KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)

K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.

Peritonitis is a common and serious complication of peritoneal dialysis (PD). Although less than 5% of peritonitis episodes result in death, peritonitis is the direct or major contributing cause of death in around 16% of PD patients (1-6). In addition, severe or prolonged peritonitis leads to structural and functional alterations of the peritoneal membrane, eventually leading to membrane failure. Peritonitis is a major cause of PD technique failure and conversion to long-term hemodialysis (1,5,7,8). Recommendations under the auspices of the International Society for Peritoneal Dialysis (ISPD) were first published in 1983 and revised in 1993, 1996, 2000, 2005, and 2010 (9-14). The present recommendations are organized into 5 sections: 1. Peritonitis rate 2. Prevention of peritonitis 3. Initial presentation and management of peritonitis 4. Subsequent management of peritonitis 5.

/pdf/ispd-peritonitis-recommendations-2016-update-on-prevention-28ki6os9ax.pdf

Ispd peritonitis recommendations: 2016 update on prevention and treatment

KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update

KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update

Strict volume control normalizes hypertension in peritoneal dialysis patients

Conclusion. The results of this uncontrolled retrospective study suggest that good long-term BP control and Background. Left ventricular hypertrophy (LVH ) is very frequent in haemodialysis patients. Only few a decrease of LVM can be achieved by continuous eVorts to control hypervolaemia. The decrease in

/pdf/regression-of-left-ventricular-hypertrophy-in-haemodialysis-3588c8f509.pdf

Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs.

Background Chronic fluid overload (FO) is frequently present in peritoneal dialysis (PD) patients and is associated with hypertension and left ventricular hypertrophy and dysfunction, which are important predictors of death in dialysis patients. In the present study, we investigated the relationship between nutrition, inflammation, atherosclerosis and body fluid volumes measured by multi-frequency bioimpedance analysis (m-BIA) in PD patients. In addition, we analysed the relationship of extracellular volume values by m-BIA to echocardiographic parameters in order to define its usefulness as a measure of FO. Methods Ninety-five prevalent PD patients (mean age 50 ± 13 years, 10 of them diabetic) were enrolled. Extracellular water (ECW), total body water (TBW), dry lean mass (DLM) and phase angle (PA) were measured by m-BIA. Volume status was determined by measuring left atrium diameter (LAD) and left ventricular end-diastolic diameter (LVEDD). Measurement of carotid artery intima-media thickness (CA-IMT) was used to assess the presence of subclinical atherosclerosis. Serum albumin was used as a nutritional marker, and serum C-reactive protein (CRP) was used as an inflammatory marker. Results Mean ECW/height was 10.0 ± 1.0 L/m for whole group and 9.3 ± 0.6 L/m in patients with normal clinical hydration parameters. In correlation analysis, markers of nutrition, inflammation and atherosclerosis correlated well with m-BIA parameters. When we used echographically measured LAD (> 40 mm) or LVEDD (> 55 mm) as a confirmatory parameter, a cut-off value of 10.48 L/m ECW/height (78% specificity, with a sensitivity of 77% for LAD and 72% specificity, with a sensitivity of 70% for LVEDD) was found in ROC analysis for the diagnosis of FO. Patients with FO were older and had higher systolic blood pressure, cardiothoracic index, serum CRP level and mean CA-IMT than patients without FO. Patients with inflammation had higher CA-IMT values. In multivariate analysis, only two factors-low urine output and ECW/height-were independently associated with the presence of inflammation. Conclusions FO defined by m-BIA is significantly correlated with markers of malnutrition, inflammation and atherosclerosis in PD patients. The indices obtained from m-BIA, especially ECW/height, correlated well with volume overload as assessed by echocardiography and might be a measure worth testing in a properly designed clinical study.

/pdf/relations-between-malnutrition-inflammation-atherosclerosis-g26x3idse0.pdf

Relations between malnutrition–inflammation–atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients

https://www.ajkd.org/article/S0272-6386(99)70346-X/pdf

Treatment of hypertension in dialysis patients by ultrafiltration: Role of cardiac dilatation and time factor

In some hypertensive haemodialysis (HD) patients, blood pressure rises further during ultrafiltration (UF). We investigated seven such patients, who were not responsive to hypotensive drugs, including converting enzyme inhibitors. All had marked cardiac dilatation, but most were non-oedematous. They were treated with repeated intense UF while monitoring cardiac function by echocardiography. After a variable time period they all became (near) normotensive without medication. Mean systolic and diastolic blood pressure decreased by 46 +/- 18 and 22 +/- 9 mmHg respectively while bodyweight decreased by a mean of 6.7 +/- 3.0 kg. Plasma volume decreased by 22%, and mean albumin increased from 3.9 +/- 0.3 to 4.2 +/- 0.3 g/dl. Cardiothoracic index decreased from a 0.56 +/- 0.02 to 0.45 +/- 0.03. Mitral and tricuspid insufficiency was present in four patients and improved or disappeared in all of them. Diameters of the inferior vena cava, left atrium, and end systolic and diastolic left ventricle markedly decreased in all patients. Ejection fraction increased, but remained subnormal in some patients, while cardiac output increased in five and decreased in two patients. We conclude that paradoxical blood pressure rise with UF usually occurs in the presence overhydration and cardiac dilatation and should be treated by intensified UF. The explanation of this phenomenon remains speculative.

Fehmi Akcicek

Papers

Strict volume control normalizes hypertension in peritoneal dialysis patients

Regression of left ventricular hypertrophy in haemodialysis patients by ultrafiltration and reduced salt intake without antihypertensive drugs.

Relations between malnutrition–inflammation–atherosclerosis and volume status. The usefulness of bioimpedance analysis in peritoneal dialysis patients

Treatment of hypertension in dialysis patients by ultrafiltration: Role of cardiac dilatation and time factor

‘Paradoxical’ rise in blood pressure during ultrafiltration in dialysis patients