24 h urine output≥100 ml, 22 patients)and no urine group (24 h urine output0.05). Pearson correlation analysis showed that residual glomerular filtration rate (rGFR) had negative correlation with interdialytic weight gain (r =- 0.257, P = 0.001). Kaplan-Meier analysis showed that with the increase of dialysis time, the rate of intradialysis hypotension increased. The comulative rate of intradialysis hypotension in no urine group was higher than that in urine group (log-rank = 14.67, P =0.000). Conclusions Residual renal function is associated with intradialysis hypotension, and it is important for clinician to consider a residual renal function protection schedule for maintenance hemodialysis patients.
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Objective To investigate the relationship between fetuin A and left ventricular function and their influences on residual renal function(RRF) in peritoneal dialysis patients.Method Eighty patients recently initiating peritoneal dialysis were enrolled into this study and were divided into high fetuin A group and low fetuin A group accordin to the value of serum fetuin A concentration.Hemoglobin,high sensitive C reactive protein(hsCRP),calcium,phosphorus,albumin,lipoproteins and left ventricular myocardial performance index(LV-MPI) were examined.All these patients were followed up for 12 months,to discover the parameters' differences between two groups and to investigate the association between fetuin A and left ventricular function and RRF.Results At the beginning of the study,there was no difference of hsCRP,calcium,phosphorus,albumin,lipoproteins and LV-MPI,estimated glomerular filtration rate (eGFR) between two groups;After 12 months follow-up,MPI was obviously shorter (P ＜ 0.05) and RRF was obviously higher (P ＜ 0.05) in high fetuin A group than thosein low fetuin A group.Compared with the beginning of the study,LV-MPI was significantly increased and eGFR was significantly decreased after 12 months follow-up (both P ＜ 0.05) in low fetuin A group,but no obviously change of LV-MPI or eGFR was found in high fetuin A group after followup.Pearson correlation analysis discovered an obvious negative correlation between fetuin A and MPI (r=-0.680,P ＜ 0.01).Multiple regression analysis indicated that eGFR had positive correlation with fetuin A (B=0.058,t=3.679,P＜ 0.01) and negative correlations with MPI (B=-0.511,t=-2.903,P=0.007),age(B=-0.144,t=-4.013,P＜0.01).Diabetes was risk factor to loss of RRF (B=-2.031,t=-2.759,P ＜ 0.05).Conclusion Fetuin A has very close relationship with left ventricular function.Decreased serum fetuin A level and decreased left ventricular function are risk factors to the loss of the RRF in ERSD patients.
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Objective To explore the effects of residual renal function (RRF) on quality of life (QOL) in patients with continuous ambulatory peritoneal dialysis (CAPD),and analyze the factors influencing QOL.Methods One hundred and eighteen patients treated with CAPD for at least 3 months in No.455 Hospital of People's Liberation Army were enrolled.All patients were divided into two groups according to residual glomerular filtration rate (rGFR):the group with RRF [rGFR≥ 1 ml·min-1 · (1.73 m2)-1],and the group without RRF [rGFR ＜ 1ml · min-1 · (1.73 m2)-1].The demographic characteristics,laboratory data,cardiothoracic ratio,dialysis adequacy parameters,rGFR,blood pressure,urine volume,ultrafiltration volume and dialysis prescription were investigated.Patient's QOL was evaluated by Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).Results There was no significant differences between the groups with and without RRF in the age,gender,causes of disease,complication,body mass index (BMI),systolic blood pressure (SBP),diastolic blood pressure (DBP),haemoglobin (Hb),cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,normalized protein catabolic rate (nPCR) and cardiothoracic ratio (all P ＞ 0.05).Compared with the patients with RRF,PD duration,ultrafiltration volume,serum creatinine (Scr),calcium,phosphorus,C-reactive protein (CRP),parathyroid hormone (PTH) and peritoneal dialysis dose in the patients without RRF were significantly higher,and urine volume,serum albumin (Alb),potassium,and urea total Kt/V were significantly lower (all P ＜ 0.05).The patients without RRF had a significantly lower score in physical function and physical component summary as compared to the patients with RRF (all P ＜ 0.05).There was no significant differences in role physical,bodily pain,general health,vitality,social function,role emotional,mental health,mental component summary and SF-36 scores (all P ＞ 0.05).Simple linear regression showed that there was no correlation between rGFR and SF-36 scores (β=1.330,P=0.070).Multiple linear regression revealed that SF-36 scores were correlated with CRP (β=-0.477,P ＜ 0.001),Scr (β=0.020,P ＜ 0.001),cardiothoracic ratio (β=-57.823,P=0.004),Alb (β=0.772,P=0.016) and ultrafiltration volume (β=-0.006,P=0.031),but not correlated with rGFR (β=0.099,P=0.302).Conclusions PD patients without and with RRF perceived different scores in physical health,but their scores were similar in mental health and QOL.RRF was no related to QOL in PD patients.Chronic inflammation,fluid overload and malnutrition were the main factors that affect QOL.
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Objective To discuss the effect of residual renal function on prognosis of maintenance dialysis in patients with end-stage renal disease ( ESRD) .Methods 90 cases of patients of maintenance hemodialysis were selected and divided into group A and group B based on different eGFR levels at the beginning of dialysis, 51 cases in group A of eGFR≤5 mL/( min· 1.73 m2 ) , while 39 cases in group B of eGFR>5 mL/( min· 1.73 m2 ).The renal function of two groups were observed,all patients underwent a five-year clinical follow-up and mortality rates, hemoglobin (Hb), serum albumin ( Alb) , C reactive protein ( CRP) of patients in both groups were observed.Results The renal function of urea nitrogen, serum creatinine, blood uric acid, urinary protein and urine creatinine in group B before dialysis was better than those in group A (all P<0.05).The Hb and Alb levels of group A were significantly lower than those of group B, while the CRP levels was significantly higher than that of group B (all P<0.05).The mortality rate of group A was 43.14%,compared with 20.51% of group B,and there was no significant difference.The two main reasons of death was cardiovascular and pulmonary infection, accounted for 50.00% and 33.33%, respectively.Conclusion Residual renal function of patients with ESRD before dialysis has important clinical significance for prognosis judgment.When eGFR level is lower before dialysis, the mortality rate of patients is higher in five years, prone to cardiovascular and cerebrovascular, with poor nutritional status, which is more vulnerable to infection.
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Objective To study the correlation of serum hepcidin with residual renal function and micro-inflammation state in continuous ambulatory peritoneal dialysis (CAPD) patients.Methods Thirty-four stable CADP patients were involved in this study as observers (CAPD group),who had accepted CAPD treatment more than three months; twenty non-dialysis patients with stage 5 of chronic kidney disease were selected as control group.According to the level of high sensitivity Creactive protein (hs-CRP),CAPD patients were divided into two subgroups.There were 14 patients in the hsCRP elevated group (hs-CRP ＞ 3.00 mg/L) and 20 patients in the hs-CRP normal group.In addition,there had been 14 patients with residual renal function in CAPD group.Serum hepcidin was measured by ELISA.Serum Ferritin (FER),hs-CRP,routine blood and biochemistry were measured by routine methods.Calculated estimated glomerular filtration rate (eGFR).Pearson correlation and linear regression were used to assess the correlation of serum hepcidin with other laboratory parameters in CAPD patients.Results (1) Serum hepcidin was significantly higher in CAPD patients than control group,but eGFR was significantly lower (P ＜ 0.01).(2) Serum hepcidin levels of no residual renal function patients increased more significantly in CAPD group (P ＜ 0.05).(3) Serum hepcidin levels were higher in hs-CRP elevated group than hs-CRP normal group (P ＜ 0.05).(4) Pearson correlation analyses revealed that serum hepcidin was positively correlated with hs-CRP (r=0.501) and FER (r=0.847,all P ＜ 0.01),and was negatively correlated with Hb (r=-0.919),TRF (r=-0.751),TIBC (r=-0.532,all P ＜ 0.05).(5) Multiple linear regression analysis showed that ferritin and hs-CRP were closely associated with serum hepcidin level in CAPD.Conclusions Serum hepcidin level markedly elevate in CAPD patients,especially in the patients with no residual renal function and micro inflammatory state increased more significantly.
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In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Delta1.2+/-2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Delta363.6+/-543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Delta0.5+/-2.7 mL/min/1.73 m2, P=0.266; -Delta108.6+/-543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, beta2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , CA-125 Antigen/analysis , Creatinine/urine , Dialysis Solutions/therapeutic use , Glomerular Filtration Rate , Glucans/therapeutic use , Glucose/therapeutic use , Interleukin-6/analysis , Kidney/physiopathology , Kidney Failure, Chronic/therapy , Membrane Proteins/analysis , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Urea/urineABSTRACT
In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Delta1.2+/-2.9 mL/min/1.73 m2, P=0.027) and urine volume (-Delta363.6+/-543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Delta0.5+/-2.7 mL/min/1.73 m2, P=0.266; -Delta108.6+/-543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, beta2-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , CA-125 Antigen/analysis , Creatinine/urine , Dialysis Solutions/therapeutic use , Glomerular Filtration Rate , Glucans/therapeutic use , Glucose/therapeutic use , Interleukin-6/analysis , Kidney/physiopathology , Kidney Failure, Chronic/therapy , Membrane Proteins/analysis , Peritoneal Dialysis , Peritoneal Dialysis, Continuous Ambulatory , Urea/urineABSTRACT
BACKGROUND/AIMS: Aims: Inflammation is an important factor in renal injury. Ferritin, an inflammatory marker, is considered an independent predictor of rapid renal progression in patients with chronic kidney disease. However, the relationship between ferritin and residual renal function (RRF) in patients undergoing peritoneal dialysis (PD) remains unclear. METHODS: We reviewed the medical records of patients who started PD between June 2001 and March 2012 at Soonchunhyang University Bucheon Hospital, Korea. A total of 123 patients were enrolled in the study. At 1 month after the initiation of PD, RRF was determined by a 24-hour urine collection and measured every 6 months thereafter. Clinical and biochemical data at the time of the initial 24-hour urine collection were considered as baseline. RESULTS: The RRF reduction rate was significantly greater in patients with high ferritin (ferritin > or = 250 ng/mL) compared with those with low ferritin (ferritin < 250 ng/mL; -1.71 +/- 1.36 mL/min/yr/1.73 m2 vs. -0.84 +/- 1.63 mL/min/yr/1.73 m2, respectively; p = 0.007). Pearson correlation analysis revealed a significant negative correlation between the baseline serum ferritin level and the RRF reduction rate (r = -0.219, p = 0.015). Using multiple linear regression analysis and adjusting for other risk factors, baseline serum ferritin was an independent factor for the RRF reduction rate (beta = -0.002, p = 0.002). CONCLUSIONS: In this study we showed that a higher ferritin level was significantly associated with a more rapid RRF decline in patients undergoing PD.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Biomarkers/blood , Chi-Square Distribution , Disease Progression , Ferritins/blood , Hospitals, University , Inflammation Mediators/blood , Kaplan-Meier Estimate , Kidney/physiopathology , Kidney Failure, Chronic/blood , Linear Models , Multivariate Analysis , Peritoneal Dialysis/adverse effects , Predictive Value of Tests , Proportional Hazards Models , Republic of Korea , Risk Factors , Time Factors , Treatment Outcome , Up-RegulationABSTRACT
BACKGROUND: The aim of this study was to compare mineral metabolism between anuric and nonanuric chronic hemodialysis patients, and determine the differences in phosphate control between the two groups. METHODS: A total of 77 chronic hemodialysis patients were enrolled in this cross-sectional study from January 2012 to February 2012. Patient demographics, laboratory findings, medication histories, and vascular calcification scores were collected. We divided the patients into anuric and nonanuric groups according to the residual renal function and then compared their clinical features. Multivariate binary regression analysis was used in each group to determine the independent factors related to phosphate control. RESULTS: The mean patient age was 59.27+/-13.95 years, and 57.1% of patients were anuric. In anuric patients, dialysis vintage was significantly longer, but the mean Kt/V was not different between groups. Serum phosphate, fibroblast growth factor (FGF)-23, and Ca/P products were significantly higher, and 1,25(OH)2D3 levels were significantly lower in the anuric patients, although the intact parathyroid hormone and 25(OH)D levels were not different. In anuric patients, LnFGF-23 [hazard ratio (HR) 2.894, 95% confidence interval (CI) 1.294-6.474, P=0.010] was an independent factor predictive of phosphate control. However, in the nonanuric patients, glomerular filtration rate (HR 0.409, 95% CI 0.169-0.989, P=0.047) and blood urea nitrogen (HR 1.090, 95% CI 1.014-1.172, P=0.019) were independent factors predictive of phosphate control. CONCLUSION: In chronic hemodialysis patients, preservation of residual renal function is a significant determinant of phosphate control, and the factors associated with phosphate control is different depending on the residual renal function status. In the anuric patients, FGF-23 is most significantly associated with phosphate control; however, glomerular filtration rate and blood urea nitrogen are more important than FGF-23 in the nonanuric HD patients.
Subject(s)
Humans , Blood Urea Nitrogen , Cross-Sectional Studies , Demography , Dialysis , Fibroblast Growth Factors , Glomerular Filtration Rate , Metabolism , Parathyroid Hormone , Renal Dialysis , Vascular CalcificationABSTRACT
Objective To validate cystatin (Cys C)-based equations for evaluation of residual renal function (RRF) in patients on continuous ambulatory peritoneal dialysis (CAPD).Methods Fifty patients on CAPD from our department were enrolled in the study.Eight patients with residual urine volume ≤ 100 ml/d and 42 patients with residual urine volume ＞ 100 ml/d were enrolled into anuria group and non-anuric group respectively.The clinical and laboratory status of each group were compared and equations (Hoek' s,Yang' s and abbreviated MDRD equations) were validated in the non -anuric group by comparing with the arithmetic average of residual renal creatinine clearance rate and residual renal urea clearance rate which was considered as the golden standard for RRF.Results (1) Anuric group had significantly higher serum Cys C than the non-anuric group [(7.73±1.13) mg/L vs (6.46± 1.15) mg/L,t =2.39,P =0.02)].(2) RRF estimated by each equation was correlated well with measured RRF (r =0.56,0.56 and 0.39,all P ＜ 0.05).(3) Yang' s equation [0.10 ml· min1· (1.73 m2)-1]was least biased,followed by Hoek' s equation [-0.73 ml· min-1 · (1.73 m2) 1] and abbreviated MDRD equation [3.15 ml· min-1 · (1.73 m2)-1].(4) The precision of Yang' s equation was equivalent to that of Hoek' s equation and both of them were better than abbreviated MDRD equation [6.2 and 6.1 vs 8.4 ml· min-1 · (1.73 m2)-1].(5) 50％ accuracy according to Yang' s equation and Hoek' s equation revealed an elevated results in comparison to that according to abbreviated MDRD equation (59.5％ and 54.8％ vs 23.8％,respectively,all P ＜ 0.01).Conclusions Serum Cys C-based prediction equations are better than the abbreviated MDRD equation in bias,precision and 50％ accuracy.For patients undergoing CAPD,the use of Cys C-based equation to estimate RRF may be a clinically acceptable alternative.
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Objective To evaluate the gastrointestinal (GI) symptoms of peritoneal dialysis (PD) patients and to explore the related factors contributing to GI symptoms. Methods Gastrointestinal Symptom Rating Scale (GSRS) was used for subjective evaluation of GI symptoms in PD patients. The information of patients was obtained by inquiring patients or review of medical records. Multiple regression analysis with stepwise backward variable selection was used to identify factors correlated with GSRS scores. Results The prevalence rate of gastrointestinal symptoms was 61.6% in the PD patients. The prevalence rates of eating dysfunction, reflux and indigestion were 43.8%, 32.1%, and 32.1%, respectively. We found that age (B=0.006, P=0.027), history of corticosteroid therapy (B=0.51,P<0.001) and daily tablet number (B=0.009, P=0.005) were positively correlated to GSRS score; and residual renal Kt/V (B=-0.27, P=0.001) was negatively correlated with GSRS score. Moreover, females seemed to have more GI symptoms than males (B=-0.15, P=0.033). The above five factors mentioned above could predict 36% of the GSRS score. Conclusion Eating dysfunction, reflux and indigestion are the most common disorders in PD patients. Old age, female sex, more daily tablet number and corticosteroid history are correlated with more severe GI symptoms, while residual renal function might be a preventing factor of GI symptom.
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OBJECTIVE: Peritonitis is one of major complication of peritoneal dialysis. It is the most important reason for removal of peritoneal catheter, death, or converting to hemodialysis. There is a debate that peritonitis decreases residual renal function. Thus, the authors carried out a study to grasp the prognosis of peritonitis which affects residual renal function (RRF) and assessed the risk factors of its clinical course. METHODS: Among 245 patients who had been on peritoneal dialysis in Soonchunhyang University Bucheon Hospital from April 2001 to March 2012, the author selected 91 patients who had kept on peritoneal dialysis for more than 3 months and experienced more than one episode of peritonitis. The medical records and laboratory findings were reviewed. RESULTS: During the average period of 36.3+/-22.8 months of peritoneal dialysis, total of 182 episodes of peritonitis developed in 91 study subjects. Among them, the 15 cases (8.2%) did not improve despite of intraperitoneal antibiotics and peritoneal catheter was subsequently removed. Eight patients were dead because of peritonitis related complications. The lactic dehydrogenase (LDH) level of peritoneal fluid at the third day of treatment had a significant correlation with peritonitis treatment failure (odds ratio [OR], 1.079; P=0.009) and death (OR, 1.071; P=0.049), respectively. The RRF after peritonitis became significantly low (P=0.011) compared to before peritonitis. But the slopes of declining rate of RRF were not different between before and after peritonitis (P=0.932). CONCLUSION: The LDH level of peritoneal fluid at the third day of treatment was correlated with treatment failure or death. The declining rate of RRF was not affected after peritonitis.
Subject(s)
Humans , Anti-Bacterial Agents , Ascitic Fluid , Catheters , Hand Strength , Medical Records , Oxidoreductases , Peritoneal Dialysis , Peritonitis , Prognosis , Renal Dialysis , Risk Factors , Treatment FailureABSTRACT
We retrospectively evaluated demographic and biochemical parameters associated with depression and health-related quality of life (HRQOL) in maintenance peritoneal dialysis (PD) patients. This study included 105 patients maintaining PD at Seoul National University Hospital. Data were collected from electronic medical record. Korean Beck's Depression Inventory and Korean version of Kidney Disease Quality of Life short form, version 1.3 were used to evaluate depression and HRQOL, respectively. Moderate to severe depression was found in 24.8% of patients. Patients with lower normalized protein equivalent of nitrogen appearance (nPNA) (< 1.2 g/kg/day), lower weekly renal Kt/V(urea) (< 0.2), and lower serum albumin level (< or = 4.0 g/dL) were associated with depression (P < 0.05). Among them, lower weekly renal Kt/V(urea) was the only independent risk factor associated with depression (OR = 3.1, P = 0.007). Depressed patients showed significantly lower scores in every dimension of HRQOL (P < 0.001). Lower weekly renal Kt/V(urea) (beta = 0.24, P = 0.005) and lower nPNA (beta = 0.15, P = 0.03) were the independent risk factors associated with lower kidney dialysis component summary, whereas lower plasma hemoglobin level was the consistent risk factor for lower physical component summary (beta = 0.22, P = 0.03) and mental component summary (beta = 0.22, P = 0.01). Depression is a prevalent psychological problem in PD population. Residual renal function is the most important factor associated with depression and impaired HRQOL in PD patients.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Demography , Depression/etiology , Health Status , Hemoglobins/analysis , Kidney Diseases/complications , Peritoneal Dialysis , Quality of Life , Republic of Korea , Retrospective Studies , Risk Factors , Serum Albumin/analysis , SoftwareABSTRACT
Objective To study the efficacy of low-dose daytime ambulatory peritoneal dialysis (DAPD) and low-dose CAPD in diabetic end-stage renal disease (ESRD) patients with better residual renal function (RRF). Methods Forty stable diabetic ESRD patients with better RRF (rGFR ≥ 5 ml/min and urine volume ≥ 750 ml/d) were enrolled. They were randomly divided into two groups: low-dose DAPD group (n=20) and low-dose CAPD group (n=20). DAPD group received three 1.5 L to 2 L daily exchanges with a nocturnal empty belly, dwelling for 3 to 4 hours. CAPD group received three 1.5 L to 2 L daily exchange or four 1.5 L daily exchange regimens and dwelled during the night. At the beginning of the study and 6 months later, total weekly Kt/V and Ccr (peritoneal+renal), rGFR were calculated. Meanwhile 24-hour urinary protein,serum albumin (Alb), hemoglobin (Hb), fasting plasma glucose, glycosylated hemoglobin and insulin dosage were measured. Nutritional status was assessed by SGA. Results Thirty-five patients fulfilled the study. There were no significant differences between two groups in age, gender, BMI,PD time, D/Pcr, etc. At the end of the 6th month, the insulin dose[(33.6±10.9) U/d] and 24-hour dialysate protein [(11.13t4.95) g] in CAPD group were significantly higher as compared to DAPD group [(20.6±6.2) U/d, P＜0.05 and (5.66±2.88) g, P＜0.01 respectively]. Alb in CAPD group [(29.7±4.2) g/L] was significantly lower than that in DAPD group [(36.5 ±3.9) g/L, P＜0.05].While the net ultrafiltration [(554±187) ml vs (309±177) ml], 24-hour urine volume [(1090±361)ml vs (750±258) ml] and rGFR [(8.21±2.40) ml/min vs (4.88±2.11) ml/min] in DAPD group were all significantly higher than those in CAPD group (all P＜0.05). Conclusion For the diabetic ESRD patients with better RRF, the low-dose DAPD regimen is more effective to control plasma glucose, improve nutritional status and protect RRF than the low-dose CAPD.