Showing papers on "Peritoneal dialysis published in 2006"
TL;DR: It is concluded that high levels of phosphate both at baseline and over follow-up are associated with mortality in incident dialysis patients.
324 citations
TL;DR: Overall patient survival is similar for PD and HD but that important differences do exist within select subgroups of patients, particularly those subgroups defined by age and the presence or absence of diabetes.
299 citations
TL;DR: NFD is a severe and usually progressive systemic fibrotic disease affecting the dermis, subcutaneous fascia, and striated muscles and it also appears that the disease can cause fibrosis of lungs, myocardium, and other organs.
260 citations
TL;DR: There is increasing evidence that residual renal and peritoneal dialysis clearance cannot be assumed to be equivalent qualitatively, thus indicating the need to preserve residual renal function in patients on dialysis.
248 citations
TL;DR: The experience in these seven regions over these two years clearly shows the feasibility of the REIN registry, which is progressively expanding to cover the entire country.
Abstract: The French Renal Epidemiology and Information Network (REIN) registry began in 2002 to provide a tool for public health decision support, evaluation and research related to renal replacement therapies (RRT) for end-stage renal disease (ESRD). It relies on a network of nephrologists, epidemiologists, patients and public health representatives, coordinated regionally and nationally. Continuous registration covers all dialysis and transplanted patients. In 2003, 2070 patients started RRT, 7854 were on dialysis and 7294 lived with a functioning graft in seven regions (with a population of 16.5 million people). The overall crude annual incidence rate of RRT for ESRD was 123 per million population (p.m.p.) with significant differences in age-adjusted rates across regions, from 84 [95% confidence interval (CI): 74-94] to 155 [138-172] p.m.p. The principal causes of ESRD were hypertension (21%) and diabetic (20%) nephropathies. Initial treatment for ESRD was peritoneal dialysis for 15% of patients and a pre-emptive graft for 3%. The one-year survival rate was 81% [79-83] in the cohort of 2002-2003 incident patients. As of December 31, 2003, the overall crude prevalence was 898 [884-913] p.m.p, with 5% of patients receiving peritoneal dialysis, 47% on haemodialysis and 48% with a functioning graft. The experience in these seven regions over these two years clearly shows the feasibility of the REIN registry, which is progressively expanding to cover the entire country.
242 citations
TL;DR: A meta-analysis of observational studies demonstrates that a higher peritoneal membrane solute transport rate is associated with a higher mortality risk and a trend to higher technique failure.
Abstract: Peritoneal membrane solute transport in peritoneal dialysis (PD) patients is assessed by the peritoneal equilibration test, which measures the ratio of creatinine in the dialysate to plasma after a standardized 4-h dwell (D/P c ). Patients then are classified as high, high-average, low-average, or low transporters on the basis of this result. A meta-analysis of observational studies was carried out to characterize the relationship between D/P c and mortality and technique failure in patients who are on PD. Citations were identified in Medline by using a combination of Medical Subject Heading search terms and key words related to PD, peritoneal membrane permeability/transport, and mortality and technique failure. The table of contents of relevant journals and bibliographies of relevant citations were reviewed in duplicate. Twenty studies that met study criteria were identified. Nineteen studies were pooled to generate a summary mortality relative risk of 1.15 for every 0.1 increase in the D/P c (95% confidence interval 1.07 to 1.23; P < 001). This result equated to an increased mortality risk of 21.9, 45.7, and 77.3% in low-average, high-average, and high transporters, respectively, as compared with patients with low transport status. Meta-regression analysis showed that the proportion of patients who were on continuous cycler PD within a study was inversely proportional to the mortality risk (P = 0.05). The pooled summary relative risk for death-censored technique failure was 1.18 (95% confidence interval 0.96 to 1.46; P = 0.12) for every 0.1 increase in the D/P c . This meta-analysis demonstrates that a higher peritoneal membrane solute transport rate is associated with a higher mortality risk and a trend to higher technique failure.
236 citations
TL;DR: Caregivers of elderly dialysis patients, especially of those on PD therapy, experience a significant burden and adverse effects on their quality of life and educational, social, and psychological support interventions should be considered to improve thequality of life of caregivers.
205 citations
TL;DR: It is concluded that the current state of PD in the United States is characterized by improving patient outcomes, higher technique success, and a predominance of use of cycler-based therapy.
197 citations
TL;DR: It is suggested that PD patients in general are more satisfied with their overall care and believe that their treatment has less impact on their lives than HD patients.
Abstract: This study was undertaken to examine patient satisfaction with peritoneal dialysis (PD) and hemodialysis (HD) therapies, focusing attention on the positive and negative impact of the therapies on patients' lives. Patients were recruited from a free-standing PD unit and two free-standing HD units. A total of 94% (n = 62) of eligible PD and 84% (n = 84) of eligible HD patients participated. HD patients were significantly older and had higher Charlson Comorbidity Index scores than the PD patients, but there were no differences in duration of dialysis treatment, prevalence of diabetes, educational backgrounds, or home situations. Patients were asked to rate their overall satisfaction with and the overall impact of their dialysis therapy on their lives, using a 1 to 10 Likert scale. In addition, patients were asked to rate the impact of their therapy on 15 domains that had been cited previously as being important for patients' quality of life. The mean satisfaction score for PD patients (8.02 +/- 1.41) was higher than for HD patients (7.4 +/- 1.4; P = 0.15). PD patients indicated that there was less impact of the dialysis treatment on their lives globally (7.25 +/- 2.12 versus 6.19 +/- 2.83; P = 0.019). In addition, PD patients noted less impact of the therapy in 14 of the 15 domains examined. With the use of a proportional odds model analysis, the only significant predictor of overall satisfaction and impact of therapy was dialysis modality (P = 0.037 and P = 0.021, respectively). Patients also were asked to comment freely on the positive and negative effects of the dialysis treatments on their lives, and a taxonomy of patient perceptions and concerns was developed. This study suggests that PD patients in general are more satisfied with their overall care and believe that their treatment has less impact on their lives than HD patients.
182 citations
TL;DR: Patients with dialysis-treated CKD 5 exhibited more functionally significant muscle wasting than patients with CKD 4, and may be amenable to modification with targeted exercise or amelioration of factors associated with observed differences in muscle mass.
Abstract: Background. Chronic renal replacement therapy patients exhibit reduction in skeletal muscle function as a result of a combination of metabolic effects and muscle fibre size reduction. The aim of this study was to compare muscle mass with function in patients with chronic kidney disease (CKD) at stages 4 and 5 on haemodialysis (HD) and peritoneal dialysis (PD), and investigate the associations of muscle wasting in a cross-sectional cohort. Methods. We studied 134 patients (60 HD, 28 PD and 46 CKD 4). The three groups were well matched for age, sex, diabetes and dialysis vintage. Cross-sectional area (CSA) of muscle and fat was measured from a standardized multi-slice CT scan of a 6 cm long section of thigh. CSA of soft tissue was taken from appropriate fat and muscle densities. Functional assessment was by the sit-to-stand 60 test, assessing both the number of sit-to-stands possible under controlled conditions in 60 s (STS 60), and the time taken to perform five sit-to-stand movements (STS 5). Data were collected on a wide range of potential determinants of muscle CSA. Results. Both male and female CKD patients had reduced muscle CSA, corrected for height by around 10% as compared with CKD 4 patients. There were no significant differences between HD and PD patients. Muscle CSA correlated well with objective functional assessments in males (STS 60 R ¼ 0.52, P<0.0001) and females (R ¼ 0.41, P ¼ 0.004), and STS performance was reduced in dialysed patients as compared with CKD 4. Univariate analysis demonstrated that muscle CSA was associated with serum albumin concentration (R ¼ 0.49, P<0.0001), age (R ¼� 0.35, P ¼ 0.005) and C-reactive protein (R ¼� 0.34, P ¼ 0.004). Creatinine clearance, dialysis adequacy, dialysis vintage and timeaveraged serum bicarbonate, calcium and phosphate concentrations were not correlated with muscle CSA. Conclusion. In conclusion, patients with dialysistreated CKD 5 exhibited more functionally significant muscle wasting than patients with CKD 4. This may be amenable to modification with targeted exercise or amelioration of factors associated with observed differences in muscle mass.
174 citations
TL;DR: The International Society for Peritoneal Dialysis (ISPD) has recently published a series of recommendations concerning the delivery of adequate peritoneal dialysis (PD).
Abstract: The previous decade saw the generation of a series of consensus and evidence-based guidelines for the optimal management of dialysis patients. The majority of these have emanated from national and regional committees. There is not always agreement among these documents; part of this disparity may have to do with the nuances of dialysis practice in different parts of the world. The International Society for Peritoneal Dialysis (ISPD) has commissioned a working group with representation from Asia, Australia, Europe, and North America to formulate a series of recommendations concerning the delivery of adequate peritoneal dialysis (PD). It is the hope of the authors that the comments and recommendations presented here are relevant and applicable to those worldwide who manage patients on PD, and that they are readable, precise, and concise. These recommendations have been approved by the Standards and Education Committee of the ISPD.
TL;DR: Compared to conventional PD solution, the use of balance, a neutral pH, low GDP solution resulted in a superior profile of PDE mesothelial cell marker and a lower degree of systemic inflammation, and the difference was maintained for 1 year.
Abstract: Background. Chronic utilization of a bio-incompatible peritoneal dialysis (PD) solution with acidic pH and a high content of glucose degradation product (GDP) has been implicated as a contributing cause of peritoneal failure. We compared a newly formulated solution of neutral pH and low levels of GDP to a standard PD solution. Methods. Fifty new PD patients were randomized to a conventional lactate-buffered fluid (control) and a pH neutral, lactate-buffered, low GDP solution (balance). Patients were followed for 12 months. Serum samples were assayed for C-reactive protein (CRP). PD effluent was collected and assayed for cancer antigen-125 (CA125) and hyaluronan (HA). Clinical end points were the residual renal function and dialysis adequacy indices. Results. After 52 weeks of treatment, PD fluid CA125 rose from 2.45 � 0.96 to 14.30 � 2.17 U/ml (P < 0.001), and HA declined from 2.26 � 0.60 to 1.45 � 0.32mg/ml (P ¼ 0.07) in the balance group. The balance group had a higher PD fluid CA-125 (14.30 � 2.17 vs 7.36 � 2.23 U/ml, P ¼ 0.007), lower HA (1.45 � 0.32 vs 2.55 � 0.32mg/ml, P ¼ 0.007), and lower serum CRP level (1.77 � 0.42 vs 7.73 � 2.42 mg/l, P ¼ 0.026) than the control group at 52 weeks. There was no difference in dialysis adequacy indices, ultrafiltration volume, urine output, residual renal function, peritonitis rate or need of hospitalization in 1 year. Conclusion. As compared to conventional PD solution, the use of balance, a neutral pH, low GDP solution resulted in a superior profile of PDE mesothelial cell marker and a lower degree of systemic inflammation, and the difference was maintained for 1 year. It remains to be determined whether these effects could result in better long-term clinical outcome.
01 Mar 2006
TL;DR: The QOL measured by the NHP and SF-36 scale showed that the normal population was statistically significantly better than the transplant recipients (P < .0001).
Abstract: The purpose of this study was to compare the quality of life (QOL) in renal transplantation patients. QOL is one of the important indicators of the effects of medical treatment. In this cross-sectional study, QOL was analyzed in 302 renal transplant recipients compared with 64 hemodialysis (HD) patients, 207 (PD) peritoneal dialysis patients, and 278 normal controls (NC) matched as closely as possible to the grafted patients regarding age, gender, education, and occupation. All groups were asked to estimate their subjective QOL by responding to sociodemographic data, Turkish adapted instruments of the Nottingham Health profile (NHP), and the Short-form 36 (SF-36). Transplant recipients were significantly younger than the HD and PD patients (P < .0001). There was no statistically significant differences between normal controls and transplant patients ages. Among the three renal replacement methods, QOL in transplants was clearly better than that in HD or PD patients (P < .0001). The QOL measured by the NHP and SF-36 scale showed that the normal population was statistically significantly better than the transplant recipients (P < .0001). Transplant renal replacement therapy provides a better QOL compared with other replacement methods.
TL;DR: Serum sRAGE levels increase in patients with decreases renal function, mainly patients with end-stage renal disease, and it remains to be elucidated whether the increase is caused just by decreased renal function or whether sRAge is upregulated to protect against toxic effects of AGEs.
TL;DR: The PD modality may be a feasible, safe and complementary alternative to HD not only in the chronic, but also in the acute setting, and may be an yet another tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy.
Abstract: Background. Peritoneal dialysis (PD) has become a well-established complementary alternative to haemodialysis (HD) as first-line renal replacement modality. At our department, � 50% of the end-stage renal disease patients are started urgently on chronic dialysis due to late referral or unexpected deterioration of residual renal function. These patients—although suitable for PD—were previously started on HD via a temporary central venous catheter. Since January 2000, patients have been offered urgent start on chronic PD right after PD-catheter insertion by open surgery. Methods. Retrospective study describing how acute APD was initiated using a standard prescription for a 12 h overnight APD in the supine position right after (<24 h) PD catheter placement and comparing shortterm (3 months) outcome measures and dialysis-related complications between a group of patients started acutely on chronic PD and a non-matched group of patients with a planned start on chronic PD. Results. The number and type of infectious complications were equal in both the groups. The total number of mechanical complications was significantly higher in the acute group compared with the planned group (P < 0.05). Consequently, the need for surgical replacement of catheters was also significantly higher in the study group (P < 0.02). With death and transplantation being the censored events, there was no difference in short-term PD technique survival rates between the two groups [39/45 (86.7%) vs 45/50 (90.0%)]. Conclusions. The PD modality may be a feasible, safe and complementary alternative to HD not only in the chronic, but also in the acute setting. The concept of acute start on chronic PD may be an yet another tool to increase the PD penetration rate among incident patients starting chronic dialysis therapy.
TL;DR: The RDPLF results demonstrate that PD may be successfully prescribed for older patients who receive assistance either from their family or from a nurse, and a larger number of younger patients should also be prescribed this technique in France.
TL;DR: Quality improvement programs with continuous monitoring of infections, both of the catheter exit site and peritonitis, are important to decrease the PD related infections in PD programs.
TL;DR: The disease was most advanced in maintenance HD patients-comparable to the full-symptomatic form of periodontitis; then it was successively diminished in CAPD and pre-dialysis CKD subjects, and CPITN indicated a high severity ofperiodontitis in all renal failure groups as compared with general population subjects.
Abstract: Background Periodontitis contributes to generalized inflammation and development of systemic diseases, including atherosclerosis and cardiovascular disease. Its extent in maintenance haemodialysis (HD) patients is disputable and not known in continuous ambulatory peritoneal dialysis (CAPD) and pre-dialysis chronic kidney disease (CKD) patients. Methods One hundred and six patients (35 on HD, mean age, 56 years; 33 on CAPD, mean age 51 years; and 38 pre-dialysis CKD stage 2-5, mean age 51 years) from north-eastern Poland were enrolled. Dialysis subjects were recruited from a cohort of 141 HD and 61 CAPD patients. Two control groups comprised 26 generally healthy individuals with advanced periodontitis requiring specialized treatment, and 30 subjects from general population. Gingival index (GI), papillary bleeding index (PBI), plaque index (PI), loss of clinical attachment level (CAL) and community periodontal index of treatment needs (CPITN) were determined according to WHO recommendations. Results Average values of the indices in HD, CAPD, pre-dialysis CKD, advanced periodontitis and general population subjects were as follows: GI-1.37, 0.95, 1, 2 and 1; PBI-1.45, 0, 0, 2.20 and 1; PI-2.05, 1.59, 1, 2 and 1; and CAL loss-5.11, 3.47, 2.50, 4.68 and 1.40 mm, respectively. CPITN, analysed separately as community periodontal index and periodontal treatment needs, further indicated a high severity of periodontitis in all renal failure groups as compared with general population subjects. The disease was most advanced in maintenance HD patients-comparable to the full-symptomatic form of periodontitis; then it was successively diminished in CAPD and pre-dialysis CKD subjects. Conclusions Periodontal disease is prevalent, severe and under recognized in renal failure patients. Prophylaxis and early dental treatment should be intensified in these subjects, and may be of interdisciplinary importance.
TL;DR: Examining the causes and consequences of the obesity paradox in dialysis patients can improve the understanding of similar paradoxes observed both for other conventional risk factors in chronicdialysis patients, and in other populations, such as patients with heart failure, cancer or AIDS or geriatric populations.
Abstract: Overweight (body mass index [BMI]=25-30 kg/m2) and obesity (BMI>30 kg/m2) have become mass phenomena with a pronounced upward trend in prevalence in most countries throughout the world and are associated with increased cardiovascular risk and poor survival. In patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis an 'obesity paradox' has been consistently reported, i.e., a high BMI is incrementally associated with better survival. While this 'reverse epidemiology' of obesity is relatively consistent in maintenance hemodialysis patients, studies in peritoneal dialysis patients have yielded mixed results. A similar obesity paradox has been described in patients with chronic heart failure as well as in 20 million members of other distinct medically 'at risk' populations in the USA. Possible causes of the reverse epidemiology of obesity include: (1) time-discrepancies between the competing risks for the adverse events that are associated with overnutrition and undernutrition; (2) sequestration of uremic toxins in adipose tissue; (3) selection of a gene pool favorable to longer survival in dialysis patients during the course of CKD progression, which eliminates over 95% of the CKD population before they commence maintenance dialysis therapy; (4) a more stable hemodynamic status; (5) alterations in circulating cytokines; (6) unique neurohormonal constellations; (7) endotoxin-lipoprotein interactions; and (8) reverse causation. Examining the causes and consequences of the obesity paradox in dialysis patients can improve our understanding of similar paradoxes observed both for other conventional risk factors in chronic dialysis patients, such as blood pressure and serum cholesterol, and in other populations, such as patients with heart failure, cancer or AIDS or geriatric populations.
TL;DR: Results support the placement of permanent accesses (fistula or PD catheter) before the start of dialysis to avoid use of HD catheters, which were associated with a strikingly increased rate of bacteremia.
Abstract: The impact of dialysis modality on infection, especially early in the course of dialysis, has not been well studied. This study compared infection between hemodialysis (HD) and peritoneal dialysis (PD) from the start of dialysis and evaluated factors that have an impact on infection risk. In this observational cohort study, all incident dialysis patients (n = 181; HD 119 and PD 62) at a single center from 1999 to 2005 had data collected prospectively beginning day 1 of dialysis. Excluded were those with any previous ESRD therapy. Infection rates were evaluated using multivariate Poisson regression. Overall infection rates were similar (HD 0.77 versus PD 0.86/yr; P = 0.24). Only HD patients had bacteremia (0.16/yr), and only PD patients had peritonitis (0.24/yr). Bacteremia that occurred < or =90 d after start of HD was 0.44/yr, increased compared with overall rate of 0.16/yr (P < 0.004). HD catheters, used in 67% of patients who started HD, were associated with a strikingly increased rate of bacteremia. Peritonitis < or =90 d was 0.22/yr, no different from the overall rate. Modality was not an independent predictor of overall infections (PD versus HD: relative risk 1.30; 95% confidence interval 0.93 to 1.8; P = 0.12) using multivariate analysis. PD and HD patients had similar infection rates overall, but type of infection and risk over time varied. HD patients had an especially high risk for bacteremia in the first 90 d, whereas the risk for peritonitis for the PD cohort was not different over time. These results support the placement of permanent accesses (fistula or PD catheter) before the start of dialysis to avoid use of HD catheters.
TL;DR: Many burdensome interventions that adversely affect the utilization of peritoneal dialysis as renal replacement therapy and patient satisfaction with this treatment modality can be avoided by earlyPeritoneal access placement with embedded catheters, implantation techniques that preempt common catheter complications, and the use of access devices that provide flexibility in exit site location.
TL;DR: There was no association between baseline sleep quality and survival; however, a decline in sleep quality during the first year on dialysis was associated with shorter survival (hazard ratio 1.44; 95% confidence interval 1.13 to 1.83).
Abstract: Although sleep problems are thought to be prevalent among patients who undergo dialysis, there is only limited information on the determinants of sleep quality and the change in sleep quality during the first year of dialysis treatment. This report uses data from a national cohort study of incident hemodialysis and peritoneal dialysis patients to identify the correlates of sleep quality and to determine the extent to which sleep quality is related to patients' health-related quality of life and survival. This report includes 909 incident dialysis patients who responded to questions about sleep quality. Three quarters of incident dialysis patients reported impaired sleep, and 14% had a decline in sleep quality in the first year of treatment. Poor sleep quality was significantly related to black race, higher serum phosphate, current smoking, benzodiazepine prescription, and complaints of severe restless legs. Poor baseline sleep quality was associated with lower SF-36 physical and mental component summary scores, vitality scores, and bodily pain scores (all P < 0.001). Younger age, current smoking, and benzodiazepine prescription were associated with decreases in sleep quality at 1 yr. There was no association between baseline sleep quality and survival; however, a decline in sleep quality during the first year on dialysis was associated with shorter survival (hazard ratio 1.44; 95% confidence interval 1.13 to 1.83; P = 0.003). Future work should examine the link between sleep quality and daytime functioning in the kidney failure population and the extent to which improving sleep quality will improve dialysis patient outcomes.
TL;DR: The literature is reviewed to determine the guidelines for PD training that are most likely to achieve the best outcomes for patients and these are established, the first set of ISPD recommendations for patient training.
Abstract: a The authors are members of the International Society for Peritoneal Dialysis (ISPD) Nursing Liaison Committee. The guidelines have been approved by the ISPD Council and the Education and Standards Committee. Patient training is an essential component of a peritoneal dialysis (PD) program but no standards have been published to guide the education process. The Nursing Liaison Committee (the Committee) of the International Society for Per itoneal Dialysis (ISPD) has previously reviewed current standards of care for PD training throughout the world through a survey of nurses (1). Furthermore, we have reviewed the literature to determine the guidelines for PD training that are most likely to achieve the best outcomes for patients. We now establish the first set of ISPD recommendations for patient training.
TL;DR: This review addresses the mechanism involved in peritoneal structural alteration by dialysis and points to the EMT of MC as the initiating mechanism ofperitoneal injury.
Abstract: Peritoneal membrane fibrosis, ranging from mild inflammation to severe sclerosing peritonitis, is one of the complications of peritoneal dialysis (PD). In parallel with fibrosis, the peritoneum shows a progressive increase of capillaries and vasculopathy, involved in increased small solute transport across the membrane and ultrafiltration failure. Glucose and glucose degradation products from PD solutions are responsible of stimulating transforming growth factor-beta (TGF-beta) and vascular endothelial growth factor (VEGF) production by mesothelial cells (MCs). TGF-beta is a potent pro-fibrotic factor and inducer of epithelial-to-mesenchymal transition (EMT) of the MC. Local production of VEGF by transitional MC appears to play a central role in the processes leading to peritoneal angiogenesis. This review addresses the mechanism involved in peritoneal structural alteration by dialysis and points to the EMT of MC as the initiating mechanism of peritoneal injury. Information from multiple origins about TGF-beta and VEGF is integrated into EMT process in a comprehensive manner. Regulation and new targets for inhibition of EMT or its deleterious effects are discussed.
TL;DR: Findings indicate that intraperitoneal and systemic inflammation increase in PD patients during the first year of therapy and the IL-6 system is associated with PSTR, particularly in the early phase of PD treatment, in which small and large solute transport are linked.
Abstract: ObjectiveTo investigate if intraperitoneal and systemic interleukin-6 (IL-6) and soluble IL-6 receptor (sIL-6R) are related to each other and to peritoneal solute transport rate (PSTR).DesignLongit...
TL;DR: Both in PD and HD patients with elevated plasma phosphorus and Ca x P concentrations, the cardiovascular mortality risk is increased, and it seems appropriate to adopt the current K/DOQI guideline in PD patients.
Abstract: Background. The K/DOQI guideline for bone metabolism and disease in chronic kidney disease is predominantly based on studies in haemodialysis (HD) patients. However, in clinical practice, this guideline is also applied to peritoneal dialysis (PD) patients. To validate the implementation of this guideline in PD patients, we evaluated the associations between plasma concentrations outside the K/DOQI-targets and the risk of cardiovascular morbidity and mortality in incident PD patients compared with HD patients. Methods. In a large prospective multicentre study in the Netherlands (The Netherlands Cooperative Study on the Adequacy of Dialysis, NECOSAD), we included patients starting PD or HD between 1997 and 2004. Relative risk of cardiovascular morbidity and mortality were estimated using time-dependent Cox regression modelling. Results. We included 586 PD patients with mean age 52 � 15 years (66% males) and 1043 HD patients with mean age 63 � 14 years (58% males). Cardiovascular disease (CVD) was the reason for hospitalization in 102 PD and 271 HD patients. In HD patients, the relative risk of CVD-related hospitalization increased with elevated plasma calcium concentrations (hazard ratio: 1.4; 95% CI: 1.1–1.9). Cardiovascular mortality was significantly higher for phosphorus concentrations above the K/DOQI-threshold in PD (2.4; 95% CI: 1.3–4.2) and HD patients (1.5; 95% CI: 1.1–2.1),
TL;DR: Assisted PD enables increased use of PD in incident dialysis patients, however, in view of the comorbidities of the assisted-PD patients, the need for frequent hospitalization has to be taken into account in such a program.
Abstract: BackgroundThe French healthcare system offers the possibility of increasing the use of peritoneal dialysis (PD) by involving in patient care nurses who work in the private system.ObjectiveThis stud...
TL;DR: In this article, the authors performed a single-center cross-sectional observational study including 70 unselected patients treated with either high-flux HD ( n =20) or peritoneal dialysis (n =50) as compared to hemodialysis (HD).
TL;DR: Pruritus is a common problem in continuous ambulatory peritoneal dialysis and haemodialysis patients and the cause of which is still unknown.
Abstract: Background Pruritus is a common problem in continuous ambulatory peritoneal dialysis (CAPD) and haemodialysis patients. There are few studies on the clinical characteristics of uremic itch, the cause of which is still unknown.
Objectives The aim of this study was to define the prevalence and clinical characteristics of pruritus in CAPD and haemodialysis patients.
Methods A questionnaire was used to evaluate pruritus in 52 CAPD and 289 haemodialysis patients in two dialysis units. The relationship of various factors and medical parameters to itch was examined.
Results Of the 341 patients, 177 (51.9%) had pruritus at the time of examination, 97 (28.4%) had pruritus in the past. Pruritus was present in 145 (50.2%) of the haemodialysis patients and 32 (61.5%) of the CAPD patients. Men, patients with liver disease, and patients with pruritus before starting dialysis treatment were more likely to have uremic pruritus.
Conclusions This study showed us that uremic pruritus was observed more in men than women. The high prevalence of uremic pruritus in our study does not support the decrease of pruritus due to an improvement in the management of dialysis patients.
TL;DR: Looking at the combined evaluation of infection control and drug use, results showed that 47% of patients needed re-training, greater for younger patients, patients with lower education degree and patients in the early or late phase of PD therapy.