Relationship between gut microbiota and vascular calcification in hemodialysis patients.

INTRODUCTION: Vascular calcification (VC) is an independent risk factor for cardiovascular mortality in end-stage renal disease (ESRD) patients. The pathogenesis of VC is complicated and unclear. Uremic toxins produced by gut microbiota can promote VC. This study aims to identify the differences in gut microbiota between the different VC groups and the main bacteria associated with VC in hemodialysis (HD) patients in an attempt to open up new preventive and therapeutic approaches and define the probable mechanism for VC in HD patients in the future. METHODS: A total of 73 maintenance HD patients were enrolled in this cross-sectional study. According to the abdominal aortic calcification (AAC) scores, the participants were divided into the high AAC score group and the low AAC score group. High-throughput sequencing of the gut microbiota was performed and the results were evaluated by alpha diversity, beta diversity, species correlation, and model predictive analyses. RESULTS: The prevalence of VC was 54.79% (40/73) in the study. The majority of phyla in the two groups were the same, including Firmicutes, Actinobacteriota, Proteobacteria, and Bacteroidota. The microbial diversity in the high AAC score group had a decreasing trend (p = 0.050), and the species abundance was significantly lower (p = 0.044) than that in the low AAC score group. The HD patients with high AAC scores showed an increased abundance of Proteobacteria and decreased abundances of Bacteroidota and Synergistota at the phylum level; increased abundances of Escherichia-Shigella, Ruminococcus_gnavus_group, and Lactobacillus; and decreased abundances of Ruminococcus and Lachnospiraceae_NK4A136_group at the genus level (p<0.05). Escherichia-Shigella and Ruminococcus_gnavus_group were positively correlated with VC, and Ruminococcus, Adlercreutzia, Alistipes, and norank_f__Ruminococcaceae were negatively correlated with VC. Escherichia-Shigella had the greatest influence on VC in HD patients, followed by Ruminococcus and Butyricimonas. CONCLUSIONS: Our results provide clinical evidence that there was a difference in gut microbiota between the different VC groups in HD patients. Escherichia-Shigella, a lipopolysaccharide (LPS)-producing bacterium, was positively correlated with VC and had the greatest influence on VC. Ruminococcus, a short-chain fatty acid (SCFA)-producing bacterium, was negatively correlated with VC and had the second strongest influence on VC in HD patients. The underlying mechanism is worth studying. These findings hint at a new therapeutic target.

Peritoneal dialysis can maintain nitrogen balance with low Kt/V in anuric patients.

BACKGROUND: A big concern for continuous ambulatory peritoneal dialysis (CAPD) is dialysis adequacy in anuric patients. Some studies have even suggested that CAPD patients should be transferred to hemodialysis when they become anuric in order to achieve adequate dialysis. In the present study, we tried to find out whether anuric patients can maintain nitrogen balance with standard or even lower dialysis dose. MATERIALS AND METHODS: This was a cross-sectional single-center study. Fifteen anuric CAPD patients were selected. Their 3-day dietary records were reviewed by a dedicated dietitian to calculate their energy, protein, and nitrogen intake (NI). Nitrogen removal (NR) from urine and dialysate was measured by Kjeldahl technique. Fluid status was evaluated by bioimpedance analysis. Subjective global nutritional assessment was used to evaluate nutritional status. RESULTS: Among the 15 patients, 9 males and 6 females, mean age was 63.80 (31 - 77) years, dialysis duration 39.76 (6 - 127) months, body weight 58.70 ± 9.86 kg, and height 160.20 ± 7.93 cm. The mean dietary protein intake was 43.28 ± 7.57 g/day (0.80 ± 0.15 g/kg/d), total Kt/V was 1.59 ± 0.32 with dialysis dose of 7,904.00 ± 1,481.79 mL. However, they achieved neutral nitrogen balance (NI 6.92 ± 1.21 g/d vs. NR 6.83 ± 1.36 g/d, N balance 0.09 ± 1.00 g/d). All of them maintained good nutritional status (SGA "A", serum albumin 39.67 ± 3.58 g/L), and no symptom of nitrogen retention (serum urea 20.49 ± 3.06 mmol/L). Meanwhile, they achieved good volume control with a slightly low total fluid removal (704.00 ± 293.21 mL/d). CONCLUSION: Our study suggested that anuric patients (even with low Kt/V) can achieve nitrogen balance and stay well-nourished with appropriate dietary protein intake.

Low-dose dialysis combined with low protein intake can maintain nitrogen balance in peritoneal dialysis patients in poor economies
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OBJECTIVE: Due to limited economic conditions, we tried to provide "fitted" dialysis doses instead of the doses recommended by the international guidelines to the individual patients. In the present cross-sectional study, we studied the dialysis adequacy and nutritional status of 5 peritoneal dialysis patients who had a low dialysis dose (2 bags, 4,000 mL/day). METHODS: The 3-day dietary records were reviewed to calculate patients' energy, protein, and nitrogen intake (NI). The nitrogen removal (NR) from urine and dialysate was measured by Kjeldahl technique. Fecal nitrogen was estimated as 0.0155 g/kg/day. Subjective global nutritional assessment was used to evaluate the nutritional status. RESULTS: Among the 5 patients, 1 male and 4 female, mean age was 59 (42 - 81) years, dialysis duration 43 (33 - 74) months, body weight 51.05 ± 2.53 kg. The mean dietary protein intake was 0.66 g/kg/day, total weekly Kt/v was 1.25 (residual kidney Kt/v was 0.09), and total daily fluid removal was 699 mL. However, they achieved lower-level neutral nitrogen balance (NI 5.26 ± 0.93 g/day vs. NR 5.33 ± 0.81 g/day, N balance -0.07 ± 0.60 g/day). All of them maintained good nutritional status (SGA "A") without symptoms of nitrogen retention (serum urea 22 ± 4.18 mmol/L). CONCLUSIONS: Lower dialysis dose with lower daily protein intake can achieve a lower-level nitrogen balance and does not lead to malnutrition. It may be an effective approach to solve the dialysis problem for the economically week population in China, especially for people with a smaller body size with lower transport membrane.
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Influence of Different Payment Schemes on the Clinical Outcome in Peritoneal Dialysis Patients.

UNLABELLED: ♦ BACKGROUND: Cost is always a big issue for dialysis patients. In the present study, we analyzed the effect of different payment schemes on dialysis adequacy and clinical outcome in our peritoneal dialysis program. ♦ METHODS: This is a single-center cohort study. A total of 175 patients who began dialysis from January 2006 to December 2007 were included. Baseline data, including volume status, dietary intake and nutrition status, dialysis adequacy, and sodium removal were collected at 6 months after peritoneal dialysis. Based on the different payment schemes, the patients were divided into 2 groups, higher payment group (GHP, 130 cases, with more than 85% reimbursement), and lower payment group (GLP, 45 cases, with less than 50% payment or totally self-paid). Patients were followed up until dropout or until December 31, 2013. ♦ RESULTS: At baseline, patients in the 2 groups had nearly the same residual renal function. But the GLP group patients dialyzed at a lower dose (4,516.91 ± 1,768.20 mL vs 6,058.17 ± 2,013.43 mL, p < 0.001). They had lower creatinine clearance (51.64 ± 24.23 L/w vs 70.54 ± 30.27 L/w, p < 0.001), sodium removal (2.23 ± 1.29 g vs 2.77 ± 1.29 g, p = 0.027), and fluid removal (970.33 ± 545.97 mL vs 1,146.66 ± 460.93 mL, p = 0.038). Normalized by height (in meters), the GLP group patients still had a lower normalized dialysis dose (2,890.61 ± 1084.44 mL/m vs 3,761.34 ± 1,237.10 mL/m, p < 0.001). Baseline nutritional and dietary parameters were comparable except that a lower daily protein intake (42.73 ± 10.99 g vs 47.26 ± 14.30 g, p = 0.032) and higher serum urea level (23.43 ± 6.88 mmol/L vs 19.84 ± 5.92 mmol/L, p < 0.001) were presented in the GLP group. There was no difference in volume status. During the follow-up, Kaplan-Meier analysis showed that there was no significant difference in patient survival and technique survival. In multivariate Cox regression analysis, after adjusting for related factors, payment was again not a strong predictor of survival in the study population. ♦ CONCLUSION: Our study found that GLP group patients were adherent to lifestyle modification with lower dialysis doses, and they also had nearly the same long-term clinical outcome as the GHP group patients. Thus, lower dialysis doses combined with controlled dietary intake may be an effective approach to solve the dialysis problem for the low socio-economic status (SES) population.

The correlation of plasma omentin-1 with insulin resistance in non-obese polycystic ovary syndrome.

OBJECTIVES: Aberrant circulating adipokines are considered to be related to the pathological mechanism of polycystic ovary syndrome (PCOS). This study aims to evaluate the relationship between plasma omentin-1 levels, metabolic and hormonal parameters in the setting of non-obese Chinese women with PCOS. MATERIAL AND METHODS: This was a case-controlled, cross-sectional study of 153 non-obese (BMI<25kg/m(2)) PCOS and 114 age-matched healthy non-obese control individuals. Levels of plasma omentin-1, fasting blood glucose, insulin and sexual hormones and ovary volume were analyzed in all subjects. RESULTS: Plasma omentin-1 levels of non-obese PCOS individuals were significantly lower than in healthy non-obese controls. Body Mass Index (BMI), homeostasis model of assessment for insulin resistance index (HOMA-IR), levels of testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), LH/FSH ratio and ovary volume (OV) were significantly higher in subjects with PCOS than controls. In the HOMA-IR stratified subgroups, PCOS individuals with insulin resistance had lower omentin-1 than those without insulin resistance after BMI adjustment. Omentin-1 was negatively correlated with BMI, HOMA-IR and fasting insulin. Multiple linear regressions revealed that BMI contributed to omentin-1 levels. Ovary volume was negatively correlated to HOMA-IR but had no correlation with omentin-1. CONCLUSIONS: Plasma omentin-1 concentrations were decreased in the non-obese PCOS group. Insulin resistance could further decrease plasma omentin-1 in non-obese individuals with PCOS independent of BMI status.

Phospholipids profiling and outcome of peritoneal dialysis patients.

OBJECTIVES: To investigate phospholipids (PLs) biomarkers in predicting outcome of patients undergoing peritoneal dialysis (PD). MATERIALS AND METHODS: Twenty PD patients were followed using baseline plasma PLs with an improved online two-dimensional liquid chromatography-quadrupole time-of-flight mass spectrometry system. RESULTS: Significant differences were observed in eight PL species with sphingomyelin (SM) and glycerophosphocholine between technical survival (n=15) and failure patients (n = 5). Cox regression showed SM 21:0 (adjusted HR 13.7, 95% CI 2.42-77.88, p = 0.003) was independently associated with patients technical failure. CONCLUSIONS: PD failure patients had different plasma PLs profiling as compared with survival patients. Elevated plasma SM 21:0 level may potentially serve as a biomarker of PD patients at risk for adverse outcomes.

Potassium metabolism in continuous ambulatory peritoneal dialysis patients.

BACKGROUND: Hypokalemia is common and may have contributed to the poor clinical outcome in peritoneal dialysis (PD) patients. In this study, we made a detailed investigation on the potassium metabolism in continuous ambulatory peritoneal dialysis (CAPD) patients and tried to find out the possible factors associated with the high prevalence of hypokalemia in PD patients. METHODS: A cross-sectional survey in 243 clinically stable CAPD patients was made in our PD center in 2010. Patients were divided into four groups according to whether they were anuric or not and different dialysis regimens. Patients' demographic data and data on potassium metabolism including dietary potassium intakes, residual renal potassium, and peritoneal dialysis potassium removal were collected. RESULTS: The average potassium intake in our 243 PD patients was 32.1 ± 11.1 mmol/day. The total potassium removal was significantly higher in non-anuric patients as compared to anuric patients (33.2 ± 9.1 vs. 23.0 ± 4.7 mmol/day for 3 exchanges per day and 35.2 ± 8.9 vs. 28.6 ± 6.3 mmol/day for 4 exchanges per day, respectively, p < 0.01) and in anuric patients dialyzed with 4 exchanges per day as compared to anuric patients dialyzed with 3 exchanges per day (28.6 ± 6.3 vs. 23.0 ± 4.7 mmol/L, p < 0.05). Compared to non-anuric patients dialyzed with 3 exchanges per day, serum potassium level was significantly lower (4.1 ± 0.7 vs. 4.5 ± 0.7 mmol/L, p < 0.05) while the prevalence of hypokalemia was significantly higher (22.2% vs. 9.3%, p < 0.05) in non-anuric patients that dialyzed with 4 exchanges per day. There was a strong correlation between renal potassium removal and renal urea Kt/V (R(2) linear = 0.645, p < 0.05). In a linear multiregression analysis, dietary potassium intake, intracellular water (ICW) significantly positively predicted serum potassium level while dialysis exchanges, residual renal function (RRF), D/P potassium all significantly negatively predicted serum potassium levels. CONCLUSIONS: Our study suggested that if potassium intake was limited in PD patients, we should be aware of the risk of hypokalemia with high doses of PD when patients have good RRF. Our study also suggested that potassium removal in PD patients may not necessarily reflect potassium intake even if serum potassium is normal, the effect of ICW should be considered when evaluating potassium homeostasis.

Characterizing the role of iodine doping in improving photovoltaic performance of dye-sensitized hierarchically structured ZnO solar cells.

We report two novel types of hierarchically structured iodine-doped ZnO (I-ZnO)-based dye-sensitized solar cells (DSCs) using indoline D205 and the ruthenium complex N719 as sensitizers. It was found that iodine doping boosts the efficiencies of D205 I-ZnO and N719 I-ZnO DSCs with an enhancement of 20.3 and 17.9 %, respectively, compared to the undoped versions. Transient absorption spectra demonstrated that iodine doping impels an increase in the decay time of I-ZnO, favoring enhanced exciton life. Mott-Schottky analysis results indicated a negative shift of the flat-band potential (V(fb)) of ZnO, caused by iodine doping, and this shift correlated with the enhancement of the open circuit voltage (V(oc)). To reveal the effect of iodine doping on the effective separation of e(-)-h(+) pairs which is responsible for cell efficiency, direct visualization of light-induced changes in the surface potential between I-ZnO particles and dye molecules were traced by Kelvin probe force microscopy. We found that potential changes of iodine-doped ZnO films by irradiation were above one hundred millivolts and thus significantly greater. In order to correlate enhanced cell performance with iodine doping, electrochemical impedance spectroscopy, incident-photon-current efficiency, and cyclic voltammetry investigations on I-ZnO cells were carried out. The results revealed several favorable features of I-ZnO cells, that is, longer electron lifetime, lower charge-transfer resistance, stronger peak current, and extended visible light harvest, all of which serve to promote cell performance.

Gastrointestinal symptoms predict peritonitis rates in CAPD patients.

OBJECTIVE: Peritonitis is still one of the major causes of peritoneal dialysis (PD) patients' dropout. In the present study, we analyzed the relationship between gastrointestinal (GI) problems and peritonitis in our CAPD patients. METHODS: It is a prospective observational study. In December, 2008, 158 patients on continuous ambulatory peritoneal dialysis (CAPD) for more than 3 months from our PD unit were included in this study. A questionnaire was used to evaluate their GI symptoms score (GISS). All patients were followed up for 24 months or until they dropped out from our PD program. All peritonitis events were recorded. RESULTS: The patients' PD duration was 22 (4 - 132) months before the study. During the 24 months follow-up, 37 patients dropped out. And 37 patients had 46 episodes of peritonitis (peritonitis group) whereas the other 121 patients did not have peritonitis (peritonitisfree group). The overall peritonitis rate was one episode per 75.87 patient months. The peritonitis free group had lower GISS (1.35 ± 1.94 vs. 2.95 ± 3.19, p = 0.006), higher albumin level and longer dialysis duration at baseline as compared to the peritonitis group. Multivariate Cox-regression analysis showed that only GISS (OR 1.206, 95% CI 1.093 - 1.330) and dialysis duration (OR 1.018, 95% CI 1.006 - 1.031) were the risk factors for the time to first peritonitis episodes during the follow-up. Further analysis identified 2 GISS components, belching and constipation, as the strongest predictors of peritonitis during the follow-up period (p < 0.005). CONCLUSION: Our study showed that GI symptoms could predict peritonitis in CAPD patients. Prevention and treatment for GI problems may thus be helpful to decrease peritonitis rate.

Metabolic syndrome and its components associated with endothelial dysfunction in chronic kidney disease patients.

BACKGROUND: Cardiovascular disease is more common in patients with chronic kidney disease (CKD) than in the general population. Endothelial dysfunction is an early predictor of cardiovascular events. OBJECTIVE: We conducted a cross-sectional study in CKD patients to explore the association of metabolic syndrome (MetS) components with endothelial cell function. METHODS: We evaluated clinical and laboratory data in 161 CKD patients from stage 1 to stage 5. Endothelial function was estimated by flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. MetS was defined according to the National Cholesterol Education Program-Adult Treatment Panel III criteria. RESULTS: Patients were grouped into two groups according to whether or not they had MetS. FMD was significantly lower in the MetS group than in the group without MetS (P = 0.012). In a Pearson's correlation analysis, FMD was significantly negatively correlated with waist circumference in women (r = -0.223, P = 0.03) and fasting blood glucose (r = -0.186, P = 0.001). Multiple linear regression analysis showed that fasting blood glucose was an independently associated factor for FMD. CONCLUSION: MetS and some components of MetS (waist circumference in women and fasting blood glucose) are closely associated with a decreased FMD in CKD patients.

Factors contributing to formation of edema in volume overloaded continuous ambulatory peritoneal dialysis patients.

BACKGROUND: Volume control is critical for the success of peritoneal dialysis (PD) but dry weight in PD has been difficult to obtain. Edema free is, in general, accepted clinically as a target for volume control in PD patients. However, PD patients can be free of edema despite significant volume overload. The present study investigates the possible factors that influence the formation of pitting edema in volume-overloaded PD patients. METHODS: In this cross-sectional study, patients' fluid status was evaluated by multifrequency bioelectrical impedance spectroscopy analysis. Values for overhydration were obtained. Patients with overhydration ≥ 2.0 kg were considered volume overloaded and were eligible for inclusion. From 1 March 2009 to 1 December 2009, a total of 96 patients on continuous ambulatory PD were included. Endothelial function was evaluated by flow-mediated dilatation (FMD). Other clinical indicators, such as blood pressure, dialysis adequacy, nutrition status, and biochemical parameters, were recorded. Patients were divided into 2 groups based on edema status: the edema group (n = 35 volume-overloaded patients with bilateral pitting edema) and the non-edema group (n = 61 volume-overloaded patients without bilateral pitting edema). RESULTS: Overhydration in the edema group was significantly higher than in the non-edema group (4.28 ± 1.75 kg vs 3.12 ± 0.81 kg, p < 0.001), whereas both FMD and serum albumin in the edema group were significantly lower than in the non-edema group (6.65% ± 5.2% vs 10.3% ± 5.1%, p = 0.001; 37.6 ± 4.2 g/L vs 39.3 ± 3.5 g/L, p = 0.047, respectively). Edema status (edema = 1, non-edema = 0) was positively correlated with overhydration (r = 0.341, p < 0.001), gender (male = 1, female = 2: r = 0.184, p = 0.072), and total fluid removal (r = 0.188, p = 0.074) and negatively correlated with endothelial function, as assessed by FMD (r = -0.33, p = 0.001), and serum albumin (r = -0.18, p = 0.055). Logistic regression analysis showed that FMD [odds ratio (OR) 0.90, 95% confidence interval (CI) 0.81 - 0.99; p = 0.036], gender (male = 1, female = 2: OR 4.06, 95% CI 1.23 - 13.35; p = 0.021), overhydration (OR 3.06, 95% CI 1.53 - 6.13; p = 0.002), and serum albumin (OR 0.86, 95% CI 0.75 - 0.99; p = 0.035) were independent factors affecting the edema status of the study population. CONCLUSION: Our study showed that endothelial function (assessed by FMD), gender, serum albumin, and overhydration are independent determinants of edema status in PD patients. This may explain why some PD patients can maintain free of edema despite significant volume overload.

Volume control in peritoneal dialysis patients guided by bioimpedance spectroscopy assessment.

BACKGROUND: Volume overload is a common problem in peritoneal dialysis patients and may contribute to the high cardiac mortality in this patient population. Controlling volume status is difficult due to the lack of appropriate and accurate assessment of dry weight. This randomized, controlled study was conducted to test if the recent use of overhydration value (OH) provided by bioimpedance spectroscopy and patients' education would help to control overhydration. METHODS: 160 continuous ambulatory peritoneal patients were included in this study. All the patients were randomly allocated to 2 groups: in Group 1 the patients and their primary nurses were informed of the OH values provided by bioimpedance spectroscopy whereas in Group 2 the values were not revealed and patients' volume was measured by the standard methods. Fluid status was evaluated by means of repeated bioimpedance analysis and clinical assessment. Urine volume, blood pressure and use of antihypertensive medications were recorded. RESULTS: There were no differences in gender, age, diabetes, height, weight and clinical hydration status between the 2 groups at the baseline. In Group 1, OH (p < 0.05), extracellular volume and the extracellular volume to intracellular volume ratio decreased steadily during the 3-month follow-up. On the contrary, all 3 parameters increased significantly in Group 2. SBP decreased significantly in Group 1 but increased significantly in Group 2. CONCLUSION: Our study shows that the use of OH as determined by bioimpedance spectroscopy may facilitate volume control in peritoneal dialysis patients.

Prevalence and risk factors for peripheral artery disease among patients on maintenance peritoneal dialysis.

BACKGROUND: Cardiovascular disease is common in end-stage renal disease patients and accounts for more than half of the mortalities. Peripheral artery disease (PAD) is frequently found in this population and is an independent predictor of cardiovascular mortality. However, there have been limited studies reporting the prevalence and risk factors for PAD among patients on maintenance continuous ambulatory peritoneal dialysis (CAPD) therapy. METHODS: 343 CAPD patients from our clinic were recruited, and PAD was diagnosed using a value of ankle-brachial index <0.9. Both traditional and dialysis-related factors were evaluated. RESULTS: The prevalence of PAD was 27.4% in all patients, which increased to 45% in patients aged >70 years. In age- and gender-adjusted logistic regression, diabetes mellitus (OR 2.354, 95% CI 1.288-4.3), diastolic blood pressure (OR 0.964, 95% CI 0.939-0.989), extracellular/intracellular water ratio (OR 2.504, 95% CI 1.067-5.804), and lnCRP (OR 1.251, 95% CI 1.031-1.518) were independently associated with PAD. CONCLUSION: Our study suggested that PAD is a common problem in patients on maintenance peritoneal dialysis, especially in elderly dialysis subjects. Diabetes mellitus, elevated hsCRP level, and extracellular/intracellular water ratio are all independent risk factors for PAD. It also suggested that aggressive risk factor management for PAD should be undertaken in CAPD patients.

Implementing continuous quality improvement process in potassium management in peritoneal dialysis patients.

BACKGROUND: Abnormal plasma potassium levels are not uncommon in peritoneal dialysis (PD) patients. Here, we implemented a continuous quality improvement (CQI) approach that mainly focused on dietary management to improve potassium control in PD patients. METHODS: All clinically stable patients who visited the PD clinic monthly were included in this study. A CQI team that included nephrologists, primary nurses, dietician, patients, and their family members was organized, and it monitored patients for 6 months. Patients were asked to provide their dialysis records and 3-day dietary records at each visit. Dialysis adequacy, including potassium and phosphorus removals, was checked before and after the implementation of CQI. Changes in dietary prescription, without altering dialysis prescriptions and potassium supplementation, were made monthly, according to patients' dietary information and blood potassium levels. RESULTS: In total, 84 patients (28 male and 56 female) were included in this study. At baseline, the prevalence of hyperkalemia and hypokalemia was 14.3% each. After the intervention, the prevalence of hyperkalemia dropped to 10.7% and 6% at 3 months and 6 months, respectively. The prevalence of hypokalemia dropped to 8.3% and 7.1% at 3 months and 6 months, respectively. CONCLUSIONS: Our data suggest that implementing CQI, with a focus on dietary intervention, could significantly reduce the prevalence of potassium abnormality in PD patients.

Promoting self-management improves the health status of patients having peritoneal dialysis.

AIM: This paper is a report of a study conducted to explore the effects of promoting self-management on the well-being of patients having peritoneal dialysis. BACKGROUND: Peritoneal dialysis is a home-based treatment for end-stage renal disease. Promoting self-management has been shown to improve the health status of people with diabetes mellitus and other chronic diseases. However, little is known about the effects of self-management support for patients having peritoneal dialysis. METHOD: Thirty patients who had received peritoneal dialysis for at least 6 months and were clinically stable were enrolled in the study in 2006. A multidisciplinary team was built to support the patients' self-management. Various forms of education such as group discussion and individual consultation were used to improve patients' self-efficacy and all were followed up for 6 months. We compared the volume status, adequacy of dialysis, nutritional status, quality of life, rehabilitation status, self-management capacity and self-efficacy levels at baseline, 3 and 6 months after enrolment. RESULTS: During follow-up, patients' urine volume and residual renal function decreased, while the adequacy of dialysis (Kt/v and Ccr) did not change. Volume status, quality of life and rehabilitation status all improved, whereas nutritional status did not deteriorate. Both self-management capacity and self-efficacy level increased statistically significantly. CONCLUSION: A team approach needs to be taken to achieve successful self-management in patients having peritoneal dialysis, as with other chronic disease treatments. Nurses should use multiple strategies based on self-efficacy theory to improve patients' self-efficacy levels and self-management capacities.

Effect of nutrition on arterial stiffness in peritoneal dialysis patients.

BACKGROUND: A poor nutritional state is associated with an increased risk of cardiovascular events in end-stage renal disease. It is unclear whether malnutrition itself can induce cardiovascular disease (CVD). We examined the impact of nutritional status on patients' arterial stiffness in peritoneal dialysis (PD) patients. METHODS: We prospectively enrolled 121 stable PD patients and evaluated them at baseline and 1 year later. According to patients' Subjective Global Assessment (SGA) changes from baseline to the end, patients were divided into four groups: group 1, SGA from A to B; group 2, SGA remained A, group 3, SGA changed from B to A, and group 4, SGA remained B. Arterial stiffness was assessed by pulse-wave velocity (PWV). RESULTS: At baseline, PWV in well-nourished patients were lower than malnourished patients (p < 0.05). One year later, in group 1, as compared with baseline, PWV increased significantly (p < 0.001) whereas handgrip strength (HGS), daily dietary protein intake and dietary energy intake decreased significantly. In group 3, PWV decreased significantly (p < 0.05) whereas HGS and ALB increased significantly. In groups 1 and 3, lgCRP level remained unchanged. CONCLUSION: There was a closely longitudinal association between nutritional status and arterial stiffness in PD patients, suggesting a possible impact of nutritional status on arterial function.

Establishing a renal management clinic in China: initiative, challenges, and opportunities.

BACKGROUND: Chronic kidney disease (CKD) has been identified as a growing global burden and traditional health care systems are inadequate for the management of CKD patients. This paper describes an initiative to establish a renal management clinic (RMC) in China and discusses the challenges and opportunities in the management of CKD patients. SUBJECTS AND METHODS: We collected and analyzed the data for the first 1,000 CKD patients treated since the establishment of the RMC (from April 2006 to April 2007). They had CKD stages 1-4 and stage 5 (before dialysis), as described by the Kidney Outcome Quality Initiatives (KDOQI). They were managed at the RMC established at the Peking University Third Hospital, by a multidisciplinary team (nephrologists, nurses, and dietitians) who developed care plans, clinical pathways, and a multidimensional patient-education program. RESULTS: The most frequent causes of CKD among these 1,000 patient were glomerulonephritis (35%), hypertensive nephrosclerosis (19%), chronic interstitial nephritis (13%), and diabetic nephropathy (11%). Six percent of the patients had stage 1 CKD, 27% stage 2, 33% stage 3, 20% stage 4, and 13% had stage 5. Five hundred and fifty-four were male and 446 were female; mean age was 55 +/- 18.9 years (range 18-92 years). Seven hundred and seventy patients (77%) had hypertension; 400 patients (40%) had body mass index (BMI) equal to or higher than 25 kg/m(2); 180 (18%) had overt cardiovascular disease; 726 (72.6%) had low-density lipoprotein (LDL)-cholesterol higher than 2.6 mmol/l; 440 patients (44%) had hyperuriemia; and 274 patients (27.4%) had anemia (hemoglobin <110 g/l). Although the team is multidisciplinary, management of the patients in the RMC is undertaken mainly by nephrologists, whereas nurses and dietitians still do not play an important role. There are no family doctors in China and nephrologists are responsible for management of these patients' kidney disease and related complications. CONCLUSIONS: Our findings show that the prevalence of hypertension, diabetes mellitus, overweight. and hyperuricemia is high among Chinese CKD population. Nurses and dietitians do not yet play an important role in the present pattern of RMC. We believe that the present medical care model should be revised because it does not address the concerns of CKD patients and their need for lifestyle changes that would help them to cope with their chronic condition.

Menu suggestion: an effective way to improve dietary compliance in peritoneal dialysis patients.

OBJECTIVE: Poor compliance with the dietary prescriptions is quite common in dialysis patients. We believe that most of the noncompliance is caused by the patient's poor understanding of the dietary prescription. Therefore, in the present study, we tried to investigate the role of menu suggestion in improving the patient's compliance with the dietary prescription. DESIGN AND SETTING: A longitudinal cohort study conducted at an outpatient dialysis clinic. PATIENTS: Seventy clinically stable patients on peritoneal dialysis were included in this prospective study during April 1, 2004, to November 31, 2004, in a single center. Patients who had significant cognitive impairment and thus did not understand the food contents during the training course were not eligible for enrollment. INTERVENTION: All the patients were randomly assigned to 1 of 2 groups. Group 1 patients received the traditional patient education method. Group 2 patients additionally received individualized menu suggestions based on their food preferences and education on how to exchange the foods at equivalent amounts according to the exchange list. MAIN OUTCOME MEASURES: At present, there are no clear optimal dietary protein intake levels for peritoneal dialysis patients. Our experience is that a dietary protein intake level of 0.8 to 1.2 g/kg/d can maintain our patients in a good nutritional status. Thereafter, in this study we prescribed the dietary protein intake level at 0.8 to 1.2 g/kg/d and defined compliance as meeting this target protein intake level. RESULTS: There were 35 patients in each group. The compliance was 22.9% in group 1 and 57.1% in group 2 (P < .05). CONCLUSIONS: Our study suggests that menu suggestion may be an effective way of improving the compliance with the diet in peritoneal dialysis patients. It improves the patient's understanding of the dietary prescription.

[Energy pooling collisions for K(4P) + Cs(5D) in a K-Cs mixture].

The rate coefficients for energy-pooling collisions K(4P) + Cs(5D) --> Cs(6S) + K(4D, 6S) in the K-Cs vapor mixture were measured relative to a known energy-pooling rate coefficient of a homonuclear reaction [i. e., Cs(6P) + Cs(5D) --> Cs(6S) + Cs (7D(J))]. Populations of the Cs(6P, 5D) and K(4P) states were produced by photodissociation of K2 and Cs2 molecules through the use of a dye laser radiation. The resulting fluorescence included the direct components emitted in the decay of the excited states produced by photodissociation and the induced components arising from the collisionally populated states. By combining relative intensities of the components with the effective lifetimes of Cs(6P) and K(4P) states, the rate coefficients (in units of 10(-9) cm3 x s(-1)) for the heteronuclear energy-pooling were found to be 2.6 and 3.6, respectively. The contribution to the rate coefficients from other processes are discussed.