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Sample records for dialysis patients treated

  1. Arthritis associated with calcium oxalate crystals in an anephric patient treated with peritoneal dialysis

    SciTech Connect

    Rosenthal, A.; Ryan, L.M.; McCarty, D.J.

    1988-09-02

    The authors report a case of calcium oxalate arthropathy in a woman undergoing intermittent peritoneal dialysis who was not receiving pharmacologic doses of ascorbic acid. She developed acute arthritis, with calcium oxalate crystals in Heberden's and Bouchard's nodes, a phenomenon previously described in gout. Intermittent peritoneal dialysis may be less efficient than hemodialysis in clearing oxalate, and physicians should now consider calcium oxalate-associated arthritis in patients undergoing peritoneal dialysis who are not receiving large doses of ascorbic acid.

  2. Nutrition in dialysis patients.

    PubMed

    Sen, D; Prakash, J

    2000-07-01

    Malnutrition is a common clinical problem in dialysis patients, which is multifactorial in origin. It is most often found in a patient of chronic renal failure (CRF) during the period when the glomerular filtration rate (GFR) falls below 10 ml/min, but dialysis is yet to be started. The loss of proteins, aminoacids and other essential nutrients during the procedure of dialysis may further aggravate the malnutrition. Poor nutrition in dialysis patients is associated with increased morbidity and mortality in the form of delayed wound healing, malaise, fatigue, increased susceptibility to infection and poor rehabilitation. In view of the above consequences, all patients on dialysis must undergo nutritional assessment. It is very vital to maintain good nutritional status in-patients on dialysis by adequate protein and calories intake, appropriate supplementation of iron, calcium, minerals and water-soluble vitamins and, of course, the supplementation should be individualised. Nutritional needs are enhanced in presence of stresses like infection or surgery to limit excessive tissue catabolism and therefore, these are the situations, which demand intensive nutrition therapy. Total parenteral nutrition (TPN) may be required for patients on dialysis in intensive care unit, using a central venous catheter. However, enteral route is always preferred to parenteral ones, whenever possible. Even after adequate dialysis has been given, dietary counselling is often required for both hemodialysis and peritoneal dialysis patients to ensure that they ingest the recommended amount of protein, calories and essential micronutrients. PMID:11273510

  3. Inflammatory Biomarkers in Refractory Congestive Heart Failure Patients Treated with Peritoneal Dialysis

    PubMed Central

    Kunin, Margarita; Carmon, Vered; Arad, Michael; Levin-Iaina, Nomy; Freimark, Dov; Holtzman, Eli J.; Dinour, Dganit

    2015-01-01

    Proinflammatory cytokines play a pathogenic role in congestive heart failure. In this study, the effect of peritoneal dialysis treatment on inflammatory cytokines levels in refractory congestive heart failure patients was investigated. During the treatment, the patients reached a well-tolerated edema-free state and demonstrated significant improvement in NYHA functional class. Brain natriuretic peptide decreased significantly after 3 months of treatment and remained stable at 6 months. C-reactive protein, a plasma marker of inflammation, decreased significantly following the treatment. Circulating inflammatory cytokines TNF-α and IL-6 decreased significantly after 3 months of peritoneal dialysis treatment and remained low at 6 months. The reduction in circulating inflammatory cytokines levels may be partly responsible for the efficacy of peritoneal dialysis for refractory congestive heart failure. PMID:26539513

  4. [Calciphylaxis in dialysis patients: To recognize and treat it as soon as possible].

    PubMed

    Jean, Guillaume; Terrat, Jean-Claude; Vanel, Thierry; Hurot, Jean-Marc; Lorriaux, Christie; Mayor, Brice; Chazot, Charles

    2010-11-01

    Calciphylaxis (CPX) or calcific uraemic arteriolopathy is a rare life-threatening complication, affecting mainly dialysis patients. The condition is characterized by calcifications and thrombosis of the small cutaneous vessels and small vessels in the fat tissue, resulting in the development of necrotizing and non-healing ulcers. The development of these lesions leads to poor outcomes owing to infectious complications and some frequently associated unfavourable medical conditions: obesity, diabetes, and peripheral vascular disease. We report the case of six patients with different clinical forms of CPX in the past 10 years with favourable outcomes observed in five of the six patients. The diagnosis was based on clinical presentation: bilateral and hyperalgesic necrotic lesions along with a history of mineral metabolism disorder or warfarin use. The therapeutic strategy included the following: daily dialysis, hyperbaric oxygen therapy, treatment of limb artery stenosis, maintenance of the optimal haemodynamic stability, delivery of cutaneous care, administration of analgesics and antibiotics, warfarin and calcium cessation, and additional therapy with cinacalcet or parathyroidectomy and therapy with bisphosphonates or sodium thiosulphate. Healing was observed in five out of six CPX patients by using this strategy that should be rapidly employed in order to decrease the necrotizing areas that result in poor outcomes. Prevention includes identification of at-risk patients in order to optimize the treatment of the identified risk factors for CPX. PMID:20627839

  5. Depression in dialysis patients.

    PubMed

    King-Wing Ma, Terry; Kam-Tao Li, Philip

    2016-08-01

    Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients. PMID:26860073

  6. Optimal convection volume for improving patient outcomes in an international incident dialysis cohort treated with online hemodiafiltration.

    PubMed

    Canaud, Bernard; Barbieri, Carlo; Marcelli, Daniele; Bellocchio, Francesco; Bowry, Sudhir; Mari, Flavio; Amato, Claudia; Gatti, Emanuele

    2015-11-01

    Online hemodiafiltration (OL-HDF), the most efficient renal replacement therapy, enables enhanced removal of small and large uremic toxins by combining diffusive and convective solute transport. Randomized controlled trials on prevalent chronic kidney disease (CKD) patients showed improved patient survival with high-volume OL-HDF, underlining the effect of convection volume (CV). This retrospective international study was conducted in a large cohort of incident CKD patients to determine the CV threshold and range associated with survival advantage. Data were extracted from a cohort of adult CKD patients treated by post-dilution OL-HDF over a 101-month period. In total, 2293 patients with a minimum of 2 years of follow-up were analyzed using advanced statistical tools, including cubic spline analyses for determination of the CV range over which a survival increase was observed. The relative survival rate of OL-HDF patients, adjusted for age, gender, comorbidities, vascular access, albumin, C-reactive protein, and dialysis dose, was found to increase at about 55 l/week of CV and to stay increased up to about 75 l/week. Similar analysis of pre-dialysis β2-microglobin (marker of middle-molecule uremic toxins) concentrations found a nearly linear decrease in marker concentration as CV increased from 40 to 75 l/week. Analysis of log C-reactive protein levels showed a decrease over the same CV range. Thus, a convection dose target based on convection volume should be considered and needs to be confirmed by prospective trials as a new determinant of dialysis adequacy. PMID:25945407

  7. [Subcapsular fatty infiltration of the liver in peritoneal dialysis patients treated with intraperitoneal insulin: US and CT features (case report)].

    PubMed

    Oğuzkurt, Levent; Hürcan, Cem Erim; Torun, Dilek; Yildirim, Tülin

    2004-09-01

    In recent years a characteristic subcapsular and periligamentous fatty infiltration of the liver has been reported in diabetic patients on intraperitoneal insulin treatment by continuous ambulatory peritoneal dialysis. The finding is unique to these patients on continuous ambulatory peritoneal dialysis and has not been defined in diabetics using subcutaneous insulin. We present characteristic US and CT findings in two such patients with focal subcapsular fatty infiltration of the liver. PMID:15470629

  8. Efficacy & safety of continuous erythropoietin receptor activator (CERA) in treating renal anaemia in diabetic patients with chronic kidney disease not on dialysis

    PubMed Central

    Vankar, Sameer G.; Dutta, Pinaki; Kohli, H.S.; Bhansali, Anil

    2014-01-01

    Background & objectives: Chronic kidney disease (CKD) patients on dialysis regularly receive erythropoiesis stimulating agent (ESA) for treating renal anaemia during their dialysis unlike those who are not on dialysis. In such patients, the longer acting ESA can be helpful in reducing their frequent visits to the health care facilities and improving their compliance. This study was aimed to examine the efficacy and safety of continuous erythropoietin receptor activator (CERA), a long acting ESA in treating renal anaemia in patients with diabetic CKD not on dialysis. Methods: In this prospective, open-labelled, pilot clinical study, 35 adult type 2 diabetes patients with nephropathy and renal anaemia, who were not on dialysis nor receiving treatment with ESA were administered CERA subcutaneously once in two weeks for a period of 24 weeks. The primary efficacy end point was to evaluate the Hb response (Hb rise of ≥1 g/dl above the baseline or Hb level ≥11 g/dl) during the study period. Results: All patients showed Hb rise ≥1 g/dl during the study period and 80 per cent patients could achieve Hb value ≥11 g/dl. The maximum median Hb rise of 1.2 g/dl occurred in the initial 6 weeks after starting the treatment. The mean creatinine clearance (CrCl) improved by 2.8 ml/min, with mean Hb rise of 2.6 g/dl from the baseline after administration of CERA. Worsening of blood pressure (BP) control (42.9%) was the most common adverse event. Interpretation & conclusions: CERA once in two weeks was found to be efficacious in correcting anaemia in the ESA-naïve patients with diabetic nephropathy who are not on dialysis. However, regular monitoring of blood pressure is required while on treatment with CERA. PMID:24604046

  9. Managing diabetes in dialysis patients.

    PubMed

    O'Toole, Sam M; Fan, Stanley L; Yaqoob, M Magdi; Chowdhury, Tahseen A

    2012-03-01

    Burgeoning levels of diabetes are a major concern for dialysis services, as diabetes is now the most common cause of end-stage renal disease in most developed nations. With the rapid rise in diabetes prevalence in developing countries, the burden of end stage renal failure due to diabetes is also expected to rise in such countries. Diabetic patients on dialysis have a high burden of morbidity and mortality, particularly from cardiovascular disease, and a higher societal and economic cost compared to non-diabetic subjects on dialysis. Tight glycaemic and blood pressure control in diabetic patients has an important impact in reducing risk of progression to end stage renal disease. The evidence for improving glycaemic control in patients on dialysis having an impact on mortality or morbidity is sparse. Indeed, many factors make improving glycaemic control in patients on dialysis very challenging, including therapeutic difficulties with hypoglycaemic agents, monitoring difficulties, dialysis strategies that exacerbate hyperglycaemia or hypoglycaemia, and possibly a degree of therapeutic nihilism or inertia on the part of clinical diabetologists and nephrologists. Standard drug therapy for hyperglycaemia (eg, metformin) is clearly not possible in patients on dialysis. Thus, sulphonylureas and insulin have been the mainstay of treatment. Newer therapies for hyperglycaemia, such as gliptins and glucagon-like peptide-1 analogues have become available, but until recently, renal failure has precluded their use. Newer gliptins, however, are now licensed for use in 'severe renal failure', although they have yet to be trialled in dialysis patients. Diabetic patients on dialysis have special needs, as they have a much greater burden of complications (cardiac, retinal and foot). They may be best managed in a multidisciplinary diabetic-renal clinic setting, using the skills of diabetologists, nephrologists, clinical nurse specialists in nephrology and diabetes, along with

  10. Prescribing for patients on dialysis

    PubMed Central

    Smyth, Brendan; Jones, Ceridwen; Saunders, John

    2016-01-01

    SUMMARY The pharmacokinetics of a drug may be altered in patients with renal impairment who require dialysis. Some drugs are contraindicated. The drug’s clearance and therapeutic index determine if a dose adjustment is needed. A lower dose or less frequent dosing may be required. Consult a reference source or the patient’s nephrologist before prescribing. Start at a low dose and increase gradually. If possible give once-daily drugs after dialysis. PMID:27041803

  11. Pharmacokinetics and safety of oseltamivir in patients with end-stage renal disease treated with automated peritoneal dialysis

    PubMed Central

    Patel, Kashyap; Rayner, Craig R; Giraudon, Mylène; Kamal, Mohamed A; Morcos, Peter N; Robson, Richard; Kirkpatrick, Carl M

    2015-01-01

    AIMS Patients with end-stage renal disease (ESRD) are at increased risk of developing complications associated with influenza infection. Oseltamivir is indicated for influenza treatment in ESRD patients, but the disposition is poorly understood in this patient population. This study aimed to characterize the pharmacokinetics and tolerability of oseltamivir in automated peritoneal dialysis (APD) and construct a pharmacokinetic model to assist with optimized dosing. METHODS Ten adults with ESRD were prescribed an aggressive APD regimen consisting of three continuous cycler-assisted peritoneal dialysis (CCPD) sessions during the day and two continuous ambulatory (CAPD) sessions overnight. Oseltamivir was administered as a single 75 mg dose, immediately before APD treatment. RESULTS Oseltamivir was rapidly eliminated via first-pass metabolism, with most of the dose (Fraction metabolized = 0.964) reaching the circulation as the active metabolite, oseltamivir carboxylate. This metabolite was cleared slowly and was quantifiable throughout the sampling interval. The disposition of oseltamivir and oseltamivir carboxylate was described by a two- and a one-compartment model, respectively. Metabolite clearance by CCPD [0.32 l h−1 (70 kg)−1] was 1.9-fold faster than via CAPD [0.17 l h−1 (70 kg)−1], with renal elimination being dominant in patients with residual urine production. Model simulations showed that a single 75 mg dose attained target exposures in patients with negligible or low urine clearance. However, higher doses are recommended for further investigation in patients with high residual renal function. In all patients, oseltamivir was well tolerated. CONCLUSIONS In APD patients with anuria or low residual renal elimination, a single 75 mg dose of oseltamivir produced exposures at the upper end of the safety margin. PMID:25289522

  12. Dialysis water treated by reverse osmosis decreases the levels of C-reactive protein in uremic patients.

    PubMed

    Thomé, F S; Senger, M; Garcez, C; Garcez, J; Chemello, C; Manfro, R C

    2005-05-01

    Atherosclerosis is a major complication of chronic renal failure. Microinflammation is involved in atherogenesis and is associated with uremia and dialysis. The role of dialysate water contamination in inducing inflammation has been debated. Our aim was to study inflammatory markers in patients on chronic dialysis, before and 3 to 6 months after switching the water purification system from deionization to reverse osmosis. Patients had demographic, clinical and nutritional information collected and blood drawn for determination of albumin, ferritin, C-reactive protein (CRP), interleukin-6, and tumor necrosis factor-alpha in both situations. Acceptable levels of water purity were less than 200 colony-forming units of bacteria and less than 1 ng/ml of endotoxin. Sixteen patients died. They had higher median CRP (26.6 vs 11.2 mg/dl, P = 0.007) and lower median albumin levels (3.1 vs 3.9 g/l, P < 0.05) compared to the 31 survivors. Eight patients were excluded because of obvious inflammatory conditions. From the 23 remaining patients (mean age +/- SD: 51.3 +/- 13.9 years), 18 had a decrease in CRP after the water treatment system was changed. Overall, median CRP was lower with reverse osmosis than with deionization (13.2 vs 4.5 mg/l, P = 0.022, N = 23). There was no difference in albumin, cytokines, subjective global evaluation, or clinical and biochemical parameters. In conclusion, uremic patients presented a clinically significant reduction in CRP levels when dialysate water purification system switched from deionization to reverse osmosis. It is possible that better water treatments induce less inflammation and eventually less atherosclerosis in hemodialysis patients. PMID:15917962

  13. Survival advantages of obesity in dialysis patients.

    PubMed

    Kalantar-Zadeh, Kamyar; Abbott, Kevin C; Salahudeen, Abdulla K; Kilpatrick, Ryan D; Horwich, Tamara B

    2005-03-01

    In the general population, a high body mass index (BMI; in kg/m(2)) is associated with increased cardiovascular disease and all-cause mortality. However, the effect of overweight (BMI: 25-30) or obesity (BMI: >30) in patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis (MHD) is paradoxically in the opposite direction; ie, a high BMI is associated with improved survival. Although this "reverse epidemiology" of obesity or dialysis-risk-paradox is relatively consistent in MHD patients, studies in CKD patients undergoing peritoneal dialysis have yielded mixed results. Growing confusion has developed among physicians, some of whom are no longer confident about whether to treat obesity in CKD patients. A similar reverse epidemiology of obesity has been described in geriatric populations and in patients with chronic heart failure (CHF). Possible causes of the reverse epidemiology of obesity include a more stable hemodynamic status, alterations in circulating cytokines, unique neurohormonal constellations, endotoxin-lipoprotein interaction, reverse causation, survival bias, time discrepancies among competitive risk factors, and malnutrition-inflammation complex syndrome. Reverse epidemiology may have significant clinical implications in the management of dialysis, CHF, and geriatric patients, ie, populations with extraordinarily high mortality. Exploring the causes and consequences of the reverse epidemiology of obesity in dialysis patients can enhance our insights into similar paradoxes observed for other conventional risk factors, such as blood pressure and serum cholesterol and homocysteine concentrations, and in other populations such as those with CHF, advanced age, cancer, or AIDS. Weight-gaining interventional studies in dialysis patients are urgently needed to ascertain whether they can improve survival and quality of life. PMID:15755821

  14. Plasma Adiponectin Levels in Acute Liver Failure Patients Treated with Plasma Filtration with Dialysis and Plasma Exchange.

    PubMed

    Yamamoto, Hiroshi; Nakae, Hajime; Uji, Yoshitaka; Maeda, Kazuhisa; Tani, Tohru; Eguchi, Yutaka

    2015-08-01

    Plasma filtration with dialysis (PDF) is a blood purification therapy in which simple plasma exchange (PE) is performed using a selective membrane plasma separator while the dialysate flows outside of the hollow fibers. Improvement of hypoadiponectinemia is considered to be a useful therapeutic approach for ameliorating fatal conditions including cardio-metabolic and infectious disease. We investigated the effects of PDF in comparison to PE in terms of plasma adiponectin (APN) changes in patients with acute liver failure. Seventeen patients with liver failure were studied; PDF was performed 55 times and PE 14 times. Plasma APN levels increased significantly after PDF, while decreasing significantly after PE. PDF appears to be among the most useful blood purification therapies in acute liver failure cases in terms of increasing APN levels. PMID:26386223

  15. Satisfaction with care in peritoneal dialysis patients.

    PubMed

    Kirchgessner, J; Perera-Chang, M; Klinkner, G; Soley, I; Marcelli, D; Arkossy, O; Stopper, A; Kimmel, P L

    2006-10-01

    Patient satisfaction is an important aspect of dialysis care, only recently evaluated in clinical studies. We developed a tool to assess peritoneal dialysis (PD) customer satisfaction, and sought to evaluate and validate the Customer Satisfaction Questionnaire (CSQ), quantifying PD patient satisfaction. The CSQ included questions regarding administrative issues, Delivery Service, PD Training, Handling Requests, and transportation. The study was performed using interviews in all Hungarian Fresenius Medical Care dialysis centers offering PD. CSQ results were compared with psychosocial measures to identify if patient satisfaction was associated with perception of social support and illness burden, or depression. We assessed CSQ internal consistency and validity. Factor analysis explored potential underlying dimensions of the CSQ. One hundred and thirty-three patients treated with PD for end-stage renal disease for more than 3 months were interviewed. The CSQ had high internal consistency. There was high patient satisfaction with customer service. PD patient satisfaction scores correlated with quality of life (QOL) and social support measures, but not with medical or demographic factors, or depressive affect. The CSQ is a reliable tool to assess PD customer satisfaction. PD patient satisfaction is associated with perception of QOL. Efforts to improve customer satisfaction may improve PD patients' quantity as well as QOL. PMID:16900092

  16. Is Dialysis Modality a Factor in the Survival of Patients Initiating Dialysis After Kidney Transplant Failure?

    PubMed Central

    Perl, Jeffrey; Dong, James; Rose, Caren; Jassal, Sarbjit Vanita; Gill, John S.

    2013-01-01

    ♦ Background: Kidney transplant failure (TF) is among the leading causes of dialysis initiation. Whether survival is similar for patients treated with peritoneal dialysis (PD) and with hemodialysis (HD) after TF is unclear and may inform decisions concerning dialysis modality selection. ♦ Methods: Between 1995 and 2007, 16 113 adult dialysis patients identified from the US Renal Data System initiated dialysis after TF. A multivariable Cox proportional hazards model was used to evaluate the impact of initial dialysis modality (1 865 PD, 14 248 HD) on early (1-year) and overall mortality in an intention-to-treat approach. ♦ Results: Compared with HD patients, PD patients were younger (46.1 years vs 49.4 years, p < 0.0001) with fewer comorbidities such as diabetes mellitus (23.1% vs 25.7%, p < 0.0001). After adjustment, survival among PD patients was greater within the first year after dialysis initiation [adjusted hazard ratio (AHR): 0.85; 95% confidence interval (CI): 0.74 to 0.97], but lower after 2 years (AHR: 1.15; 95% CI: 1.02 to 1.29). During the entire period of observation, survival in both groups was similar (AHR for PD compared with HD: 1.09; 95% CI: 1.0 to 1.20). In a sensitivity analysis restricted to a cohort of 1865 propensity-matched pairs of HD and PD patients, results were similar (AHR: 1.03; 95% CI: 0.93 to 1.14). Subgroups of patients with a body mass index exceeding 30 kg/m2 [AHR: 1.26; 95% CI: 1.05 to 1.52) and with a baseline estimated glomerular filtration rate (eGFR) less than 5 mL/min/1.73 m2 (AHR: 1.45; 95% CI: 1.05 to 1.98) experienced inferior overall survival when treated with PD. ♦ Conclusions: Compared with HD, PD is associated with an early survival advantage, inferior late survival, and similar overall survival in patients initiating dialysis after TF. Those data suggest that increased initial use of PD among patients returning to dialysis after TF may be associated with improved outcomes, except among patients with a higher

  17. [Destructive spondylarthropathy in dialysis patients].

    PubMed

    Stein, G; Schneider, A; Marzoll, I; Sperschneider, H; Ritz, E

    1991-01-01

    Back pain and a cervicobrachial syndrome, as well as progressive sensory and motor deficits as far as symptoms of paraplegia, developed in two dialysis patients two and five years after the start of dialysis. One was a 60-year-old woman with pyelonephritis, the other a 55-year-old man with glomerulonephritis. There were typical radiological signs of destructive spondylarthropathy (narrowed intervertebral spaces and slippage of the vertebral bodies). The female patient required several operations (spondylothesis and orthothesis) and both patients received daily 10,000 IU vitamin D and 3-4 g calcium carbonate. In the woman the destructive process no longer progressed one year after onset of symptoms, but she still required many analgesics. She died three months later of circulatory failure. The man died four weeks after the onset of symptoms from purulent meningitis. At autopsy only renal fibrous ostitis was still demonstrable. Amyloidosis resulting from an increase in beta 2-microglobulin level were excluded by both histological and immunohistochemical examinations. PMID:1985800

  18. Con: Higher serum bicarbonate in dialysis patients is protective.

    PubMed

    Chauveau, Philippe; Rigothier, Claire; Combe, Christian

    2016-08-01

    Metabolic acidosis is often observed in advanced chronic kidney disease, with deleterious consequences on the nutritional status, bone and mineral status, inflammation and mortality. Through clearance of the daily acid load and a net gain in alkaline buffers, dialysis therapy is aimed at correcting metabolic acidosis. A normal bicarbonate serum concentration is the recommended target in dialysis patients. However, several studies have shown that a mild degree of metabolic acidosis in patients treated with dialysis is associated with better nutritional status, higher protein intake and improved survival. Conversely, a high bicarbonate serum concentration is associated with poor nutritional status and lower survival. It is likely that mild acidosis results from a dietary acid load linked to animal protein intake. In contrast, a high bicarbonate concentration in patients treated with dialysis could result mainly from an insufficient dietary acid load, i.e. low protein intake. Therefore, a high pre-dialysis serum bicarbonate concentration should prompt nephrologists to carry out nutritional investigations to detect insufficient dietary protein intake. In any case, a high bicarbonate concentration should be neither a goal of dialysis therapy nor an index of adequate dialysis, whereas mild acidosis could be considered as an indicator of appropriate protein intake. PMID:27411724

  19. Inhibition of Gastric Acid Secretion by H2 Receptor Antagonists Associates a Definite Risk of Enteric Peritonitis and Infectious Mortality in Patients Treated with Peritoneal Dialysis

    PubMed Central

    Pérez-Fontan, Miguel; Machado Lopes, Daniela; García Enríquez, Alba; López-Calviño, Beatriz; López-Muñiz, Andrés; García Falcón, Teresa; Rodríguez-Carmona, Ana

    2016-01-01

    Background Evidences linking treatment with inhibitors of gastric acid secretion (IGAS) and an increased risk of serious infections are inconclusive, both in the population at large and in the particular case of patients with chronic kidney disease. We have undertaken an investigation to disclose associations between treatment with IGAS and infectious outcomes, in patients undergoing chronic Peritoneal Dialysis (PD). Method Observational, historic cohort, single center design. Six hundred and ninety-one patients incident on PD were scrutinized for an association among treatment with IGAS (H2 antagonists H2A or proton pump inhibitors PPI) (main study variable), on one side, and the risks of enteric peritoneal infection (main outcome), overall peritoneal infection, and general and infectious mortality (secondary outcomes). We applied a three-step multivariate approach, based on classic Cox models (baseline variables), time-dependent analyses and, when appropriate, competing risk analyses. Main results The clinical characteristics of patients treated with H2A, PPI or none of these were significantly different. Multivariate analyses disclosed a consistently increased risk of enteric peritonitis in patients treated with IGAS (RR 1.65, 95% CI 1.08–2.55, p = 0.018, Cox). Stratified analysis indicated that patients treated with H2A, rather than those on PPI, supported the burden of this risk. Similar findings applied for the risk of infectious mortality. On the contrary, we were not able to detect any association among the study variables, on one side, and the general risks of peritonitis or mortality, on the other. Conclusions Treatment with IGAS associates increased incidences of enteric peritonitis and infectious mortality, among patients on chronic PD. The association is clear in the case of H2A but less consistent in the case of PPI. Our results support the convenience of preferring PPI to H2A, for gastric acid inhibition in PD patients. PMID:26872254

  20. Clinical outcomes and mortality in elderly peritoneal dialysis patients

    PubMed Central

    Sakacı, Tamer; Ahbap, Elbis; Koc, Yener; Basturk, Taner; Ucar, Zuhal Atan; Sınangıl, Ayse; Sevınc, Mustafa; Kara, Ekrem; Akgol, Cuneyt; Kayalar, Arzu Ozdemır; Caglayan, Feyza Bayraktar; Sahutoglu, Tuncay; Ünsal, Abdulkadir

    2015-01-01

    OBJECTIVES: To evaluate the clinical outcomes and identify the predictors of mortality in elderly patients undergoing peritoneal dialysis. METHODS: We conducted a retrospective study including all incident peritoneal dialysis cases in patients ≥65 years of age treated from 2001 to 2014. Demographic and clinical data on the initiation of peritoneal dialysis and the clinical events during the study period were collected. Infectious complications were recorded. Overall and technique survival rates were analyzed. RESULTS: Fifty-eight patients who began peritoneal dialysis during the study period were considered for analysis, and 50 of these patients were included in the final analysis. Peritoneal dialysis exchanges were performed by another person for 65% of the patients, whereas 79.9% of patients preferred to perform the peritoneal dialysis themselves. Peritonitis and catheter exit site/tunnel infection incidences were 20.4±16.3 and 24.6±17.4 patient-months, respectively. During the follow-up period, 40 patients were withdrawn from peritoneal dialysis. Causes of death included peritonitis and/or sepsis (50%) and cardiovascular events (30%). The mean patient survival time was 38.9±4.3 months, and the survival rates were 78.8%, 66.8%, 50.9% and 19.5% at 1, 2, 3 and 4 years after peritoneal dialysis initiation, respectively. Advanced age, the presence of additional diseases, increased episodes of peritonitis, the use of continuous ambulatory peritoneal dialysis, and low albumin levels and daily urine volumes (<100 ml) at the initiation of peritoneal dialysis were predictors of mortality. The mean technique survival duration was 61.7±5.2 months. The technique survival rates were 97.9%, 90.6%, 81.5% and 71% at 1, 2, 3 and 4 years, respectively. None of the factors analyzed were predictors of technique survival. CONCLUSIONS: Mortality was higher in elderly patients. Factors affecting mortality in elderly patients included advanced age, the presence of comorbid

  1. [Patient receiving peritoneal dialysis after treatment of ovarian cancer].

    PubMed

    Jaśkowski, Piotr; Krzanowska, Katarzyna; Miarka, Przemysław; Krzanowski, Marcin; Sułowicz, Wiadysław

    2014-01-01

    Peritoneal dialysis is one of the three available options for renal replacement therapy. This method of treatment of end-stage renal disease gives patients relatively high sense of independence and control over their disease, especially in comparison with hemodialysis, and therefore is often preferable method for young individuals wishing to lead an active lifestyle. We present a case of 22 year old female patient with stage 5 of chronic kidney disease, which is a consequence of multi-agent chemotherapy for endo-dermal sinus tumor of the right ovary (diagnosed at the age of 13). Particularly important in the context of treating our patient with peritoneal dialysis is the fact of confirmed metastases into the peritoneum, which was the reason for the use of chemotherapy reserved for high-risk patients (ifosfamide + etoposide + cisplatin). The selected program of chemotherapy provided effective eradication of cancer, but a side effect of treatment was renal tubular damage. In the period from 03.2006 to 05.2007 our patient required hemodialysis (with gradually reduce dose of dialysis), at a later time to 12.2011 patient did not require renal replacement therapy (stable renal function were observed at the stage 4 of chronic kidney disease), but in 12.2011 resumption of dialysis was necessary and the patient, in accordance with her selection, is receiving peritoneal dialysis. Qualification of our patient for treatment with peritoneal dialysis was associated with reasonable concern about the ability to provide acceptable adequacy of dialysis. Apprehensions proved to be unfounded, the clinical observation of the patient presents proper ratios of dialysis adequacy. Our patient was also qualified for renal transplantation. PMID:25546920

  2. Renal function recovery in chronic dialysis patients.

    PubMed

    Chu, Jay K; Folkert, Vaughn W

    2010-01-01

    Renal function recovery (RFR) from acute kidney injury requiring dialysis occurs at a high frequency. RFR from chronic dialysis, on the other hand, is an uncommon but well-recognized phenomenon, occurring at a rate of 1.0-2.4% according to data from large observational studies. The underlying etiology of renal failure is the single most important predicting factor of RFR in chronic dialysis patients. The disease types with the highest RFR rates are atheroembolic renal disease, systemic autoimmune disease, renovascular diseases, and scleroderma. The disease types with the lowest RFR rates are diabetic nephropathy and cystic kidney disease. Initial dialysis modality does not appear to influence RFR. Careful observation and history taking are needed to recognize the often nonspecific clinical and laboratory signs of RFR. When RFR is suspected in a chronic dialysis patient, a 24-hour urine urea and creatinine clearance should be measured. Based on the renal clearance, along with other clinical factors, the dialysis prescription may be gradually reduced until a complete discontinuation of dialysis. After RFR from maintenance dialysis, patients require close follow-up in an office setting for chronic kidney disease management. PMID:21166875

  3. Geriatric Issues in Older Dialysis Patients.

    PubMed

    Bhattarai, Manoj

    2016-01-01

    Geriatric syndrome is common among older patients on dialysis. Basic knowledge about its prevalence and management is crucial for nephrologists to provide standard patient care. In busy clinical settings, up-to-date and holistic medical care can be delivered to elderly dialysis patients by collaboration of nephrology and geriatrics teams, or in part by training nephrology fellows the basics of geriatrics. [Full article available at http://rimed.org/rimedicaljournal-2016-07.asp, free with no login]. PMID:27379352

  4. Assessment and Management of Hypertension in Patients on Dialysis

    PubMed Central

    Flynn, Joseph; Pogue, Velvie; Rahman, Mahboob; Reisin, Efrain; Weir, Matthew R.

    2014-01-01

    Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. PMID:24700870

  5. Effects of disinfectants in renal dialysis patients

    SciTech Connect

    Klein, E.

    1986-11-01

    Patients receiving hemodialysis therapy risk exposure to both disinfectants and sterilants. Dialysis equipment is disinfected periodically with strong solutions of hypochlorite or formaldehyde. Gross hemolysis resulting from accidental hypochlorite infusion has led to cardiac arrest, probably as a result of hyperkalemia. Formaldehyde is commonly used in 4% solutions to sterilize the fluid paths of dialysis controllers and to sterilize dialyzers before reuse. It can react with red cell antigenic surfaces leading to the formation of anti-N antibodies. The major exposure risk is the low concentration of disinfectant found in municipal water used to prepare 450 L dialysate weekly. With thrice-weekly treatment schedules, the quality requirements for water used to make this solution must be met rigorously. Standards for water used in the preparation of dialysate have recently been proposed but not all patients are treated with dialysate meeting such standards. The introduction of sterilants via tap water is insidious and has let to more pervasive consequences. Both chlorine and chloramines, at concentrations found in potable water, are strong oxidants that cause extensive protein denaturation and hemolysis. Oxidation of the Fe/sup 2 +/ in hemoglobin to Fe/sup 3 +/ forms methemoglobin, which is incapable of carrying either O/sub 2/ or CO/sub 2/. Chloramine can form not only methemoglobin, but can also denature proteins within the red cell, thus forming aggregates (Heinz bodies). Chloramines also inhibit hexose monophosphate shunt activity, a mechanism that makes the red cell even more susceptible to oxidant damage.

  6. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program...

  7. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each... for self-dialysis and home dialysis. (b) CMS determines the amount on the basis of program...

  8. The elderly patient on dialysis: geriatric considerations.

    PubMed

    Singh, Pooja; Germain, Michael J; Cohen, Lewis; Unruh, Mark

    2014-05-01

    The burgeoning population of older dialysis patients presents opportunities to provide personalized care. The older dialysis population has a high burden of chronic health conditions, decrements in quality of life and a high risk of death. In order to address these challenges, this review will recommend routinely establishing prognosis through the use of prediction instruments and communicating these findings to older patients. The challenges to prognosis in adults with end-stage renal disease (ESRD) include the subjective nature of clinical judgment, application of appropriate prognostic tools and communication of findings to patients and caregivers. There are three reasons why we believe these conversations occur infrequently with the dialysis population. First, there have previously been no clinically practical instruments to identify individuals undergoing maintenance hemodialysis (HD) who are at highest risk for death. Second, nephrologists have not been trained to have conversations about prognosis and end-of-life care. Third, other than hospitalizations and accrual of new diagnoses, there are no natural milestone guidelines in place for patients supported by dialysis. The prognosis can be used in shared decision-making to establish goals of care, limits on dialysis support or parameters for withdrawal from dialysis. As older adults with ESRD benefit from kidney transplantation, prognosis can also be used to determine who should be referred for evaluation by a kidney transplant team. The use of prognosis in older adults may determine approaches to optimize well-being and personalize care among older adults ranging from hospice to kidney transplantation. PMID:23787545

  9. Restless legs syndrome in patients on dialysis.

    PubMed

    Al-Jahdali, Hamdan H; Al-Qadhi, Waleed A; Khogeer, Haithm A; Al-Hejaili, Fayez F; Al-Ghamdi, Saeed M; Al Sayyari, Abdullah A

    2009-05-01

    Restless legs syndrome (RLS) is an extremely distressing problem experienced by patients on dialysis; the prevalence appears to be greater than in the general population, with a wide variation from 6.6% to 80%. The diagnosis of RLS is a clinical one, and its definition has been clarified and standardized by internationally recognized diagnostic criteria, published in 1995 by the International Restless Legs Syndrome Study Group (IRLSSG). This study was designed to find out the prevalence of RLS in Saudi patients with end-stage renal disease (ESRD) on maintenance dialysis. This is a cross sectional study carried out between May and Sept 2007 at two centers, King Abdulaziz Medical City-King Fahad National Guard Hospital (KAMC-KFNGH), Riyadh and King Faisal Specialist Hospital and Research Centre (KFHRC), Jeddah, Saudi Arabia. Data were gathered on 227 Saudi patients on chronic maintenance hemodialysis or chronic peritoneal dialysis. The prevalence of RLS was measured using IRLSSG's RLS Questionnaire (RLSQ). Potential risk factors for RLS including other sleep disorders, underlying cause of chronic renal failure, duration on dialysis, dialysis shift, biochemical tests and demographic data were also evaluated. The overall prevalence of RLS was 50.22% including 53.7% males and 46.3% females. Their mean age was 55.7 +/- 17.2 years and mean duration on dialysis 40.4 +/- 37.8 months. Significant predictors of RLS were history of diabetes mellitus (DM), coffee intake, afternoon dialysis, gender and type of dialysis (P= 0.03, 0.01, < 0.001, 0.05 and 0.009 respectively). Patients with RLS were found to be at increased risk of having insomnia and excessive daytime sleepiness (EDS) (P= < 0.001 and 0.001, respectively). Our study suggests that RLS is a very common problem in dialysis population and was significantly associated with other sleep disorders, particularly insomnia, and EDS. Optimal care of dialysis patient should include particular attention to the diagnosis and

  10. Cost Analysis of Hemodialysis and Peritoneal Dialysis Access in Incident Dialysis Patients

    PubMed Central

    Coentrão, Luis A.; Araújo, Carla S.; Ribeiro, Carlos A.; Dias, Claúdia C.; Pestana, Manuel J.

    2013-01-01

    ♦ Background: Although several studies have demonstrated the economic advantages of peritoneal dialysis (PD) over hemodialysis (HD), few reports in the literature have compared the costs of HD and PD access. The aim of the present study was to compare the resources required to establish and maintain the dialysis access in patients who initiated HD with a tunneled cuffed catheter (TCC) or an arteriovenous fistula (AVF) and in patients who initiated PD. ♦ Methods: We retrospectively analyzed the 152 chronic kidney disease patients who consecutively initiated dialysis treatment at our institution in 2008 (HD-AVF, n = 65; HD-CVC, n = 45; PD, n = 42). Detailed clinical and demographic information and data on access type were collected for all patients. A comprehensive measure of total dialysis access costs, including surgery, radiology, hospitalization for access complications, physician costs, and transportation costs was obtained at year 1 using an intention-to-treat approach. All resources used were valued using 2010 prices, and costs are reported in 2010 euros. ♦ Results: Compared with the HD-AVF and HD-TCC modalities, PD was associated with a significantly lower risk of access-related interventions (adjusted rate ratios: 1.572 and 1.433 respectively; 95% confidence intervals: 1.253 to 1.891 and 1.069 to 1.797). The mean dialysis access-related costs per patient-year at risk were €1171.6 [median: €608.8; interquartile range (IQR): €563.1 - €936.7] for PD, €1555.2 (median: €783.9; IQR: €371.4 - €1571.7) for HD-AVF, and €4208.2 (median: €1252.4; IQR: €947.9 - €2983.5) for HD-TCC (p < 0.001). In multivariate analysis, total dialysis access costs were significantly higher for the HD-TCC modality than for either PD or HD-AVF (β = -0.53; 95% CI: -1.03 to -0.02; and β = -0.50; 95% CI: -0.96 to -0.04). ♦ Conclusions: Compared with patients initiating HD, those initiating PD required fewer resources to establish and maintain a dialysis

  11. ELECTROLYTIC MEMBRANE DIALYSIS FOR TREATING WASTEWATER STREAMS

    SciTech Connect

    Ronald C. Timpe

    2000-04-01

    This project will determine whether electrolytic dialysis has promise in the separation of charged particles in an aqueous solution. The ability to selectively move ions from one aqueous solution to another through a semipermeable membrane will be studied as a function of emf, amperage, and particle electrical charge. The ions selected for the study are Cl{sup -} and SO{sub 4}{sup 2-}. These ions are of particular interest because of their electrical conduction properties in aqueous solution resulting with their association with the corrosive action of metals. The studies will be performed with commercial membranes on solutions prepared in the laboratory from reagent salts. pH adjustments will be made with dilute reagent acid and base. Specific objectives of the project include testing a selected membrane currently available for electrolytic dialysis, membrane resistance to extreme pH conditions, the effectiveness of separating a mixture of two ions selected on the basis of size, the efficiency of the membranes in separating chloride (Cl{sup 1-}) from sulfate (SO{sub 4}{sup 2-}), and separation efficiency as a function of electromotive force (emf).

  12. [Anemia treatment in peritoneal dialysis patients].

    PubMed

    Janković, Nikola; Janković, Mateja

    2009-09-01

    Anemia is highly prevalent among chronic kidney disease (CKD) patients and patients receiving renal replacement therapy. In this paper we will outline the prevention and treatment of anemia in patients treated with peritoneal dialysis (PD). PD patients are less anemic and more sensitive to erythropoesis-stimulating agent (ESA) than their hemodialysis (HD) counterparts and, in general, dosages required for achieving similar hemoglobin levels to those achieved in HD patients are remarkably less. Before starting with ESA treatment we have to evaluate the degree of anemia and excluded other causes which are not connected with CKD and method of treatment. Patient's compliance is crucial for a successful therapy and it can be improved by decreasing frequency of administration of ESA. Since ESAare expensive, "cost-effectivnes" studies represent an important factor in choosing a distinct drug. Subcutaneous administration provides better long-term utilization of ESA in comparison to intravenous administration and is therefore preferred in PD patients. Intraperitoneal administration is not recommended due to poor bioavailability. In some patients we can observe the reduced response to ESA therapy. The definition of reduced response is generally regarded as a failure to achieve target hemoglobin concentration of >11 g/dL. Identification of underlying cause is not always easy but every attempt should be made to investigate every patient with resistance to therapy because some causes are easily corrected. Since 2005 particular ESA drugs have been approved by Croatian Institute for Health Insurance and registered for use in Croatia. For PD patients the ESAcan be prescribed by general practitioner. The list of available drugs is available in the official government newspaper Nardone novine No.27, March 2nd, 2009. PMID:20232548

  13. Soft tissue calcification in chronic dialysis patients.

    PubMed Central

    Kuzela, D. C.; Huffer, W. E.; Conger, J. D.; Winter, S. D.; Hammond, W. S.

    1977-01-01

    Autopsy protocols and microscopic slides of 56 dialyzed and 18 nondialyzed chronically uremic patients were reviewed to assess the presence, extent, and severity of extraosseous soft tissue calcification. Calcification was identified in 79% of the dialysis patients and 44% of the nondialysis patients (P iss less than .025). Soft tissue calcification most frequently involved the heart, lungs, stomach, and kidneys. Lesions were severe in 36% of the dialysis patients and, when strategically located within the myocardium, were life-threatening. The deaths of 6 dialysis patients were attributed to severe calcification of the cardiac conduction system and/or myocardium. The presence and severity of soft tissue calcification was not related to duration of dialysis, patients' age, degree of parathyroid gland hyperplasia, radiographic evidence of soft tissue calcification, serum calcium and phosphate levels, Ca X P products, or type or severity of metabolic bone disease. Images Figure 7 Figure 8 Figure 9 Figure 10 Figure 1 Figure 2 Figure 11 Figure 12 Figure 3 Figure 4 Figure 5 Figure 6 PMID:836675

  14. Characteristics of central dialysis fluid delivery system and single patient dialysis machine for HDF.

    PubMed

    Aoike, Ikuo

    2011-01-01

    The central dialysis fluid delivery system (CDDS), with which dialysis fluid is prepared at a single location and sent to each patient station, was developed as a unique system of dialysis in Japan and has been widely used. Maintenance hemodialysis using the single patient dialysis machine (SPDM), with which reverse osmosis water is first sent to each dialysis unit, and the dialysis fluid is prepared and used at each patient station, is used in many areas worldwide other than Japan and some Asian regions. Purification of dialysis fluid is essential for online hemodiafiltration, and it is possible to achieve the target purification level with both CDDS and SPDM by keeping the appropriate procedure. It is therefore desirable to understand the characteristics of both systems and make a selection based on the scale of the facility and the concept of treatment. PMID:20938129

  15. Obesity paradox in patients on maintenance dialysis.

    PubMed

    Kalantar-Zadeh, Kamyar; Kopple, Joel D

    2006-01-01

    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. PMID:16929133

  16. Risk of Tuberculosis Among Patients on Dialysis

    PubMed Central

    Shu, Chin-Chung; Hsu, Chia-Lin; Wei, Yu-Feng; Lee, Chih-Yuan; Liou, Hung-Hsiang; Wu, Vin-Cent; Yang, Feng-Jung; Lin, Hsien-Ho; Wang, Jann-Yuan; Chen, Jin-Shing; Yu, Chong-Jen; Lee, Li-Na

    2016-01-01

    Abstract Patients on long-term dialysis are at high risk for tuberculosis (TB). Although latent tuberculosis infection (LTBI) is good target for TB eradication, interferon-gamma release assay-defined LTBI has a high proportion of negative conversion and lacks active TB correlation among patients on dialysis. Patients on long-term dialysis were screened in multiple centers in Taiwan. QuantiFERON-TB Gold In-tube (QFT-GIT) was used to define LTBI and was performed thrice at 6-month intervals. The primary outcome was active TB diagnosed after LTBI screening. The incidence and predictive value of QFT-GIT were analyzed. The 940 dialysis patients enrolled had an average age of 59.3 years. The initial QFT-GIT results were positive in 193, including 49.6% with persistent positive results on second check. In an average follow-up period of 3 years, 7 patients had TB. Three (319.1 per 100,000 person-yrs) and 4 (141.8 per 100,000 person-yrs) of them were prevalent and incident TB cases, respectively. Persistent positive QFT-GIT for 2 and 3 times correlated with increased hazard ratio for TB (14.44 and 20.29, respectively) compared with a single positive result (hazard ratio 10.38). Among those with 3 positive QFT-GIT results, TB development rate was 4.5% and incidence rate was 1352.3 per 100,000 person-years. In contrast, none of the incident TB occurred in those with initial positive and then negative conversion of QFT-GIT. In an area of intermediate TB incidence, dialysis patients have high TB risk. LTBI status is a good predictor of TB development, especially for those with more than 1 positive result. After excluding prevalent TB cases, serial follow-up of LTBI may narrow the target population to reduce treatment costs. PMID:27258523

  17. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Program § 414.316 Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each patient, the carrier pays a flat amount that covers all physician services...

  18. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Program § 414.316 Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each patient, the carrier pays a flat amount that covers all physician services...

  19. 42 CFR 414.316 - Payment for physician services to patients in training for self-dialysis and home dialysis.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... training for self-dialysis and home dialysis. 414.316 Section 414.316 Public Health CENTERS FOR MEDICARE... Program § 414.316 Payment for physician services to patients in training for self-dialysis and home dialysis. (a) For each patient, the carrier pays a flat amount that covers all physician services...

  20. Hamster bite peritonitis: Pasteurella pneumotropica peritonitis in a dialysis patient.

    PubMed

    Campos, A; Taylor, J H; Campbell, M

    2000-11-01

    We report the first case of Pasteurella pneumotropica peritonitis in a peritoneal dialysis patient. This rare infection was the result of contamination of the dialysis tubing by a pet hamster. We stress the importance of household pets as a source of infection in the peritoneal dialysis population. PMID:11095007

  1. Pre-Dialysis Visits to a Nephrology Department and Major Cardiovascular Events in Patients Undergoing Dialysis

    PubMed Central

    Huang, Chih-Yuan; Hsu, Chia-Wen; Chuang, Chi-Rou; Lee, Ching-Chih

    2016-01-01

    Background and Objectives Pre-dialysis care by a nephrology out-patient department (OPD) may affect the outcomes of patients who ultimately undergo maintenance dialysis. This study examined the effect of pre-dialysis care by a nephrology OPD on the incidence of one-year major cardiovascular events after initiation of dialysis. Design, Setting Participants, & Measurements The study consisted of Taiwanese patients with chronic kidney disease (CKD) who commenced dialysis from 2006 to 2008. The number of nephrology OPD visits during the critical care period (within 6 months of initiation of dialysis) and the early care period (6–36 months before initiation of dialysis) were analyzed. The primary outcome measure was one-year major cardiovascular events. Results A total of 1191 CKD patients who initiated dialysis from 2006 to 2008 were included. Binary logistic regression showed that patients with ≧3 visits during the critical care period and those with ≧11 visits during the early care period had fewer composite major cardiovascular events than those with 0 visits. Patients with early referral are less likely to experience composite major cardiovascular events than those with late referral, with aOR 0.574 (95% CI = 0.43–0.77, P<0.001). Patients with both ≧3 visits during critical care period and ≧11 visits during early care period were less likely to experience composite major cardiovascular events (aOR = 0.25, 95% CI = 0.16–0.39, P < 0.001). Conclusions Patients with adequate pre-dialysis nephrology OPD visits, not just early referral, may had fewer one-year composite major cardiovascular events after initiation of dialysis. This information may be important to medical care providers and public health policy makers in their efforts to improve the well-being of CKD patients. PMID:26900915

  2. Dialysis

    MedlinePlus

    ... kidney transplant, you will need a treatment called dialysis. There are two main types of dialysis. Both types filter your blood to rid your ... clinic for treatments several times a week. Peritoneal dialysis uses the lining of your abdomen, called the ...

  3. Pleural effusion in a peritoneal dialysis patient.

    PubMed

    Bae, Eun Hui; Kim, Chang Seong; Choi, Joon Seok; Kim, Soo Wan

    2011-04-01

    A 34-year-old female presented with end-stage renal disease (ESRD) treated by peritoneal dialysis (CAPD) complained of a dry cough. Chest X-ray and chest computed tomography (CT) scan revealed massive right hydrothorax. Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we performed isotope and contrast peritoneography. We used CT for localizing it. MRI was also trying to show transdiaphragmatic leakage in peritoneoflural fistula. Temporary discontinuation of CAPD, tetracycline instillation into the pleural space and surgical patch grafting of the diaphragmatic leak have all been described. A novel method may be video-assisted talc pleurodesis. PMID:22111056

  4. Pro: Higher serum bicarbonate in dialysis patients is protective.

    PubMed

    Misra, Madhukar

    2016-08-01

    Chronic metabolic acidosis is common in dialysis patients. Bicarbonate administration via the dialysate helps maintain the acid-base balance in these patients. Serum bicarbonate level in dialysis patients is determined by several factors that include dietary protein intake, nutritional status and dialysis prescription, etc. Additionally, a meaningful interpretation of serum bicarbonate in dialysis patients requires an understanding of complexities involving its measurement. Both very low as well very high levels of serum bicarbonate have been associated with adverse outcomes in observational studies. However, recent observational data, when adjusted for the confounding effects of nutritional status, do not associate higher predialysis serum bicarbonate with adverse consequences. At this time, there are no prospective studies available that have examined the association of serum bicarbonate with hard outcomes in dialysis patients. The ideal level of serum bicarbonate in dialysis patients is therefore unknown. This article examines the available data with regard to the benefits of higher predialysis serum bicarbonate. PMID:27411723

  5. Impact of Improving Quality of Dialysis Fluid on Oxidative Stress and Lipid Profile in Hemodialysis Patients

    PubMed Central

    Elkabbaj, Driss; Bahadi, Abdelali; Cherrah, Yahia; Errasfa, Mourad; Eljaoudi, Rachid

    2013-01-01

    The aim of this study was to evaluate the levels of malondialdehyde as an oxidative stress marker in the same hemodialysis patients after changing the quality of dialysate with ultrapure dialysis fluid. Methods. This prospective study concerns hemodialysis patients; all patients were in the first step treated with conventional dialysate, and in the second step (three months later) the same patients were treated with online produced ultrapure dialysis fluid. The malondialdehyde, C-reactive protein, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, fibrinogen, and albumin were quantified before the two steps. Results. Thirty-seven patients completed the study. Ultrapure dialysis fluid reduced but not significantly the malondialdehyde concentrations. Both dialysis fluids were associated with improvement in the malondialdehyde level before and after the hemodialysis session. In lipid parameters, there was a significant decrease with conventional dialysis fluid versus ultrapure dialysis fluid of triglycerides, total cholesterol, and high-density lipoprotein in patients' blood. Instead, the level of low-density lipoprotein, fibrinogen, albumin, and C-reactive protein does not change significantly. Conclusion. The lipid parameters were improved for triglycerides and total cholesterol. Malondialdehyde increases following the hemodialysis session, and the conventional dialysate increased malondialdehyde levels more than the ultrapure dialysis but the differences were not statistically significant. PMID:24967229

  6. Factors Affecting Hemodialysis Patients' Satisfaction with Their Dialysis Therapy

    PubMed Central

    Al Eissa, M.; Al Sulaiman, M.; Jondeby, M.; Karkar, A.; Barahmein, M.; Shaheen, F. A. M.; Al Sayyari, A.

    2010-01-01

    Aim. To assess the degree of satisfaction among hemodialysis patients and the factors influencing this satisfaction. Methods. Patients were recruited from 3 Saudi dialysis centers. Demographic data was collected. Using 1 to 10 Likert scale, the patients were asked to rate the overall satisfaction with, and the overall impact of, their dialysis therapy on their lives and to rate the effect of the dialysis therapy on 15 qualities of life domains. Results. 322 patients were recruited (72.6% of the total eligible patients). The mean age was 51.7 years (±15.4); 58% have been on dialysis for >3 years. The mean Charlson Comorbidity Index was 3.2 (±2), and Kt/V was 1.3 (±0.44). The mean satisfaction score was (7.41 ± 2.75) and the mean score of the impact of the dialysis on the patients' lives was 5.32 ± 2.55. Male patients reported worse effect of dialysis on family life, social life, energy, and appetite. Longer period since the commencement of dialysis was associated with adverse effect on finances and energy. Lower level of education was associated with worse dialysis effect on stress, overall health, sexual life, hobbies, and exercise ability. Conclusion. The level of satisfaction is affected by gender, duration on dialysis, educational level, and standard of care given. PMID:21152200

  7. Vitamin K Status of Canadian Peritoneal Dialysis Patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Vitamin K –dependent proteins have been implicated in the regulation of vascular calcification, a condition that is prevalent among peritoneal dialysis patients. Vitamin K status in this patient population is unknown. In a cross-sectional study of 22 peritoneal dialysis patients selected from a Can...

  8. Oral Tori in Chronic Peritoneal Dialysis Patients

    PubMed Central

    Hsu, Chia-Lin; Hsu, Ching-Wei; Chang, Pei-Ching; Huang, Wen-Hung; Weng, Cheng-Hao; Yang, Huang-Yu; Liu, Shou-Hsuan; Chen, Kuan-Hsing; Weng, Shu-Man; Chang, Chih-Chun; Wang, I-Kuan

    2016-01-01

    Background The pathogenesis of oral tori has long been debated and is thought to be the product of both genetic and environmental factors, including occlusal forces. Another proposed mechanism for oral tori is the combination of biomechanical forces, particularly in the oral cavity, combined with cortical bone loss and trabecular expansion, as one might see in the early stages of primary hyperparathyroidism. This study investigated the epidemiology of torus palatinus (TP) and torus mandibularis (TM) in peritoneal dialysis patients, and analyzed the influences of hyperparathyroidism on the formation of oral tori. Method In total, 134 peritoneal dialysis patients were recruited between July 1 and December 31, 2015 for dental examinations for this study. Patients were categorized into two subgroups based on the presence or absence of oral tori. Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis. Results The prevalence of oral tori in our sample group was high at 42.5% (57 of 134), and most patients with oral tori were female (61.4%). The most common location of tori was TP (80.7%), followed by TP and TM (14.0%), then TM (5.3%). All 54 TP cases were at the midline, and most were <2 cm (59.3%), flat (53.7%), and located in the premolar region (40.7%). Of the 11 TM cases, all were bilateral and symmetric, mostly <2 cm (81.9%), lobular (45.4%), and located at premolar region (63.6%). Interestingly, patients with oral tori had slightly lower serum levels of intact parathyroid hormones than those without oral tori, but the difference was not statistically significant (317.3±292.0 versus 430.1±492.6 pg/mL, P = 0.126). In addition, patients with oral tori did not differ from patients without tori in inflammatory variables such as serum high sensitivity C-reactive protein levels (6.6±8.2 versus 10.3±20.2 mg/L, P = 0.147) or nutritional variables such as serum albumin levels (3.79±0.38 versus 3.77±0.45 g/dL, P = 0

  9. Dialysis

    MedlinePlus

    ... kidney transplant, you will need a treatment called dialysis. There are two main types of dialysis. Both types filter your blood to rid your body of harmful wastes, extra salt, and water. Hemodialysis uses a machine. It is sometimes called an ...

  10. Comparison of the Prevalence of Latent Tuberculosis Infection among Non-Dialysis Patients with Severe Chronic Kidney Disease, Patients Receiving Dialysis, and the Dialysis-Unit Staff: A Cross-Sectional Study

    PubMed Central

    Shu, Chin-Chung; Hsu, Chia-Lin; Lee, Chih-Yuan; Wang, Jann-Yuan; Wu, Vin-Cent; Yang, Feng-Jung; Wang, Jann-Tay; Yu, Chong-Jen; Lee, Li-Na

    2015-01-01

    Background Patients with renal failure are vulnerable to tuberculosis, a common worldwide infectious disease. In the growing dialysis population, the risk for tuberculosis among the associated sub-groups is important but unclear. This study investigated latent tuberculosis infection (LTBI) in patients with severe chronic kidney disease (CKD) and among dialysis-unit staff caring for patients on dialysis. Methods From January 2012 to June 2013, patients undergoing dialysis, those with severe CKD (estimated glomerular filtration rate <30ml/min/1.73 m2), and the dialysis-unit staff (nursing staff and doctors in hemodialysis units) in several Taiwan hospitals were prospectively enrolled. Interferon-gamma release assay (IGRA) through QuantiFERON-TB Gold In-tube was used to determine LTBI. Predictors for LTBI were analyzed. Results Of the 599 participants enrolled, 106 (25%) in the dialysis group were IGRA positive. This was higher than the seven (11%) among severe CKD patients and 12 (11%) in the dialysis-unit staff. Independent predictors of LTBI in patient with renal dysfunction were old age (odds ratio [OR]: 1.03 [1.01–1.04] per year increment), prior TB lesion on chest radiograph (OR: 2.90 [1.45–5.83]), serum albumin (OR: 2.59 [1.63–4.11] per 1 g/dl increment), and need for dialysis (OR: 2.47, [1.02–5.95]). The QFT-GIT response was similar among the three groups. Malignancy (OR: 4.91 [1.84–13.10]) and low serum albumin level (OR: 0.22 [0.10–0.51], per 1 g/dl decrease) were associated with indeterminate IGRA results. Conclusions More patients on dialysis have LTBI compared to those with severe CKD and the dialysis-unit staff. Old age, prior radiographic TB lesion, high serum albumin, and need for dialysis are predictors of LTBI in patients with renal failure. Patients with severe CKD are a lower priority for LTBI screening. The hemodialysis environment is not a risk for LTBI and dialysis-unit staff may be treated as general healthcare workers. PMID

  11. Peritonitis caused by Rothia mucilaginosa in a peritoneal dialysis patient.

    PubMed

    Gosmanova, Elvira O; Garrett, Tiffani R; Wall, Barry M

    2013-12-01

    Peritonitis is an important cause of morbidity in patients undergoing peritoneal dialysis. Rothia mucilaginosa has been reported as an unusual cause of peritoneal dialysis associated peritonitis. Difficulty in the management of this microorganism lies in the absence of uniform recommendations for anti-microbial therapy directed against this pathogen. The current report describes the clinical course of an episode of peritoneal dialysis associated peritonitis caused by Rothia mucilaginosa. Treatment options for this organism are summarized. PMID:24263080

  12. Ceftriaxone-Induced Acute Encephalopathy in a Peritoneal Dialysis Patient

    PubMed Central

    Safadi, Sami; Mao, Michael; Dillon, John J.

    2014-01-01

    Encephalopathy is a rare side effect of third and fourth generation cephalosporins. Renal failure and preexisting neurological disease are notable risk factors. Recognition is important as discontinuing the offending agent usually resolves symptoms. We present a case of acute encephalopathy in a patient with end stage renal disease (ESRD) treated with peritoneal dialysis (PD) who received intravenous ceftriaxone for peritonitis. This case illustrates the potential severe neurologic effects of cephalosporins, which are recommended by international guidelines as first-line antimicrobial therapy for spontaneous bacterial peritonitis. PMID:25544915

  13. Treatment of severe metastatic calcification and calciphylaxis in dialysis patients.

    PubMed

    Goel, Saurabh K; Bellovich, Keith; McCullough, Peter A

    2011-01-01

    Metastatic calcification is a frequent complication encountered in patients undergoing maintenance dialysis and has a complex pathogenesis. It is often difficult to treat and is associated with high morbidity and mortality. Early recognition and prompt initiation of treatment is vital. Local wound care and aggressive metabolic control remain the cornerstones of the therapy. Various novel treatment strategies including sodium thiosulfate and hyperbaric oxygen therapy have been utilized and reviewed in this paper. The response rate to treatment is poor and prevention is the best approach. PMID:21423552

  14. Disaster management of chronic dialysis patients.

    PubMed

    Zoraster, Richard; Vanholder, Raymond; Sever, Mehmet S

    2007-01-01

    The chronically ill are often the hardest hit by disruptions in the healthcare system--they may be highly dependent on medications or treatments that suddenly become unavailable, they are more physically fragile than the rest of the population, and for socioeconomic reasons they may be more limited in their ability to prepare or react. Medical professionals involved in disaster response should be prepared to care for individuals suffering from the complications of chronic illness, and they must have some idea of how to do so with limited resources. Dialysis-dependent, end-stage renal disease patients are at especially high risk following disasters. Infrastructure damage may make dialysis impossible for days, and few physicians have experience or training in the nondialytic management of end-stage renal disease. Nondialytic management strategies include dietary restrictions, aggressive attempts at potassium removal via resins and cathartics, and adaptations of acute treatment strategies. Appropriate planning and stockpiling of medications such as Kayexalate are critical to minimizing morbidity and mortality. PMID:18271158

  15. Mycobacterium fortuitum Peritonitis in a Patient on Continuous Ambulatory Peritoneal Dialysis (CAPD): A Case Report.

    PubMed

    Sangwan, Jyoti; Lathwal, Sumit; Kumar, Satish; Juyal, Deepak

    2013-12-01

    Mycobacterium fortuitum, an environmental organism, is capable of producing a variety of clinical infections such as cutaneous infections, abscesses and nosocomial infections. Rarely, it has been a documented as a cause of peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD). Continuous Ambulatory Peritoneal dialysis (CAPD) is one of the treatment options which are used for patients with end-stage renal disease (ESRD). Although peritonitis rates have declined in parallel with advances in peritoneal dialysis (PD) technology, peritonitis remains a leading complication of CAPD and it is the major cause for transfer to other methods of dialysis. We are reporting a case of M. fortuitum peritonitis in a patient who was undergoing CAPD, which was successfully treated. This case emphasizes the importance of mycobacterial cultures in patients with CAPD-associated peritonitis, whose routine cultures may yield no organisms. PMID:24551685

  16. Kidney Dialysis Patients Discover New Hope through ABE Program.

    ERIC Educational Resources Information Center

    Amonette, Linda; And Others

    A program was developed to provide adult basic education (ABE) to kidney patients while they are receiving dialysis treatment. The program, which relies on an individualized learning approach, involved the coordinated efforts of the following parties: West Virginia Dialysis Facilities, Inc.; the Charleston Renal Group; and the Kanawha County Adult…

  17. Measures of blood pressure and cognition in dialysis patients

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There are few reports on the relationship of blood pressure with cognitive function in maintenance dialysis patients. The Cognition and Dialysis Study is an ongoing investigation of cognitive function and its risk factors in six Boston area hemodialysis units. In this analysis, we evaluated the rela...

  18. Strategies for preserving residual renal function in peritoneal dialysis patients

    PubMed Central

    Nongnuch, Arkom; Assanatham, Montira; Panorchan, Kwanpeemai; Davenport, Andrew

    2015-01-01

    Although there have been many advancements in the treatment of patients with chronic kidney disease (CKD) over the last 50 years, in terms of reducing cardiovascular risk, mortality remains unacceptably high, particularly for those patients who progress to stage 5 CKD and initiate dialysis (CKD5d). As mortality risk increases exponentially with progressive CKD stage, the question arises as to whether preservation of residual renal function once dialysis has been initiated can reduce mortality risk. Observational studies to date have reported an association between even small amounts of residual renal function and improved patient survival and quality of life. Dialysis therapies predominantly provide clearance for small water-soluble solutes, volume and acid-base control, but cannot reproduce the metabolic functions of the kidney. As such, protein-bound solutes, advanced glycosylation end-products, middle molecules and other azotaemic toxins accumulate over time in the anuric CKD5d patient. Apart from avoiding potential nephrotoxic insults, observational and interventional trials have suggested that a number of interventions and treatments may potentially reduce the progression of earlier stages of CKD, including targeted blood pressure control, reducing proteinuria and dietary intervention using combinations of protein restriction with keto acid supplementation. However, many interventions which have been proven to be effective in the general population have not been equally effective in the CKD5d patient, and so the question arises as to whether these treatment options are equally applicable to CKD5d patients. As strategies to help preserve residual renal function in CKD5d patients are not well established, we have reviewed the evidence for preserving or losing residual renal function in peritoneal dialysis patients, as urine collections are routinely collected, whereas few centres regularly collect urine from haemodialysis patients, and haemodialysis dialysis

  19. Critical Care Dialysis System

    NASA Technical Reports Server (NTRS)

    1992-01-01

    Organon Teknika Corporation's REDY 2000 dialysis machine employs technology originally developed under NASA contract by Marquardt Corporation. The chemical process developed during the project could be applied to removing toxic waste from used dialysis fluid. This discovery led to the development of a kidney dialysis machine using "sorbent" dialysis, a method of removing urea from human blood by treating a dialysate solution. The process saves electricity and, because the need for a continuous water supply is eliminated, the patient has greater freedom.

  20. Atrial fibrillation and risk of stroke in dialysis patients

    PubMed Central

    Wetmore, James B.; Ellerbeck, Edward F.; Mahnken, Jonathan D.; Phadnis, Milind; Rigler, Sally K.; Mukhopadhyay, Purna; Spertus, John A.; Zhou, Xinhua; Hou, Qingjiang; Shireman, Theresa I.

    2013-01-01

    Purpose Both stroke and chronic atrial fibrillation (AF) are common in dialysis patients, but uncertainty exists in the incidence of new strokes and the risk conferred by chronic AF. Methods A cohort of dually-eligible (Medicare & Medicaid) incident dialysis patients was constructed. Medicare claims were used to determine the onset of chronic AF, which was specifically treated as a time-dependent covariate. Cox proportional hazards models were used to model time to stroke. Results Of 56,734 patients studied, 5629 (9.9%) developed chronic AF. There were 22.8 ischemic and 5.0 hemorrhagic strokes per 1000 patient-years, a ratio of approximately 4.5:1. Chronic AF was independently associated with time to ischemic (HR 1.26, 99% CI’s 1.06 – 1.49, P = 0.0005), but not hemorrhagic, stroke. Race was strongly associated with hemorrhagic stroke: African-Americans (HR 1.46, 99% CI’s 1.08 – 1.96), Hispanics (HR 1.64, 99% CI’s 1.16 – 2.31), and others (HR 1.76, 99% CI’s 1.16 – 2.78) had higher rates than did Caucasians (P < 0.001 for all). Conclusions Chronic AF has a significant, but modest, association with ischemic stroke. Race/ethnicity is strongly associated with hemorrhagic strokes. The proportion of strokes due to hemorrhage is much higher than in the general population. PMID:23332588

  1. Management of the patient with ESRD after withdrawal from dialysis.

    PubMed

    DeVelasco, R; Dinwiddie, L C

    1998-12-01

    When dialysis no longer achieves the goal of prolonging quality life for the ESRD patient, withdrawal from dialysis is an option. Many patients, their families, and caregivers cannot make an informed decision to withdraw because they do not have sufficient information or, worse, are misinformed about what the patient might experience. This paper reviews the clinical circumstances in which dialysis is discontinued as well as the physiological signs and symptoms of the uremic-related death. Palliative management of those symptoms is from one nephrologist's model and provides a starting point for dialogue about this necessary care. PMID:10188396

  2. Roxadustat (FG-4592): Correction of Anemia in Incident Dialysis Patients.

    PubMed

    Besarab, Anatole; Chernyavskaya, Elena; Motylev, Igor; Shutov, Evgeny; Kumbar, Lalathaksha M; Gurevich, Konstantin; Chan, Daniel Tak Mao; Leong, Robert; Poole, Lona; Zhong, Ming; Saikali, Khalil G; Franco, Marietta; Hemmerich, Stefan; Yu, Kin-Hung Peony; Neff, Thomas B

    2016-04-01

    Safety concerns with erythropoietin analogues and intravenous (IV) iron for treatment of anemia in CKD necessitate development of safer therapies. Roxadustat (FG-4592) is an orally bioavailable hypoxia-inducible factor (HIF) prolyl hydroxylase inhibitor that promotes coordinated erythropoiesis through HIF-mediated transcription. We performed an open-label, randomized hemoglobin (Hb) correction study in anemic (Hb≤10.0 g/dl) patients incident to hemodialysis (HD) or peritoneal dialysis (PD). Sixty patients received no iron, oral iron, or IV iron while treated with roxadustat for 12 weeks. Mean±SD baseline Hb was 8.3±1.0 g/dl in enrolled patients. Roxadustat at titrated doses increased mean Hb by ≥2.0 g/dl within 7 weeks regardless of baseline iron repletion status, C-reactive protein level, iron regimen, or dialysis modality. Mean±SEM maximal change in Hb from baseline (ΔHbmax), the primary endpoint, was 3.1±0.2 g/dl over 12 weeks in efficacy-evaluable patients (n=55). In groups receiving oral or IV iron,ΔHbmaxwas similar and larger than in the no-iron group. Hb response (increase in Hb of ≥1.0 g/dl from baseline) was achieved in 96% of efficacy-evaluable patients. Mean serum hepcidin decreased significantly 4 weeks into study: by 80% in HD patients receiving no iron (n=22), 52% in HD and PD patients receiving oral iron (n=21), and 41% in HD patients receiving IV iron (n=9). In summary, roxadustat was well tolerated and corrected anemia in incident HD and PD patients, regardless of baseline iron repletion status or C-reactive protein level and with oral or IV iron supplementation; it also reduced serum hepcidin levels. PMID:26494833

  3. Zinc status in patients with chronic renal failure on conservative and peritoneal dialysis treatment

    PubMed Central

    Yonova, D; Vazelov, E; Tzatchev, K

    2012-01-01

    Background and aim: The physiological mechanisms regulating zinc homeostasis in humans have been elucidated and described, but the knowledge of zinc status and zinc distribution in the tissues and in the different biological compartments of patients with conservatively treated chronic renal failure (CRF) and on peritoneal dialysis is still insufficient. This investigation examines and compares zinc content in urine, erythrocytes, plasma, and outflow dialysis solution in a group of continuous ambulatory peritoneal dialysis (CAPD) patients, a group of patients with CRF on conservative treatment and in healthy controls. Material and Methods: Data from the last 6 months of 22 adult hemodialysis patients with a mean age of 61 ± 14 years were analyzed retrospectively. Dialysis vintage, normalized protein catabolic rate (nPCR), serum biochemical parameters, mid arm muscle circumference (MAMC) were determined as mean and standard deviation. Correlations between the variables were computed by coefficient p of Pearson. Results and conclusion: In patients on CAPD treatment (group 3) compared to healthy controls (group 1) plasma zinc level was diminished (р<0.05), while erythrocyte zinc elevated (р<0.01). The investigation found out difference between plasma, erythrocyte and urine levels of zinc between the patients with chronic renal failure (group 2) on conservative treatment and those treated by CAPD (group 3), which proves, that continuous ambulatory peritoneal dialysis influences redistribution of zinc in human organism "per se". PMID:23935317

  4. [Cardiac valves calcifications in dialysis patients].

    PubMed

    Klarić, Dragan; Klarić, Vera; Kristić, Ivica

    2011-10-01

    Chronic kidney disease (CKD) patients, especially those with end-stage renal disease (ESRD), are at much higher risk of cardiovascular disease (CVD) than the general population. High serum phosphorus (P) level play important role in pathogenesis of cardiovascular calcifications and is a frequent and important cardiovascular risk factor in patients with CKD. We aimed to investigate the association of serum levels of C-reactive protein (CRP), parathyroid hormon (PTH). calcium phosphorus product (CaxP) with cardiac valves calcifications (VC) in patients on hemodialysis (HD). We investigated for VC using colour Doppler echocardiography. VC were considered present if mitral annular calcifications and/or aortic annular calcifications were visualized. We divided patients in two groups. VC negative group (VC-) were patients with absence of VC. Patients with presence of VC were VC positive (VC+). CRP mean levels in two samples were higher in VC+ group than in VC- group (17.0 vs 3.4mg/L) and (17.1 vs 4.0 mg/L) p<0.0001. CaxP mean level in both samples was higher in VC+ group than in VC- group, 4.8 vs 4.2 (p=0.0219) and 5.0 vs 4.3 (p=0.0078). We also made analysis of absolute highest levels of three samples of CRP (CRPmax) between groups. CRPmax was higher in VC+ group than in VC- group, 19.5 vs 9.7 mg/L, (p=0.0045). We made analysis of absolute higher levels of two samples of Ca x P (CaxPmax) between groups. CaxPmax was higher in VC+ group than in VC- group, 5.2 vs 4.4 (p=0.0014). We found cardiac valve calcifications in 40 percent of patients on hemodialysis. We found that patients with correlation between PTH level, CRP level, CaxP product and cardiac valve calcifications have higher serum levels of PTH and CRP. We also found that CaxP product is higher in patients with cardiac valve calcifications. We didn't find correlation between age, dialysis duration, BMI and cardiac valve calcifications. These findings support careful monitoring of calcium metabolisum in end stage

  5. [Renal osteodystrophy (3); its treatment in dialysis patients].

    PubMed

    Ghitu, S; Oprisiu, R; Benamar, L; Said, S; Tataru Albu, A; Arsenescu, I; el Esper, N; Morinière, P; Fournier, A

    2000-01-01

    The prevalence and the clinical gravity of the various histopathological varieties of renal osteodystrophy in dialysis patients depends on the severity of both the aluminium intoxication and that of hyperparathyroidism. The prevalence of bone pains, fractures and hypercalcemias are the highest in adynamic bone diseases (ABD) with severe aluminium intoxication, then in osteitis fibrosa and mixed osteopathy, in the ABD with moderate aluminium intoxication and rare in the mild lesion in spite of similar moderate aluminium intoxication. In the absence of aluminium intoxication, hypercalcemia and hyperphosphatemia prevalence is higher only when intact PTH is more that 4 times the upper limit of normal. When PTH is between 1 and 2 folds the ULN this prevalence is null and bone mineral density is the highest. 2. The low turnover aluminic bone diseases (osteomalacic or adynamic) will be cured by long term deferoxamine treatment. The hazards of such treatment justify the performance of a bone biopsy to ensure the diagnosis. Their prevention relies on adequate treatment of tapwater and definitive exclusion of long term administration of aluminum phosphate binders. 3. Non aluminic osteomalacia will be treated according to the same guidelines given for the uremic patients before dialysis. 4. Non aluminic adynamic bone disease will be cured by means aiming at stimulating PTH secretion as discontinuing 1 alpha hydroxylated vitamin D derivatives, and, if there is no hyperphosphatemia by discontinuation of calcium supplement. In case of hyperphosphatemia in dialysis patients CaCO3 doses have to be nevertheless increased after the dialysate calcium concentration (DCa) has been decreased in order to induce a negative perdialytic calcium balance for PTH secretion stimulation. In the near future substitution of CaCO3 by non calcemic non aluminic phosphate binders will suffice. 5. Osteitis fibrosa due to hyperparathyroidism will be treated first by securing an optimal vitamin D

  6. Dialysis therapy among elderly patients; data from the Canadian Organ Replacement Register, 1981-1991.

    PubMed

    Fenton, S S; Desmeules, M; Jeffery, J R; Corman, J L

    1993-01-01

    Reports of clinical outcomes after commencement of dialysis treatment among elderly patients with end-stage renal disease (ESRD) are not been numerous. This paper describes the demographic and clinical characteristics of the elderly treated for ESRD in Canada using the Canadian Organ Replacement Register data. Comparisons with younger age groups are also presented. Analyses of data for the period 1981-1991 indicated that the elderly (65+) represent an expanding portion of all new ESRD patients in Canada. Distributions of dialysis modalities showed no major differences by age groups (45-54, 55-64, 65-75, 75+). However, the overall usage of intermittent peritoneal dialysis has decreased over time (from 17% of patients in 1981-83 to 7% in 1990-91). Deaths from social causes were slightly more frequent among the elderly (15.9% of all deaths among those aged 65+ vs 10% among those aged 45-64). Moreover, deaths from infections were more common among patients on dialysis for a longer period of time and more common among patients on peritoneal dialysis than among those on hemodialysis. Discontinuations of continuous ambulatory peritoneal dialysis (CAPD) because of the inability to cope increased with age. Patients with comorbid conditions were more likely to receive hemodialysis, and, as expected, the presence of these conditions increased with age and significantly reduced survival. Other determinants of survival included calendar period of registration, renal center size, and treatment modality. This paper illustrates the many changes over time in the elderly population treated for ESRD. Also of importance, however, is the elderly Canadian population with ESRD which is not presently treated. PMID:8105905

  7. Optical indicators of baseline blood status in dialysis patients

    NASA Astrophysics Data System (ADS)

    Lagali, Neil S.; Burns, Kevin D.; Zimmerman, Deborah L.; Munger, Rejean

    2007-06-01

    In a step towards the development of improved long-term prognostic indicators for patients with end-stage renal disease, we utilized absorption spectroscopy to determine the baseline status of whole blood in a cohort of 5 clinically-stable hemodialysis patients. The optical absorption spectrum of pre-dialysis and post-dialysis blood samples in the 400-1700nm wavelength range was measured for the cohort over a four-week period. Absorption spectra were consistent over time, with a maximum coefficient of variation (CV) of absorption under 2% (650-1650nm) for any given patient over the four-week period (pre and post-dialysis). Spectra varied by a greater amount across patients, with a maximum CV of 5% in any given week. Analysis of variance indicated a broad spectral range (650-1400nm) where within-patient spectral variation was significantly less than between-patient variation (p<0.001), providing the potential for development of stable baseline blood status indicators. The spectra were investigated using principal component analysis (PCA) including a further set of whole blood absorption spectra obtained from 4 peritoneal dialysis patients. PCA revealed the fingerprint-like nature of the blood spectrum, an overall similarity of the spectrum within each treatment mode (hemodialysis or peritoneal dialysis), and a distinct spectral difference between the treatment modes.

  8. Peritonitis with multiple rare environmental bacteria in a patient receiving long-term peritoneal dialysis.

    PubMed

    Levitski-Heikkila, Teresa V; Ullian, Michael E

    2005-12-01

    We describe a patient receiving long-term peritoneal dialysis who experienced 2 episodes of peritonitis in successive months caused by unusual bacteria of environmental origin: Agrobacterium radiobacter, Pseudomonas oryzihabitans, and Corynebacterium aquaticum. A radiobacter and P oryzihabitans occurred simultaneously in the first episode of peritonitis, and C aquaticum, in the second episode. The patient's vocation necessitated exposure to moist soiled conditions. Both episodes responded promptly to antibiotics commonly used to treat peritonitis. Although these organisms rarely lead to loss of life and commonly are considered to be contaminants, they can cause symptomatic peritonitis and peritoneal dialysis catheter loss. A review of previous case reports is included. PMID:16310563

  9. Updates on the Management of Diabetes in Dialysis Patients

    PubMed Central

    Rhee, Connie M.; Leung, Angela M.; Kovesdy, Csaba P.; Lynch, Katherine E.; Brent, Gregory A.; Kalantar-Zadeh, Kamyar

    2014-01-01

    Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U.S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. The treatment of diabetes in ESRD patients is challenging, given changes in glucose homeostasis, the unclear accuracy of glycemic control metrics, and the altered pharmacokinetics of glucose-lowering drugs by kidney dysfunction, the uremic milieu, and dialysis therapy. Up to one-third of diabetic dialysis patients may experience spontaneous resolution of hyperglycemia with hemoglobin A1c (HbA1c) levels <6%, a phenomenon known as “Burnt-Out Diabetes,” which remains with unclear biologic plausibility and undetermined clinical implications. Conventional methods of glycemic control assessment are confounded by the laboratory abnormalities and comorbidities associated with ESRD. Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7 to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients. PMID:24588802

  10. Updates on the management of diabetes in dialysis patients.

    PubMed

    Rhee, Connie M; Leung, Angela M; Kovesdy, Csaba P; Lynch, Katherine E; Brent, Gregory A; Kalantar-Zadeh, Kamyar

    2014-03-01

    Diabetes mellitus is the leading cause of end-stage renal disease (ESRD) in the U.S. and many countries globally. The role of improved glycemic control in ameliorating the exceedingly high mortality risk of diabetic dialysis patients is unclear. The treatment of diabetes in ESRD patients is challenging, given changes in glucose homeostasis, the unclear accuracy of glycemic control metrics, and the altered pharmacokinetics of glucose-lowering drugs by kidney dysfunction, the uremic milieu, and dialysis therapy. Up to one-third of diabetic dialysis patients may experience spontaneous resolution of hyperglycemia with hemoglobin A1c (HbA1c) levels <6%, a phenomenon known as "Burnt-Out Diabetes," which remains with unclear biologic plausibility and undetermined clinical implications. Conventional methods of glycemic control assessment are confounded by the laboratory abnormalities and comorbidities associated with ESRD. Similar to more recent approaches in the general population, there is concern that glucose normalization may be harmful in ESRD patients. There is uncertainty surrounding the optimal glycemic target in this population, although recent epidemiologic data suggest that HbA1c ranges of 6% to 8%, as well as 7% to 9%, are associated with increased survival rates among diabetic dialysis patients. Lastly, many glucose-lowering drugs and their active metabolites are renally metabolized and excreted, and hence, require dose adjustment or avoidance in dialysis patients. PMID:24588802

  11. Mineral Metabolic Abnormalities and Mortality in Dialysis Patients

    PubMed Central

    Abe, Masanori; Okada, Kazuyoshi; Soma, Masayoshi

    2013-01-01

    The survival rate of dialysis patients, as determined by risk factors such as hypertension, nutritional status, and chronic inflammation, is lower than that of the general population. In addition, disorders of bone mineral metabolism are independently related to mortality and morbidity associated with cardiovascular disease and fracture in dialysis patients. Hyperphosphatemia is an important risk factor of, not only secondary hyperparathyroidism, but also cardiovascular disease. On the other hand, the risk of death reportedly increases with an increase in adjusted serum calcium level, while calcium levels below the recommended target are not associated with a worsened outcome. Thus, the significance of target levels of serum calcium in dialysis patients is debatable. The consensus on determining optimal parathyroid function in dialysis patients, however, is yet to be established. Therefore, the contribution of phosphorus and calcium levels to prognosis is perhaps more significant. Elevated fibroblast growth factor 23 levels have also been shown to be associated with cardiovascular events and death. In this review, we examine the associations between mineral metabolic abnormalities including serum phosphorus, calcium, and parathyroid hormone and mortality in dialysis patients. PMID:23525083

  12. Adequacy of dialysis: the patient's role and patient concerns.

    PubMed

    Newmann, John M; Litchfield, William E

    2005-03-01

    The patient's role in adequacy of hemodialysis is demanding and complex. It requires meticulous attention to initiating, accepting, and maintaining extraordinary behavioral change. This includes the following: (1) major alteration of dietary habits, often contrary to a patient's familial and cultural customs; (2) compliance with a new, voluminous medication routine, often straining personal finances; (3) reallocation of time for transportation, treatment, and partial recovery, frequently consuming a minimum of 6 to 8 hours 3 days each week; (4) psychologic adjustment to unaccustomed chronic dependency on, and accountability to, an array of variably experienced and competent renal care staff; (5) skills, seldom taught, required to communicate clearly and regularly with overworked medical professionals who are often much younger with less life experience; and (6) additional commitment to compensating for the physical fatigue that routinely accompanies hemodialysis. Reasonable behavioral modification in these 6 categories is likely to increase the chances of a patient fulfilling his role in adequacy of dialysis. Some patients, however committed the staff have been in assisting them, may show little interest in dialysis adequacy and the patient's role. Other patients periodically may fail in their role unless the renal care team recognizes the patient as an individual who is included as an important team member. The patient requires consistent and repeated education about their disease, treatment, and risks and benefits of adherence. The unique, unnatural requirements of adequate chronic hemodialysis require this patient support from the renal staff, enhanced by continuous sensitive attention, empathy, and persuasion. This will help the patient achieve success in their role. PMID:15791563

  13. Atrial fibrillation in dialysis patients: time to abandon warfarin?

    PubMed

    Brancaccio, Diego; Neri, Luca; Bellocchio, Francesco; Barbieri, Carlo; Amato, Claudia; Mari, Flavio; Canaud, Bernard; Stuard, Stefano

    2016-05-16

    Atrial fibrillation (AF) is a frequent clinical complication in dialysis patients, and warfarin therapy represents the most common approach for reducing the risk of stroke in this population. However, current evidence based on observational studies, offer conflicting results, whereas no randomized controlled trials have been carried out so far. Additionally, many clinicians are wary of the possible role of warfarin as vascular calcification inducer and its potential to increase the high risk of bleeding among patients on dialysis. Ideally the most promising therapy would be based on direct inhibitors of factor IIa or Xa; however, at the moment, none of these drugs can be safely prescribed in dialysis patients, because of their potentially dangerous accumulation, and the lack of sufficient experience with apixaban or rivaroxaban, two drugs showing a favorable pharmacokinetic profile in end-stage renal disease. Hence, the use of vitamin K inhibitors is currently the only pharmacological option for stroke prevention in dialysis patients with atrial fibrillation, leaving the clinicians in a management conundrum.This review discusses the trade-offs implicated in warfarin use for this population, the promises of newly developed drugs, the role of dialysis as atrial fibrillation trigger, as well as potential non-pharmacological management options suitable in selected clinical situations. PMID:27079417

  14. Revisiting the association between altitude and mortality in dialysis patients.

    PubMed

    Shapiro, Bryan B; Streja, Elani; Rhee, Connie M; Molnar, Miklos Z; Kheifets, Leeka; Kovesdy, Csaba P; Kopple, Joel D; Kalantar-Zadeh, Kamyar

    2014-04-01

    It was recently reported that residential altitude is inversely associated with all-cause mortality among incident dialysis patients; however, no adjustment was made for key case-mix and laboratory variables. We re-examined this question in a contemporary patient database with comprehensive clinical and laboratory data. In a contemporary 8-year cohort of 144,892 maintenance dialysis patients from a large dialysis organization, we examined the relationship between residential altitude and all-cause mortality. Using data from the US Geological Survey, the average residential altitudes per approximately 43,000 US zip codes were compiled and linked to the residential zip codes of each patient. Mortality risks for these patients were estimated by Cox proportional hazard ratios. The study population's mean ± standard deviation age was 61 ± 15 years. Forty-five percent of patients were women, and 57% of patients had diabetes. In fully adjusted analysis, those residing in the highest altitude strata (≥ 6000 ft) had a lower all-cause mortality risk in fully adjusted analyses: death hazard ratio: 0.92 (95% confidence interval, 0.86-0.99), as compared with patients in the reference group (<250 ft). Residential altitude is inversely associated in all-cause mortality risk in maintenance dialysis patients notwithstanding the unknown and unmeasured confounders. PMID:24422763

  15. [Management of color-Doppler imaging in dialysis patients].

    PubMed

    Battaglia, Yuri; Granata, Antonio; Zamboli, Pasquale; Lusenti, Tiziano; Di Lullo, Luca; Floccari, Fulvio; Logias, Franco; D'Amelio, Alessandro; Fiorini, Fulvio

    2012-01-01

    In recent decades, the survival of dialysis patients has gradually increased thanks to the evolution of dialysis techniques and the availability of new drug therapies. These elements have led to an increased incidence of a series of dialysis-related diseases that might compromise the role of dialysis rehabilitation: vascular disease, skeletal muscle disease, infectious disease, cystic kidney disease and cancer. The nephrologist is therefore in charge of a patient group with complex characteristics including the presence of indwelling vascular and/or peritoneal catheters, conditions secondary to chronic renal failure (hyperparathyroidism, anemia, amyloid disease, etc.) and superimposed disorders due to old age (cardiac and respiratory failure, cancer, type 2 diabetes mellitus, etc.). Early clinical and organizational management of such patients is essential in a modern and ''economic'' vision of nephrology. The direct provision of ultrasound services by the nephrologist responds to these requirements. A minimum level of expertise in diagnostic ultrasonography of the urinary tract and dialysis access should be part of the nephrologist's cultural heritage, acquired through theoretical and practical training programs validated by scientific societies, especially for those who choose to specialize in these procedures and become experts in imaging or interventional ultrasonography. PMID:23229666

  16. Valacyclovir-associated neurotoxicity in peritoneal dialysis patients.

    PubMed

    Chaudhari, Dhara; Ginn, David

    2014-01-01

    Valacyclovir is an oral antiviral agent being used more frequently than acyclovir because of the ease of administration and efficacy. Serious neuropsychiatric side effects have been demonstrated with the use of valacyclovir in renal failure patients. We report a case of valacyclovir neurotoxicity to emphasis the importance of dose adjustment in patients with chronic kidney disease and on dialysis. PMID:23528373

  17. Dental considerations for the patient receiving dialysis for renal failure.

    PubMed

    Levy, H M

    1988-01-01

    A review of the literature describing the dental management of patients receiving hemodialysis because of renal failure is presented. A description of the renal failure process is given. Pretreatment and day of treatment precautions are considered. A pertinent dental case report of a dialysis patient is also presented. PMID:2978765

  18. Fibroblast Growth Factor 23 in Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Isakova, Tamara; Xie, Huiliang; Barchi-Chung, Allison; Vargas, Gabriela; Sowden, Nicole; Houston, Jessica; Wahl, Patricia; Lundquist, Andrew; Epstein, Michael; Smith, Kelsey; Contreras, Gabriel; Ortega, Luis; Lenz, Oliver; Briones, Patricia; Egbert, Phyllis; Ikizler, T. Alp; Jueppner, Harald

    2011-01-01

    Summary Background and objectives Fibroblast growth factor 23 (FGF23) is an independent risk factor for mortality in patients with ESRD. Before FGF23 testing can be integrated into clinical practice of ESRD, further understanding of its determinants is needed. Design, setting, participants, & measurements In a study of 67 adults undergoing peritoneal dialysis, we tested the hypothesis that longer dialysis vintage and lower residual renal function and renal phosphate clearance are associated with higher FGF23. We also compared the monthly variability of FGF23 versus parathyroid hormone (PTH) and serum phosphate. Results In unadjusted analyses, FGF23 correlated with serum phosphate (r = 0.66, P < 0.001), residual renal function (r = −0.37, P = 0.002), dialysis vintage (r = 0.31, P = 0.01), and renal phosphate clearance (r = −0.38, P = 0.008). In adjusted analyses, absence of residual renal function and greater dialysis vintage associated with higher FGF23, independent of demographics, laboratory values, peritoneal dialysis modality and adequacy, and treatment with vitamin D analogs and phosphate binders. Urinary and dialysate FGF23 clearances were minimal. In three serial monthly measurements, within-subject variability accounted for only 10% of total FGF23 variability compared with 50% for PTH and 60% for serum phosphate. Conclusions Increased serum phosphate, loss of residual renal function, longer dialysis vintage, and lower renal phosphate clearance are associated with elevated FGF23 levels in ESRD patients undergoing peritoneal dialysis. FGF23 may be a more stable marker of phosphate metabolism in ESRD than PTH or serum phosphate. PMID:21903990

  19. Arterial Stiffening and Clinical Outcomes in Dialysis Patients.

    PubMed

    Kato, Akihiko

    2015-09-01

    Cardiovascular disease (CVD) is an important cause of morbidity and mortality in dialysis patients. Brachial-ankle pulse wave velocity (baPWV) is more efficient to handily assess arteriosclerosis than aortic PWV. The cardio-ankle vascular index (CAVI) is also a novel blood pressure-independent arterial stiffness parameter. In dialysis patients, both baPWV and CAVI are increased compared to general subjects. Several studies have demonstrated that increased baPWV is associated with carotid atherosclerosis and diastolic left ventricular dysfunction in hemodialysis (HD) patients. In addition, higher baPWV is related to all-cause and cardiovascular (CV) mortality. CAVI is similarly associated with CVD. However, baPWV is superior to CAVI as a predictor of CV outcomes in HD patients. Besides these outcomes, a close relationship exists between sarcopenia, abdominal visceral obesity and arterial stiffening. Reduction of thigh muscle mass is inversely correlated with baPWV and CAVI in males. Abdominal fatness is also associated with increased arterial stiffness in females. These observations provide further evidence of higher risk of CV events in HD patients with sarcopenic obesity. In addition, arterial stiffness is associated with cerebral small vessel disease and decreased cognitive function in the elderly. However, it is unknown whether arterial stiffness may be useful as an early indicator of cognitive decline in dialysis patients. Because dialysis patients are at risk of developing dementia, more studies are needed to elucidate the causal link between arterial stiffness and cognitive impairment. PMID:26587457

  20. Delivered dialysis dose is suboptimal in hospitalized patients.

    PubMed

    Obialo, C I; Hernandez, B; Carter, D

    1998-01-01

    Underdialyzed patients have high hospitalization and mortality rates. It is unclear if such patients receive adequate dialysis during hospitalization. In this cross-sectional study, we evaluated single treatment delivered dialysis dose during hospitalization and compared this to the dosage received at the free-standing outpatient clinics in the same patients. Eighty-four patients (54% male) aged 23-63 years (means +/- SD 55.5 +/- 14.6) who have been on dialysis for at least 3 months were evaluated. Hypertension and diabetes were the most common diagnoses, while thrombosed graft or fistula accounted for 40% of admissions. The mean dialysis treatment time (Td) was 30 min longer in the outpatient (OP) setting than the hospital (H): 3.6 +/- 0.3 vs. 3.1 +/- 0.2 h (p < 0.0001). Attained blood flow (QB) was 15% greater in the OP than H: 394 +/- 40 vs. 331 +/- 54 ml/min (p < 0.0001). The Kt/V was analyzed in 49 of 84 patients; the OP Kt/V was 20% greater than the H Kt/V: 1.38 +/- 0.2 vs. 1.11 +/- 0.1 (p < 0.0001). A further breakdown of H Kt/V according to access and membrane types showed that patients with functional grafts/fistula had a higher Kt/V than those with temporary accesses 1.14 +/- 0.1 vs. 1.07 +/- 0.1 (p = 0.01). We conclude that hospitalized patients receive suboptimal dialysis dose, this could have a negative impact on survival if hospitalization is recurrent and prolonged. Kinetic modeling should be routinely performed in such patients and Td should be increased in patients with temporary accesses. PMID:9845829

  1. Quality of life of caregivers and patients on peritoneal dialysis.

    PubMed

    Fan, Stanley Lin-Sun; Sathick, Insara; McKitty, Khadija; Punzalan, Sally

    2008-05-01

    Peritoneal dialysis is the archetypal home-based therapy and is often favoured by patients. However, as patients with end-stage renal failure become more elderly, with more co-morbidity, their dependence on carers to provide physical, emotional and logistical support increases. The effect of this chronic burden has not been systematically studied. We have prospectively studied patients with end-stage renal failure starting peritoneal dialysis and their carers over a 1-year period. We selected a cohort of caregivers that are actively involved with the care of their partners' dialysis. Quality of Life (QoL) assessed by SF-36 questionnaires showed the patients and carers had impairment of QoL at the start of dialysis. As expected, the baseline QoL Physical Component Scores highly correlated with co-morbidity and assessment of functional capacity. Scores of all QoL domains improved after 1 year and this reached statistical significance for social functioning for both patients and carers. When we compared carers of highly dependent patients (required to perform daily dialysis) with carers of less dependent patients, we noted that the former had a statistically significant worsening of their mental health but other parameters were not different. We have shown that despite increasing the burden for caregivers, with careful selection, education and support, we did not adversely impact on the QoL of carers whilst there was some evidence of improvement, especially in social functioning. This gives reassurance that establishing dependent patients on PD is compatible with a holistic approach to the patients and their families. PMID:18182410

  2. Mitochondrial neurogastrointestinal encephalomyopathy treated with peritoneal dialysis and bone marrow transplantation.

    PubMed

    Ariaudo, Claudia; Daidola, Germana; Ferrero, Bruno; Guarena, Cesare; Burdese, Manuel; Segoloni, Giuseppe Paolo; Biancone, Luigi

    2015-02-01

    Mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) is a rare disease caused by thymidine phosphorylase deficiency which leads to toxic accumulations of thymidine (dThd) and deoxyuridine (dUrd). It lacks an established treatment and the prognosis is traditionally poor. We report a case of a young female patient with normal renal function and MNGIE treated by peritoneal dialysis (PD) and allogeneic bone marrow transplantation (BMT). PD was effective in reducing dThd and dUrd plasma levels and in improving clinical symptoms. To our knowledge, this is the first report on the beneficial effects of PD regarding MNGIE neurological symptoms. PD, therefore, should be considered especially in medically compromised patients as a supportive treatment to improve clinical conditions before BMT. PMID:24599829

  3. Candidate Gene Analysis of Mortality in Dialysis Patients

    PubMed Central

    Verschuren, Jeffrey J. W.; Dekker, Friedo W.; Rabelink, Ton J.; Jukema, J. Wouter; Rotmans, Joris I.

    2015-01-01

    Background Dialysis patients have high cardiovascular mortality risk. This study aimed to investigate the association between SNPs of genes involved in vascular processes and mortality in dialysis patients. Methods Forty two SNPs in 25 genes involved in endothelial function, vascular remodeling, cell proliferation, inflammation, coagulation and calcium/phosphate metabolism were genotyped in 1330 incident dialysis patients. The effect of SNPs on 5-years cardiovascular and non-cardiovascular mortality was investigated. Results The mortality rate was 114/1000 person-years and 49.4% of total mortality was cardiovascular. After correction for multiple testing, VEGF rs699947 was associated with all-cause mortality (HR1.48, 95% CI 1.14–1.92). The other SNPs were not associated with mortality. Conclusions This study provides further evidence that a SNP in the VEGF gene may contribute to the comorbid conditions of dialysis patients. Future studies should unravel the underlying mechanisms responsible for the increase in mortality in these patients. PMID:26587841

  4. Patient-Staff Interactions and Mental Health in Chronic Dialysis Patients

    ERIC Educational Resources Information Center

    Swartz, Richard D.; Perry, Erica; Brown, Stephanie; Swartz, June; Vinokur, Amiram

    2008-01-01

    Chronic dialysis imposes ongoing stress on patients and staff and engenders recurring contact and long-term relationships. Thus, chronic dialysis units are opportune settings in which to investigate the impact of patients' relationships with staff on patient well-being. The authors designed the present study to examine the degree to which…

  5. INVESTIGATION OF SERUM MICROCYSTIN CONCENTRATIONS AMONG DIALYSIS PATIENTS, BRAZIL, 1996

    EPA Science Inventory

    Investigation of Serum Microcystin Concentrations Among Dialysis Patients, Brazil, 1996

    Elizabeth D. Hilborn 1, Wayne W. Carmichael 2, Sandra M.F.O. Azevedo 3
    1- USEPA/ORD/NHEERL, Research Triangle Park, NC
    2- Wright State University, Dayton, OH
    3- Federal Univers...

  6. Treatment of hyperlipemia in diabetic patients on dialysis with a physiological substance.

    PubMed

    Coronel, F; Tornero, F; Torrente, J; Naranjo, P; De Oleo, P; Macia, M; Barrientos, A

    1991-01-01

    Hyperlipemia is a very frequent complication of the diabetic patient on dialysis. There is difficulty of treatment with the diet, because the dietary restriction already imposed on these patients and the secondary effects and toxicity of the available drugs in uremics aggravate the problem. We have treated 22 diabetic patients on dialysis (8 on hemodialysis and 14 on continuous ambulatory peritoneal dialysis) suffering from hyperlipemia with pantethine, a physiological substance and coenzyme A precursor in the Krebs cycle. With the administration of an oral dose of 900 mg/day we obtained a reduction of total cholesterol (275 +/- 72 vs. 231 +/- 54 mg/dl; p less than 0.001), very-low-density lipoprotein (VLDL)-cholesterol (66 +/- 36 vs. 46 +/- 18 mg/dl; p less than 0.01) and triglycerides (332 +/- 182 vs. 227 +/- 90 mg/dl; p less than 0.01) at 2 months. High-density lipoprotein (HDL)-cholesterol did not change, but the total cholesterol/HDL-cholesterol ratio decreased significantly (p less than 0.05). Total cholesterol, VLDL and triglycerides showed a progressive and significant reduction at 4 and 6 months. No changes were observed in serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, uric acid, blood glucose and glycosylated hemoglobin. Gastric discomfort in 2 patients and pruritus in another one were the secondary effects related. Pantethine was shown to be a very effective hypolipemic agent in diabetic patients on dialysis with a great tolerance. PMID:2048576

  7. Relapsing peritonitis with Bacillus cereus in a patient on continuous ambulatory peritoneal dialysis.

    PubMed

    Magnussen, Eyð Tausen; Vang, Amanda Gratton; Á Steig, Torkil; Gaini, Shahin

    2016-01-01

    We present a case where Bacillus cereus was determined to be the causative agent of relapsing peritonitis in a patient on continuous ambulatory peritoneal dialysis (CAPD). The patient, a 70-year-old man from the Faroe Islands, was admitted with relapsing peritonitis four times over a 3-month period. Peritoneal cultures were positive for growth of B. cereus, a rare bacterial cause of peritonitis. The cultures demonstrated susceptibility to vancomycin, and therefore the patient was treated with intraperitoneal vancomycin, intraperitoneal gentamycin and oral ciprofloxacin. As a result of the relapsing B. cereus peritonitis diagnosis and a CT scan showing contraction of the peritoneum after longstanding inflammation, the peritoneal catheter was removed and the patient converted to haemodialysis. To date, the patient has not been readmitted due to peritonitis. A lack of proper hygiene when changing the dialysis bag was the suspected source of infection with B. cereus. PMID:27118739

  8. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients.

    PubMed

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21-87) years; median time on PD 19 (3-100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (α u), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters--rather than solute transport parameters--are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane. PMID:26989432

  9. Peritoneal Fluid Transport rather than Peritoneal Solute Transport Associates with Dialysis Vintage and Age of Peritoneal Dialysis Patients

    PubMed Central

    Waniewski, Jacek; Antosiewicz, Stefan; Baczynski, Daniel; Poleszczuk, Jan; Pietribiasi, Mauro; Lindholm, Bengt; Wankowicz, Zofia

    2016-01-01

    During peritoneal dialysis (PD), the peritoneal membrane undergoes ageing processes that affect its function. Here we analyzed associations of patient age and dialysis vintage with parameters of peritoneal transport of fluid and solutes, directly measured and estimated based on the pore model, for individual patients. Thirty-three patients (15 females; age 60 (21–87) years; median time on PD 19 (3–100) months) underwent sequential peritoneal equilibration test. Dialysis vintage and patient age did not correlate. Estimation of parameters of the two-pore model of peritoneal transport was performed. The estimated fluid transport parameters, including hydraulic permeability (LpS), fraction of ultrasmall pores (αu), osmotic conductance for glucose (OCG), and peritoneal absorption, were generally independent of solute transport parameters (diffusive mass transport parameters). Fluid transport parameters correlated whereas transport parameters for small solutes and proteins did not correlate with dialysis vintage and patient age. Although LpS and OCG were lower for older patients and those with long dialysis vintage, αu was higher. Thus, fluid transport parameters—rather than solute transport parameters—are linked to dialysis vintage and patient age and should therefore be included when monitoring processes linked to ageing of the peritoneal membrane. PMID:26989432

  10. Setting research priorities for patients on or nearing dialysis.

    PubMed

    Manns, Braden; Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P G; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

    2014-10-01

    With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority-setting exercises to guide researchers in designing future studies and inform health care funders. PMID:24832095

  11. Setting Research Priorities for Patients on or Nearing Dialysis

    PubMed Central

    Hemmelgarn, Brenda; Lillie, Erin; Dip, Sally Crowe P.G.; Cyr, Annette; Gladish, Michael; Large, Claire; Silverman, Howard; Toth, Brenda; Wolfs, Wim; Laupacis, Andreas

    2014-01-01

    With increasing emphasis among health care providers and funders on patient-centered care, it follows that patients and their caregivers should be included when priorities for research are being established. This study sought to identify the most important unanswered questions about the management of kidney failure from the perspective of adult patients on or nearing dialysis, their caregivers, and the health care professionals who care for these patients. Research uncertainties were identified through a national Canadian survey of adult patients on or nearing dialysis, their caregivers, and health care professionals. Uncertainties were refined by a steering committee that included patients, caregivers, researchers, and clinicians to assemble a short-list of the top 30 uncertainties. Thirty-four people (11 patients; five caregivers; eight physicians; six nurses; and one social worker, pharmacist, physiotherapist, and dietitian each) from across Canada subsequently participated in a workshop to determine the top 10 research questions. In total, 1570 usable research uncertainties were received from 317 respondents to the survey. Among these, 259 unique uncertainties were identified; after ranking, these were reduced to a short-list of 30 uncertainties. During the in-person workshop, the top 10 research uncertainties were identified, which included questions about enhanced communication among patients and providers, dialysis modality options, itching, access to kidney transplantation, heart health, dietary restrictions, depression, and vascular access. These can be used alongside the results of other research priority–setting exercises to guide researchers in designing future studies and inform health care funders. PMID:24832095

  12. Effect of Hurricane Katrina on the mortality of dialysis patients.

    PubMed

    Kutner, Nancy G; Muntner, Paul; Huang, Yijian; Zhang, Rebecca; Cohen, Andrew J; Anderson, Amanda H; Eggers, Paul W

    2009-10-01

    To investigate whether Hurricane Katrina's landfall in August 2005 resulted in excess mortality, we conducted a cohort study of patients who started dialysis between January 2003 and late August 2005 and who received treatment at 94 Katrina-affected clinics in the area. Survival, regardless of patient location after the storm, was followed through February 2006. In adjusted Cox proportional hazards models, Hurricane Katrina (time-varying indicator) was not significantly associated with mortality risk for patients from regions of the Gulf Coast affected by Katrina or those from a subset of 40 New Orleans clinics. Subgroup analyses indicated no significant increased mortality risk by race, income status, or dialysis modality. Sensitivity analyses indicated no significant increased mortality risk for patients from clinics closed for 10 days or longer, patients in their first 90 days of dialysis, or patients not evacuated from the affected areas. Patients remaining in the New Orleans area may have been more vulnerable due to age and comorbidities; however, the change in their mortality risk in the month following the storm was not statistically significant. We suggest that disaster-related education for patients must be ongoing, and that each disaster may present a different set of circumstances and challenges that will require unanticipated response efforts. PMID:19657326

  13. Elevated levels of procoagulant plasma microvesicles in dialysis patients.

    PubMed

    Burton, James O; Hamali, Hassan A; Singh, Ruchir; Abbasian, Nima; Parsons, Ruth; Patel, Amit K; Goodall, Alison H; Brunskill, Nigel J

    2013-01-01

    Cardiovascular (CV) death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs) are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs) are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD), 17 peritoneal dialysis (PD) patients and 20 matched controls. Relative concentrations of EMVs (CD144(+ ve)) and PMVs (CD42b(+ ve)) were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p<0.05). MVs from HD and PD patients were able to generate more thrombin than the controls, with higher peak thrombin, and endogenous thrombin potential levels (p<0.02). However there were no differences in either the relative quantity or activity of MVs between the two patient groups (p>0.3). Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients. PMID:23936542

  14. Elevated Levels of Procoagulant Plasma Microvesicles in Dialysis Patients

    PubMed Central

    Burton, James O.; Hamali, Hassan A.; Singh, Ruchir; Abbasian, Nima; Parsons, Ruth; Patel, Amit K.; Goodall, Alison H.; Brunskill, Nigel J.

    2013-01-01

    Cardiovascular (CV) death remains the largest cause of mortality in dialysis patients, unexplained by traditional risk factors. Endothelial microvesicles (EMVs) are elevated in patients with traditional CV risk factors and acute coronary syndromes while platelet MVs (PMVs) are associated with atherosclerotic disease states. This study compared relative concentrations of circulating MVs from endothelial cells and platelets in two groups of dialysis patients and matched controls and investigated their relative thromboembolic risk. MVs were isolated from the blood of 20 haemodialysis (HD), 17 peritoneal dialysis (PD) patients and 20 matched controls. Relative concentrations of EMVs (CD144+ ve) and PMVs (CD42b+ ve) were measured by Western blotting and total MV concentrations were measured using nanoparticle-tracking analysis. The ability to support thrombin generation was measured by reconstituting the MVs in normal plasma, using the Continuous Automated Thrombogram assay triggered with 1µM tissue factor. The total concentration of MVs as well as the measured sub-types was higher in both patient groups compared to controls (p<0.05). MVs from HD and PD patients were able to generate more thrombin than the controls, with higher peak thrombin, and endogenous thrombin potential levels (p<0.02). However there were no differences in either the relative quantity or activity of MVs between the two patient groups (p>0.3). Dialysis patients have higher levels of circulating procoagulant MVs than healthy controls. This may represent a novel and potentially modifiable mediator or predictor of occlusive cardiovascular events in these patients. PMID:23936542

  15. Depressive Symptoms, Patient Satisfaction, and Quality of Life Over Time in Automated and Continuous Ambulatory Peritoneal Dialysis Patients

    PubMed Central

    Jung, Hee-Yeon; Jang, Hye Min; Kim, Yang Wook; Cho, Seong; Kim, Hye-Young; Kim, Sung-Ho; Bang, Kitae; Kim, Hyun Woo; Lee, So Young; Jo, Sang Kyung; Lee, Jonghyo; Choi, Ji-Young; Cho, Jang-Hee; Park, Sun-Hee; Kim, Chan-Duck; Kim, Yong-Lim

    2016-01-01

    Abstract Health-related quality of life (HRQOL) is an important clinical outcome for dialysis patients. However, relative superiority in HRQOL between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) are not clearly known. We compared HRQOL over time between APD and CAPD patients and evaluated factors associated with HRQOL. All 260 incident patients initiating APD or CAPD at multiple centers throughout Korea were prospectively enrolled in this study between October 2010 and February 2013. HRQOL, depressive symptoms, and renal treatment satisfaction were assessed 1 and 12 months after the start of dialysis by the Kidney Disease Quality of Life Short Form 36 (KDQOL-36), the Beck Depression Inventory (BDI), and the Renal Treatment Satisfaction Questionnaire (RTSQ), respectively. Of 196 patients who completed all questionnaires and did not change the peritoneal dialysis (PD) modality during the 1-year follow-up period, 160 were matched. APD patients showed better baseline HRQOL than CAPD patients for the symptoms, patient satisfaction, pain, and social function domains. There were no differences in HRQOL between the 2 groups at 12 months, and CAPD patients had significantly greater improvements in symptoms (P = 0.02), the mental composite summary (P = 0.03), and health status domains (P = 0.03) than APD patients. There were similar improvements in depressive symptoms (P = 0.01) and patient satisfaction with treatment (P = 0.01) in CAPD and APD patients. Interestingly, depressive symptoms, not PD modality, was the most influential and consistent factor for HRQOL. Despite the spontaneous improvement of depressive symptoms, considerable PD patients still had depressive symptoms at the 1-year appointment. APD has no advantage over CAPD for HRQOL. Considering the substantial negative effect of depressive symptoms on HRQOL, it is important to evaluate PD patients for depression and to treat those with depression to

  16. Lanthanum: new drug. Hyperphosphataemia in dialysis patients: more potential problems than benefits.

    PubMed

    2007-04-01

    (1) In dialysis patients with chronic renal failure, hyperphosphataemia can cause osteorenal dystrophy, leading to bone pain, fractures and excess cardiovascular mortality. In addition to a low-phosphorus diet and dialysis, phosphorus chelators are usually needed to control blood phosphorus levels. The first choice is calcium carbonate, and sevelamer is an alternative. (2) Lanthanum carbonate, a phosphorus chelator, is now also licensed for the treatment of hyperphosphataemia in dialysis patients with chronic renal failure. (3) In addition to three dose-finding placebo-controlled studies, clinical evaluation includes 2 comparative randomised unblinded trials: one 6-month trial versus calcium carbonate and a 2-year trial versus other phosphorus chelators. During these trials, lanthanum was no more effective than the comparators in terms of effects on the mortality rate, incidence of fractures, or blood phosphorus level. (4) During these trials, adverse events attributed to treatment were more frequent with lanthanum than with the other phosphorus chelators. The main problems were gastrointestinal disorders (nausea, vomiting, diarrhoea, constipation and abdominal pain), headaches, seizures, and encephalopathy. (5) The accumulation of lanthanum in the bones and brain is troubling. The known long-term adverse effects of aluminium, another trivalent cation with weak gastrointestinal absorption, suggest that caution is also required with lanthanum. (6) In practice, when a phosphorus chelator is needed to treat hyperphosphataemia in dialysis patients with chronic renal failure, calcium carbonate is the first choice and sevelamer remains the best alternative. PMID:17458039

  17. Phosphate balance in peritoneal dialysis patients: role of ultrafiltration.

    PubMed

    Granja, Carlos Andres; Juergensen, Peter; Finkelstein, Fredric O

    2009-01-01

    Current National Kidney Foundation's Disease Outcome Quality Initiative (K/DOQI) clinical practice guidelines for bone metabolism and disease in chronic kidney disease (CKD) recommend maintenance of serum phosphorus levels below 5.5 mg/dl. About 40% of patients maintained on chronic peritoneal dialysis (CPD) have phosphate levels above 5.5 mg%. The present study was designed to examine the relative contribution of ultrafiltration to phosphate removal in CPD patients. 24-hour dialysate collections were obtained in 28 CPD patients and the diffuse and ultrafiltration (UF) contributions to phosphate removal determined. 11% of phosphate removal was accounted for by UF. There was a highly significant correlation between UF rate and the % of phosphate removed by UF. The results of this study underscore the importance of individualizing the peritoneal dialysis prescription. PMID:19494614

  18. Continuous ambulatory peritoneal dialysis: nurses' experiences of teaching patients.

    PubMed

    Shubayra, Amnah

    2015-03-01

    Nine nurses were interviewed to determine nurses' experiences of teaching patients to use continuous ambulatory peritoneal dialysis (CAPD). The material was analyzed using content analysis. Data were sorted into four themes and ten subthemes. The themes were presented as follows: Importance of language, individualized teaching, teaching needs and structure of care in teaching. The findings highlighted important insights into how nurses experience teaching patients to perform CAPD. The study revealed some barriers for the nurses during teaching. The major barrier was shortage of Arabic speaking nursing staff. Incidental findings involved two factors that played an important role in teaching, retraining and a special team to perform pre-assessments, including home visits. In conclusion, the findings of this study showed several factors that are considered as barriers for the nurses during teaching the CAPD patients and the need to improve the communication and teaching in the peritoneal dialysis units, including the importance of individualized teaching. PMID:25758880

  19. Pharmacokinetics of cefepime in patients undergoing continuous ambulatory peritoneal dialysis.

    PubMed Central

    Barbhaiya, R H; Knupp, C A; Pfeffer, M; Zaccardelli, D; Dukes, G M; Mattern, W; Pittman, K A; Hak, L J

    1992-01-01

    The pharmacokinetics of cefepime were studied in 10 male patients receiving continuous ambulatory peritoneal dialysis therapy. Five patients received a single 1,000-mg dose and the other five received a single 2,000-mg dose; all doses were given as 30-min intravenous infusions. Serial plasma, urine, and peritoneal dialysate samples were collected; and the concentrations of cefepime in these fluids were measured over 72 h by using a high-performance liquid chromatographic assay with UV detection. Pharmacokinetic parameters were calculated by noncompartmental methods. The peak concentrations in plasma and the areas under the plasma concentration-versus-time curve for the 2,000-mg dose group were twice as high as those observed for the 1,000-mg dose group. The elimination half-life of cefepime was about 18 h and was independent of the dose. The steady-state volume of distribution was about 22 liters, and values for the 1,000- and 2,000-mg doses were not significantly different. The values for total body clearance and peritoneal dialysis clearance were about 15 and 4 ml/min, respectively. No dose dependency was observed for the clearance estimates. Over the 72-h sampling period, about 26% of the dose was excreted intact into the peritoneal dialysis fluid. For 48 h postdose, mean concentrations of cefepime in dialysate at the end of each dialysis interval exceeded the reported MICs for 90% of the isolates (MIC90s) for bacteria which commonly cause peritonitis resulting from continuous peritoneal dialysis. A parenteral dose of 1,000 or 2,000 mg of cefepime every 48 h would maintain the antibiotic levels in plasma and peritoneal fluid above the MIC90s for the most susceptible bacteria for the treatment of systemic and intraperitoneal infections [corrected]. PMID:1510432

  20. Hypomagnesemia Is Associated with Increased Mortality among Peritoneal Dialysis Patients

    PubMed Central

    Dai, Zhiwei; Zhu, Beixia; Fei, Jinping; Xue, Congping; Wu, Dan

    2016-01-01

    Objective Hypomagnesemia has been associated with an increase in mortality among the general population as well as patients with chronic kidney disease or those on hemodialysis. However, this association has not been thoroughly studied in patients undergoing peritoneal dialysis. The aim of this study was to evaluate the association between serum magnesium concentrations and all-cause and cardiovascular mortalities in peritoneal dialysis patients. Methods This single-center retrospective study included 253 incident peritoneal dialysis patients enrolled between July 1, 2005 and December 31, 2014 and followed to June 30, 2015. Patient’s demographic characteristics as well as clinical and laboratory measurements were collected. Results Of 253 patients evaluated, 36 patients (14.2%) suffered from hypomagnesemia. During a median follow-up of 29 months (range: 4–120 months), 60 patients (23.7%) died, and 35 (58.3%) of these deaths were attributed to cardiovascular causes. Low serum magnesium was positively associated with peritoneal dialysis duration (r = 0.303, p < 0.001) as well as serum concentrations of albumin (r = 0.220, p < 0.001), triglycerides (r = 0.160, p = 0.011), potassium (r = 0.156, p = 0.013), calcium(r = 0.299, p < 0.001)and phosphate (r = 0.191, p = 0.002). Patients in the hypomagnesemia group had a lower survival rate than those in the normal magnesium groups (p < 0.001). In a multivariate Cox proportional hazards regression analysis, serum magnesium was an independent negative predictor of all-cause mortality (hazard ratio [HR] = 0.075, p = 0.011) and cardiovascular mortality (HR = 0.003, p < 0.001), especially in female patients. However, in univariate and multivariate Cox analysis, △Mg(difference between 1-year magnesium and baseline magnesium) was not an independent predictor of all-cause mortality and cardiovascular mortality. Conclusion Hypomagnesemia was common among peritoneal dialysis patients and was independently associated with all

  1. An unusual cause of peritonitis in peritoneal dialysis patients: Pantoea agglomerans.

    PubMed

    Kazancioglu, Rumeyza; Buyukaydin, Banu; Iraz, Meryem; Alay, Murat; Erkoc, Reha

    2014-07-01

    Peritonitis is a serious infection and early diagnosis and treatment is mandatory. A variety of microorganisms are identified in these cases and during recent years a new one was included, Pantoea agglomerans. In this case report, a female patient on continuous ambulatory peritoneal dialysis therapy with a peritonitis episode caused by this organism is described. The source of infection was thought to be due to contact of catheter with non-sterile surfaces. In microbiologic culture, this organism was identified and the patient successfully treated with a three week course of gentamicin therapy. The number of reported cases with this organism has increased in last years and various infection localizations and clinical progress patterns have been identified. In peritoneal dialysis patients presenting with peritonitis, this organism must be kept in mind. PMID:25022305

  2. Gastrointestinal bleeding in patients on long-term dialysis

    PubMed Central

    Yang, Juliana; Szabo, Aniko

    2016-01-01

    Background The epidemiology of gastrointestinal bleeding (GIB) in end-stage renal disease (ESRD) has not been adequately characterized. Using United States Renal Data System data we investigated the epidemiology of GIB in hospitalized patients receiving long-term dialysis. Methods Medicare ESRD patients who began dialysis between 1996 and 2005 were followed from 90 days after starting dialysis to death, transplant, loss of Medicare, or December 31, 2006. GIB events were identified using claims data. Predictors of GIB incidence were analyzed using over-dispersed Poisson regression and Cox regression was used to evaluate the effect on survival. Repeat episodes were modeled using a partially conditional Cox regression model. Results 406,836 patients were followed for 832,131 person-years, during which 133,967 events were identified. The incidence of GIB was stable through year 2000 but steadily increased thereafter. Chronic gastric ulcer and colonic diverticulosis were the commonest defined causes of upper and lower GIB respectively. Age >49 years, female gender, hypertension as the cause of ESRD, and initiation on hemodialysis was associated with a greater risk of GIB. An episode of GIB conferred a increased hazard of death (hazard ratio 1.9, 95 % CI 1.86–1.93). A previous episode of GIB was associated with greater hazard of another episode (hazard ratio 3.93, 95 % CI 3.82–4.05). Conclusions In ESRD patients incident to long-term dialysis the incidence of hospital-associated GIB is increasing, is associated with a greater hazard of death, and carries a great hazard of repeat episodes. PMID:25185727

  3. A large pleural effusion in a patient receiving peritoneal dialysis.

    PubMed

    Tapawan, Karen; Chen, Elaine; Selk, Natalie; Hong, Edward; Virmani, Sumeet; Balk, Robert

    2011-01-01

    Hydrothorax as a complication of peritoneal dialysis (PD) is a rare but recognized event. Proposed mechanisms for the development of a pleuro-peritoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. Nearly 50% of patients with this diagnosis have resolution of hydrothorax after temporary cessation of PD with interim hemodialysis for 2-6 weeks. Historically, other treatment options have included conventional pleurodesis and open thoracotomy with direct repair, producing variable results. With the advent of video-assisted thoracoscopy (VATS), surgical repairs and pleurodesis are now frequently performed under direct visualization with minimal invasiveness. We report a case of hydrothorax in a patient after recent introduction to peritoneal dialysis. Pleuro-peritoneal communication was documented with thoracentesis and radionuclide scanning. VATS pleurodesis with talc was performed. Repeat scintigraphy performed 1 week after the procedure revealed no residual communication, and patient was able to resume PD without further complications. PMID:21480997

  4. Relationship of aluminum to neurocognitive dysfunction in chronic dialysis patients

    SciTech Connect

    Sprague, S.M.; Corwin, H.L.; Tanner, C.M.; Wilson, R.S.; Green, B.J.; Goetz, C.G.

    1988-10-01

    Aluminum has been proposed as the causative agent in dialysis encephalopathy syndrome. We prospectively assessed whether other, less severe, neuropsychologic abnormalities were also associated with aluminum. A total of 16 patients receiving chronic dialytic therapy were studied. The deferoxamine infusion test (DIT) was used to assess total body aluminum burden. Neurologic function was evaluated by quantitative measures of asterixis, myoclonus, motor strength, and sensation. Cognitive function was assessed by measures of dementia, memory, language, and depression. There were four patients with a positive DIT (greater than 125 micrograms/L increment in serum aluminum) that was associated with an increase in the number of neurologic abnormalities observed, as well as an increase in severity of myoclonus, asterixis, and lower extremity weakness. Patients with a positive DIT also showed significant impairment in memory; however, no differences were noted on tests of dementia, depression, or language. There was no significant correlation between sex, age, presence of diabetes, mode of dialysis, years of chronic renal failure, years of dialysis or years of aluminum ingestion and any neurologic or neurobehavioral measurement, serum aluminum level, or DIT. These changes may represent early aluminum-associated neurologic dysfunction.

  5. Lanthanum carbonate versus placebo for management of hyperphosphatemia in patients undergoing peritoneal dialysis: a subgroup analysis of a phase 2 randomized controlled study of dialysis patients

    PubMed Central

    2013-01-01

    Background This short-term study assessed the efficacy and safety of lanthanum carbonate in the treatment of hyperphosphatemia in dialysis patients; here, we report a prespecified subgroup analysis of patients undergoing peritoneal dialysis. Methods Men and women (n = 39) who had received continuous ambulatory peritoneal dialysis for chronic kidney disease for 6 months or more were enrolled in eight renal medicine departments in the United Kingdom. A 2-week washout period was followed by a 4-week dose-titration phase during which patients received lanthanum carbonate titrated up to 2250 mg/day. This was followed by a 4-week, randomized, placebo-controlled, parallel-group phase during which patients continued to receive either lanthanum carbonate at the titrated dose, or a matched dose of placebo. The main outcome measure was control of serum phosphate levels (1.3-1.8 mmol/l) at the end of the parallel-group phase. Results Serum phosphate was controlled in 3/39 (8%) patients at the beginning of the dose-titration phase (after washout) and in 18/31 (58%) patients treated with lanthanum carbonate at its end. After the parallel-group phase, 60% of lanthanum carbonate-treated patients and 10% of those receiving placebo had controlled serum phosphate. There was no difference in mean (95% confidence interval) serum phosphate levels between groups at randomization: lanthanum carbonate, 1.57 (1.34-1.81) mmol/l; placebo, 1.58 (1.40-1.76) mmol/l (p = 0.96). However, a difference was seen at the end of the parallel-group phase: lanthanum carbonate, 1.56 (1.33-1.79) mmol/l; placebo, 2.25 (1.81-2.68) mmol/l (p = 0.0015). There were no clinically important changes in nutritional parameters and no serious treatment-related adverse events were recorded. Conclusions At doses up to 2250 mg/day, lanthanum carbonate is well tolerated and controls hyperphosphatemia effectively. Treatment with higher doses of lanthanum carbonate may allow patients undergoing peritoneal dialysis the

  6. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes

    PubMed Central

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-01-01

    Abstract Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47–0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46–0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37–0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46–2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes

  7. Dislipemia in patients undergoing continuous ambulatory peritoneal dialysis: pharmacological therapy (simvastatin) versus hemodialysis.

    PubMed

    Marangoni, R; Civardi, F; Masi, F; Cimino, R; Maltagliati, L; Romei Longhena, G

    1993-01-01

    Peritoneal dialysis can worsen dislipemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPD) and who had developed an IV-type dislipemia. Twelve have continued CAPD treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPD and have begun HD, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: in patients treated with CAPD and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p < 0.001), and highly significant increases were noted in HDL-cholesterol (HDL-cho) (p < 0.005) and apolipoprotein-A1 (Apo-A1) (p < 0.01). In patients treated with HD, only slightly significant decreases were noted in T-cho (p < 0.01) and TG (p < 0.02), a slightly significant increase in Apo-A1 (p < 0.05), and no significant change in HDL-cho. Apolipoprotein-B showed no change in the two groups. Therefore, patients undergoing CAPD, with dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPD must abandon treatment and must be transferred to extracorporeal methods. PMID:8399632

  8. The Different Association between Serum Ferritin and Mortality in Hemodialysis and Peritoneal Dialysis Patients Using Japanese Nationwide Dialysis Registry

    PubMed Central

    Maruyama, Yukio; Yokoyama, Keitaro; Yokoo, Takashi; Shigematsu, Takashi; Iseki, Kunitoshi; Tsubakihara, Yoshiharu

    2015-01-01

    Background/Aims Monitoring of serum ferritin levels is widely recommended in the management of anemia among patients on dialysis. However, associations between serum ferritin and mortality are unclear and there have been no investigations among patients undergoing peritoneal dialysis (PD). Methods Baseline data of 191,902 patients on dialysis (age, 65 ± 13 years; male, 61.1%; median dialysis duration, 62 months) were extracted from a nationwide dialysis registry in Japan at the end of 2007. Outcomes, such as one-year mortality, were then evaluated using the registry at the end of 2008. Results Within one year, a total of 15,284 (8.0%) patients had died, including 6,210 (3.2%) cardiovascular and 2,707 (1.4%) infection-related causes. Higher baseline serum ferritin levels were associated with higher mortality rates among patients undergoing hemodialysis (HD). In contrast, there were no clear associations between serum ferritin levels and mortality among PD patients. Multivariate Cox regression analysis of HD patients showed that those in the highest serum ferritin decile group had higher rates of all-cause and cardiovascular mortality than those in the lowest decile group (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.31–1.81 and HR, 1.44; 95% CI, 1.13–1.84, respectively), whereas associations with infection-related mortality became non-significant (HR, 1.14; 95% CI, 0.79–1.65). Conclusions Using Japanese nationwide dialysis registry, higher serum ferritin values were associated with mortality not in PD patients but in HD patients. PMID:26599216

  9. Prevalence of Depressive Symptoms among Hemodialysis and Peritoneal Dialysis Patients

    PubMed Central

    AlDukhayel, AbdulRhman

    2015-01-01

    Introduction End stage renal disease (ESRD) affects patient’s physical and psychological health. Depression is the most common psychiatric illness among patients with ESRD. This study aimed to identify the prevalence of depressive symptoms among patients undergoing peritoneal (PD) and hemodialysis (HD), also to correlate these symptoms with the demographic data. Methods this is a cross-sectional study that includes 133 PD patients and 133 HD patients attending the King Fahad Dialysis Center at King Saud Medical Complex (KSMC), Riyadh, Saudi Arabia. Socio-demographic data were documented. Depression was evaluated by using the zung self- rating depression scale (Zung SDS). Results using the Zung SDS; the prevalence of depression was significantly higher among PD patients (98.5%) in compare with HD patients (83.5%). Conclusion the study reveals that there is a high prevalence of depressive symptoms among PD and HD patients. This will lead us to think of adding a system for screening, diagnosis and treatment of depression for all dialysis patients to improve their life. PMID:25901128

  10. Sleep disorders in patients with end-stage renal disease undergoing dialysis: comparison between hemodialysis, continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

    PubMed

    Losso, Ricardo L M; Minhoto, Gisele R; Riella, Miguel C

    2015-02-01

    Sleep disorders for patients on dialysis are significant causes of a poorer quality of life and increased morbidity and mortality. No study has evaluated patients undergoing automated peritoneal dialysis (APD) to assess their sleep disorders compared to hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). A total of 166 clinically stable patients who had been on dialysis for at least 3 months were randomly selected for the study and divided into HD, CAPD or APD. Socio-demographic, clinical and laboratory parameters and self-administered questionnaires were collected for the investigation of insomnia, restless legs syndrome (RLS), bruxism, rapid eye movement sleep behavior disorder, excessive daytime sleepiness (EDS), obstructive sleep apnea syndrome (OSAS), sleepwalking, sleep hygiene, depression and anxiety. Insomnia was detected in more than 80 % of patients on the three modalities. OSAS was lower for patients on HD (36 %) than on CAPD (65 %) (p < 0.01) or APD (60 %) (p < 0.04). Patients on APD were more likely to have RLS compared to those on HD or CAPD (p < 0.04) (50 vs. 23 vs. 33 %). No differences among the modalities were found in bruxism, EDS, sleepwalking, sleep hygiene, depression or anxiety. ESRD patients undergoing any one of the three dialysis modalities studied had a high prevalence of sleep disorders. Patients on HD had a lower proportion of OSAS than those on CAPD and APD, which is most likely attributed to their lower body mass indices. The possible causes of higher RLS rates in APD patients have not been established. PMID:25358390

  11. Effects of dialysis solution on the cardiovascular function in peritoneal dialysis patients.

    PubMed

    Kocyigit, Ismail; Unal, Aydin; Gungor, Ozkan; Orscelik, Ozcan; Eroglu, Eray; Dogan, Ender; Sen, Ahmet; Yasan, Mustafa; Hayri Sipahioglu, Murat; Tokgoz, Bulent; Dogan, Ali; Oymak, Oktay

    2015-01-01

    Objective Peritoneal dialysis (PD) patients have an increased cardiovascular burden. In this study, we aimed to compare certain PD solutions (Physioneal(®) and Dianeal(®)) in terms of the ambulatory blood pressure, echocardiographic parameters (ECHO), carotid atherosclerosis, endothelial function and serum asymmetric dimethylarginine (ADMA) level. Methods A total of 45 PD patients were enrolled in this prospective randomized controlled study: 23 patients in the Dianeal(®) group and 22 patients in the Physioneal(®) group. Ambulatory blood pressure measurements, echocardiography, carotid artery intima-media thickness measurements and flow mediated dilatation (FMD) and ADMA values were obtained at baseline and 12 months. Results The baseline parameters were similar between the groups with respect to the echocardiographic parameters, 24-hour ambulatory blood monitoring measurements and ADMA and FMD levels. All 24-hour blood pressure monitoring measurements, except for the average daytime systolic blood pressure, were significantly decreased in both groups at the first year. In the Physioneal(®) group, a significant decrease was observed with regard to the ADMA levels. Considering the FMD values, significant augmentation was seen at the end of the first year in both groups. Improvements in the FMD measurements were prominent in the Physioneal(®) group; however, this finding was not statistically significant. Conclusion The use of solutions with a neutral pH in PD patients results in decreased ADMA levels, which may be an important contributor to reductions in the incidence of cardiovascular events and deaths in this population. PMID:25742886

  12. Skin disorders in peritoneal dialysis patients: An underdiagnosed subject

    PubMed Central

    Gursu, Meltem; Uzun, Sami; Topcuoğlu, Derya; Koc, Leyli Kadriye; Yucel, Lamiye; Sumnu, Abdullah; Cebeci, Egemen; Ozkan, Oktay; Behlul, Ahmet; Koc, Leyla; Ozturk, Savas; Kazancioglu, Rumeyza

    2016-01-01

    AIM: To examine all skin changes in peritoneal dialysis (PD) patients followed up in our unit. METHODS: Patients on PD program for at least three months without any known chronic skin disease were included in the study. Patients with already diagnosed skin disease, those who have systemic diseases that may cause skin lesions, patients with malignancies and those who did not give informed consent were excluded from the study. All patients were examined by the same predetermined dermatologist with all findings recorded. The demographic, clinical and laboratory data including measures of dialysis adequacy of patients were recorded also. Statistical Package for Social Sciences (SPSS) for Windows 16.0 standard version was used for statistical analysis. RESULTS: Among the patients followed up in our PD unit, those without exclusion criteria who gave informed consent, 38 patients were included in the study with male/female ratio and mean age of 26/12 and 50.3 ± 13.7 years, respectively. The duration of CKD was 7.86 ± 4.16 years and the mean PD duration was 47.1 ± 29.6 mo. Primary kidney disease was diabetic nephropathy in 11, nephrosclerosis in six, uropathologies in four, chronic glomerulonephritis in three, chronic pyelonephritis in three, autosomal dominant polycystic kidney disease in three patients while cause was unknown in eight patients. All patients except for one patient had at least one skin lesion. Loss of lunula, onychomycosis and tinea pedis are the most frequent skin disorders recorded in the study group. Diabetic patients had tinea pedis more frequently (P = 0.045). No relationship of skin findings was detected with primary renal diseases, comorbidities and medications that the patients were using. CONCLUSION: Skin abnormalities are common in in PD patients. The most frequent skin pathologies are onychomycosis and tinea pedis which must not be overlooked. PMID:27458566

  13. A Palliative Approach to Dialysis Care: A Patient-Centered Transition to the End of Life

    PubMed Central

    Moss, Alvin H.; Cohen, Lewis M.; Fischer, Michael J.; Germain, Michael J.; Jassal, S. Vanita; Perl, Jeffrey; Weiner, Daniel E.; Mehrotra, Rajnish

    2014-01-01

    As the importance of providing patient-centered palliative care for patients with advanced illnesses gains attention, standard dialysis delivery may be inconsistent with the goals of care for many patients with ESRD. Many dialysis patients with life expectancy of <1 year may desire a palliative approach to dialysis care, which focuses on aligning patient treatment with patients’ informed preferences. This commentary elucidates what comprises a palliative approach to dialysis care and describes its potential and appropriate use. It also reviews the barriers to integrating such an approach into the current clinical paradigm of care and existing infrastructure and outlines system-level changes needed to accommodate such an approach. PMID:25104274

  14. [Assisted peritoneal dialysis: home-based renal replacement therapy for the elderly patient].

    PubMed

    Wiesholzer, Martin

    2013-06-01

    The number of elderly patients with end stage renal disease is constantly increasing. Conventional hämodiaylsis as the mainstay of renal replacement therapy is often poorly tolerated by frail eldery patients with multiple comorbidities. Although many of these patients would prefer a home based dialysis treatment, the number of elderly patients using peritoneal dialysis (PD) is still low. Impaired physical and cognitive function often generates insurmountable barriers for self care peritoneal dialysis. Assisted peritoneal dialysis can overcome many of these barriers and give elderly patients the ability of a renal replacement therapy in their own homes respecting their needs. PMID:23797681

  15. Survival of elderly dialysis patients is not dependent on modality or “older” age

    PubMed Central

    Jeloka, T.; Sanwaria, P.; Periera, A.; Pawar, S.

    2016-01-01

    While discussing renal replacement therapy, the choice of modality and survival on dialysis are important considerations. These issues are even more important in elderly group of patients. We studied the survival and factors affecting survival of our elderly dialysis patients. All incident patients who started dialysis from November 2006 to March 2014 were considered for inclusion. Patients who initiated dialysis at or >65 years of age and had completed 90 days of dialysis were included. Overall survival of elderly dialysis patients was determined. Patients were divided into two groups based on the modality of dialysis and age: elderly (65–70 years) and older (>70 years). The baseline data and survival were then compared between groups. Mean age of the study population was 71.8 ± 6 years with 73.8% males, and 71.4% had diabetes. Median overall survival of the patients was 26.6 months. Median survival of elderly dialysis patients was 26.5 months and of older dialysis patients was 30.1 months (P = 0.9). Median survival of hemodialysis and PD patients was also similar (30.1 and 25.2 months respectively. Multivariate analysis showed diabetes as the only determining factor affecting survival (P = 0.01). To conclude, there is no difference between survival of elderly and “older” or between elderly hemodialysis and PD patients. PMID:26937074

  16. Hurricane Katrina and chronic dialysis patients: better tidings than originally feared?

    PubMed

    Vanholder, Raymond C; Van Biesen, Wim A; Sever, Mehmet S

    2009-10-01

    Besides victims with acute kidney injury, disasters may also affect the destiny of chronic dialysis patients. This Commentary discusses the article by Kutner et al. describing the outcome of chronic dialysis patients who were victims of Hurricane Katrina. The importance of advance disaster plans, including instructions to chronic dialysis patients, is emphasized. In addition, it is expected that specific recommendations, which are currently being prepared, will offer ad hoc advice to rescuers. PMID:19752861

  17. Moderator's view: Higher serum bicarbonate in dialysis patients is protective.

    PubMed

    Kalantar-Zadeh, Kamyar

    2016-08-01

    Several observational studies have reported an association between higher serum bicarbonate level and high mortality risk in dialysis patients. However, in such studies mere discovery of associations does not allow one to infer causal relationships. This association may be related to inadequate dietary protein intake that may lead to less acid generation and hence a higher serum bicarbonate level. Since undernutrition is a strong predictor of death in hemodialysis patients, the observed association may be an epiphenomenon and not a biologically plausible relationship. Higher protein and fluid intake between two subsequent hemodialysis treatments may lead to lower serum bicarbonate level. This low bicarbonate level may appear protective, as patients with higher food intake and better appetite generally exhibit greater survival. In the contemporary three-stream proportioning system of hemodialysis treatment, the bicarbonate concentrate is separate from the acid concentrate, and the contribution of the acid concentrate organic acid (acetate, citrate or diacetate) to the delivered bicarbonate pool of the patient is negligible. The concept of 'total buffer' that assumes that the combination of bicarbonate and acetate concentrations in the dialysate are added equally as bicarbonate equivalents is likely wrong and based on the misleading notion that the acetate of the acid concentrate is fully metabolized to bicarbonate in the dialysate. Given these uncertainties it is prudent to avoid excessively high or low bicarbonate levels in dialysis patients. PMID:27411725

  18. Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia.

    PubMed

    Sanabria, M; Muñoz, J; Trillos, C; Hernández, G; Latorre, C; Díaz, C S; Murad, S; Rodríguez, K; Rivera, A; Amador, A; Ardila, F; Caicedo, A; Camargo, D; Díaz, A; González, J; Leguizamón, H; Lopera, P; Marín, L; Nieto, I; Vargas, E

    2008-04-01

    The goal of the Dialysis Outcomes in Colombia (DOC) study was to compare the survival of patients on hemodialysis (HD) vs peritoneal dialysis (PD) in a network of renal units in Colombia. The DOC study examined a historical cohort of incident patients starting dialysis therapy between 1 January 2001 and 1 December 2003 and followed until 1 December 2005, measuring demographic, socioeconomic, and clinical variables. Only patients older than 18 years were included. As-treated and intention-to-treat statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazard model. There were 1094 eligible patients in total and 923 were actually enrolled: 47.3% started HD therapy and 52.7% started PD therapy. Of the patients studied, 751 (81.3%) remained in their initial therapy until the end of the follow-up period, death, or censorship. Age, sex, weight, height, body mass index, creatinine, calcium, and Subjective Global Assessment (SGA) variables did not show statistically significant differences between the two treatment groups. Diabetes, socioeconomic level, educational level, phosphorus, Charlson Co-morbidity Index, and cardiovascular history did show a difference, and were less favorable for patients on PD. Residual renal function was greater for PD patients. Also, there were differences in the median survival time between groups: 27.2 months for PD vs 23.1 months for HD (P=0.001) by the intention-to-treat approach; and 24.5 months for PD vs 16.7 months for HD (P<0.001) by the as-treated approach. When performing univariate Cox analyses using the intention-to-treat approach, associations were with age > or =65 years (hazard ratio (HR)=2.21; confidence interval (CI) 95% (1.77-2.755); P<0.001); history of cardiovascular disease (HR=1.96; CI 95% (1.58-2.90); P<0.001); diabetes (HR=2.34; CI 95% (1.88-2.90); P<0.001); and SGA (mild or moderate-severe malnutrition) (HR=1.47; CI 95% (1.17-1.79); P=0.001); but no association was found with gender (HR=1

  19. RISK OF DEMENTIA IN PERITONEAL DIALYSIS PATIENTS COMPARED WITH HEMODIALYSIS PATIENTS

    PubMed Central

    Wolfgram, Dawn F.; Szabo, Aniko; Murray, Anne M.; Whittle, Jeff

    2016-01-01

    Background Compared with similarly aged controls, patients with end-stage renal disease (ESRD) have a higher prevalence of cognitive impairment and more rapid cognitive decline, which is not explained by traditional risk factors alone. Since previous small studies suggest an association of cognitive impairment with dialysis modality, we compared incident dementia among patients initiating hemodialysis (HD) versus peritoneal dialysis (PD) in a large national cohort. Methods This is a retrospective cohort study of incident dialysis patients in the United States from 2006 to 2008 with no diagnosis of dementia prior to beginning dialysis. We evaluated the effect of initial dialysis modality on incidence of dementia, diagnosed by Medicare claims data, adjusted for baseline demographic and clinical data from USRDS registry. Results Our analysis included 121,623 patients, of whom 8,663 initiated dialysis on PD. The mean age of our cohort was 69.2 years. Patients who initiated on PD had a lower cumulative incidence of dementia than those who initiated HD (1.0% versus 2.7%, 2.5% versus 5.3%, and 3.9% versus 7.3% at 1, 2, and 3 years, respectively). The risk of dementia for patients who started on PD was lower compared with those who started on HD, with a hazard ratio (HR) = 0.46 [0.41, 0.53], in an unadjusted model and HR 0.74 [0.64, 0.86] in a matched model. Conclusions Dialysis modality is associated with incident dementia in a cohort of older ESRD patients. This finding warrants further investigation of the effect of dialysis modality on cognitive function and evaluation for possible mechanisms. PMID:25742686

  20. Quality of Life and Physical Function in Older Patients on Dialysis: A Comparison of Assisted Peritoneal Dialysis with Hemodialysis

    PubMed Central

    Iyasere, Osasuyi U.; Brown, Edwina A.; Johansson, Lina; Huson, Les; Smee, Joanna; Maxwell, Alexander P.; Farrington, Ken; Davenport, Andrew

    2016-01-01

    Background and objectives In-center hemodialysis (HD) is often the default dialysis modality for older patients. Few centers use assisted peritoneal dialysis (PD), which enables treatment at home. This observational study compared quality of life (QoL) and physical function between older patients on assisted PD and HD. Design, setting, participants, & measurements Patients on assisted PD who were >60 years old and on dialysis for >3 months were recruited and matched to patients on HD (needing hospital transport) by age, sex, diabetes, dialysis vintage, ethnicity, and index of deprivation. Frailty was assessed using the Clinical Frailty Scale. QoL assessments included Hospital Anxiety and Depression Scale (HADS), Short Form-12, Palliative Outcomes Symptom Scale (renal), Illness Intrusiveness Rating Scale, and Renal Treatment Satisfaction Questionnaire (RTSQ). Physical function was evaluated by Barthel Score and timed up and go test. Results In total, 251 patients (129 PD and 122 HD) were recruited. In unadjusted analysis, patients on assisted PD had a higher prevalence of possible depression (HADS>8; PD=38.8%; HD=23.8%; P=0.05) and higher HADS depression score (median: PD=6; HD=5; P=0.05) but higher RTSQ scores (median: PD=55; HD=51; P<0.01). In a generalized linear regression model adjusting for age, sex, comorbidity, dialysis vintage, and frailty, assisted PD continued to be associated with higher RTSQ scores (P=0.04) but not with other QoL measures. Conclusions There are no differences in measures of QoL and physical function between older patients on assisted PD and comparable patients on HD, except for treatment satisfaction, which is higher in patients on PD. Assisted PD should be considered as an alternative to HD for older patients, allowing them to make their preferred choices. PMID:26712808

  1. Continuous Ambulatory Peritoneal Dialysis in Limpopo Province, South Africa: Predictors of Patient and Technique Survival

    PubMed Central

    Isla, Ramon A. Tamayo; Mapiye, Darlington; Swanepoel, Charles R.; Rozumyk, Nadiya; Hubahib, Jerome E.; Okpechi, Ikechi G.

    2014-01-01

    ♦ Introduction and aim: Continuous ambulatory peritoneal dialysis (CAPD) is not a frequently used modality of dialysis in many parts of Africa due to several socio-economic factors. Available studies from Africa have shown a strong association between outcome and socio-demographic variables. We sought to assess the outcome of patients treated with CAPD in Limpopo, South Africa. ♦ Methods: This was a retrospective study of 152 patients treated with CAPD at the Polokwane Kidney and Dialysis Centre (PKDC) from 2007 to 2012. We collected relevant demographic and biochemical data for all patients included in the study. A composite outcome of death while still on peritoneal dialysis (PD) or CAPD technique failure from any cause requiring a change of modality to hemodialysis (HD) was selected. The peritonitis rate and causes of peritonitis were assessed from 2008 when all related data could be obtained. ♦ Results: There were 52% males in the study and the average age of the patients was 36.8 ± 11.4 years. Unemployment rate was high (71.1%), 41.1% had tap water at home, the average distance travelled to the dialysis center was 122.9 ± 78.2 kilometres and half the patients had a total income less than USD ($)180 per month. Level of education, having electricity at home, having tap water at home, body mass index (BMI), serum albumin and hemoglobin were significantly different between those reaching the composite outcome and those not reaching it (p < 0.05). The overall peritonitis rate was 0.82/year with 1-year, 2-year and 5-year survival found to be 86.7%, 78.7% and 65.3% (patient survival) and 83.3%, 71.7% and 62.1% (technique survival). Predictors of the composite outcome were BMI (p = 0.011), serum albumin (p = 0.030), hemoglobin (p = 0.002) and more than 1 episode of peritonitis (p = 0.038). ♦ Conclusion: Treatment of anemia and malnutrition as well as training and re-training of CAPD patients and staff to prevent recurrence of peritonitis can have positive

  2. Isotopic bone mineralization rates in maintenance dialysis patients

    SciTech Connect

    Cochran, M.; Stephens, E.

    1983-09-01

    The expanding pool model of radiocalcium kinetics has been used in 13 maintenance dialysis patients to measure bone mineralization rate. No difficulties were met in applying the data to the model, and values for the bone mineralization rate ranged from 0.0 to 2.0 mmol/kg Ca++ per day. The bone histology obtained at the time of the study showed a correlation between the degree of secondary hyperparathyroidism and the bone mineralization rate, with low values of the latter occurring in atypical osteomalacia (two patients) or inactive-looking bone (one patient) and raised values in seven patients. The plasma alkaline phosphatase and immunoassayable parathyroid hormone levels each correlated significantly with the bone mineralization rate. These findings suggest that the technique is valid when applied to hemodialysis patients and provides quantitative information about skeletal calcium metabolism in different types of renal bone disease.

  3. Reconsidering the Lack of Urea Toxicity in Dialysis Patients.

    PubMed

    Massy, Ziad A; Pietrement, Christine; Touré, Fatouma

    2016-09-01

    Urea is an old uremic toxin which has been used for many years as a global biomarker of CKD severity and dialysis adequacy. Old studies were not in favor of its role as a causal factor in the pathogenesis of complications associated with the uremic state. However, recent experimental and clinical evidence is compatible with both direct and indirect toxicity of urea, particularly via the deleterious actions of urea-derived carbamylated molecules. Further studies are clearly needed to explore the potential relevance of urea-related CKD complications for patient management, in particular the place of new therapeutic strategies to prevent urea toxicity. PMID:27174444

  4. Assessing the utility of testing aluminum levels in dialysis patients.

    PubMed

    Sharma, Ashish K; Toussaint, Nigel D; Pickering, Janice; Beeston, Tony; Smith, Edward R; Holt, Stephen G

    2015-04-01

    Plasma aluminum (Al) is routinely tested in many dialysis patients. Aluminum exposure may lead to acute toxicity and levels in excess of ∼2.2 μmol/L (60 μg/L) should be avoided. Historically, toxicity has been caused by excessive dialyzate Al but modern reverse osmosis (RO) water should be Al free. Nevertheless, many units continue to perform routine Al levels on dialysis patients. This single-center study retrospectively analyzed Al levels in plasma, raw water feed, and RO product between 2010 and 2013 using our database (Nephworks 6) with the aim of determining the utility of these measurements. Two thousand fifty-eight plasma Al tests in 755 patients (61.9% male, mean age 64.7 years) were reviewed showing mean ± SD of 0.41 ± 0.30 μmol/L. One hundred eleven (5.4%) tests from 61 patients had Al levels >0.74 μmol/L and 45 (73.8%) of these patients were or had been prescribed Al hydroxide (Al(OH)(3)) as a phosphate binder. Seven patients had Al concentrations >2.2 μmol/L with no source of Al identified in 1 patient. One hundred sixty-six patients taking Al(OH)(3) (78.7% of all patients on Al(OH)(3)) had levels ≤0.74 μmol/L, the odds ratio of plasma Al > 0.74 μmol/L on Al(OH)3 was 9. The cost of plasma Al assay is $A30.60; thus, costs were $A62,974.80 over the study period. Despite RO feed water Al levels as high as 48 μmol/L, Al output from the RO was almost always undetectable (<0.1 μmol/L) with dialyzate Al levels > 2.2 μmol/L only 3 times since 2010, and never in the last 3 years. Routine unselected testing of plasma Al appears unnecessary and expensive and more selective testing in dialysis patients should be considered. PMID:25306885

  5. Dental management in renal failure: patients on dialysis.

    PubMed

    Jover Cerveró, Alba; Bagán, José V; Jiménez Soriano, Yolanda; Poveda Roda, Rafael

    2008-07-01

    Chronic renal failure is an important health care problem throughout the world, with an incidence of 337, 90, 107 and 95 new cases per million inhabitants/year in the United States, Australia, New Zealand and the United Kingdom, respectively. These figures moreover invariably tend to increase. During the progression of renal damage, clinical manifestations are noted in practically all body organs and systems, and 90% of all affected patients experience oral symptoms. The existing management options range from simple measures based on changes in diet and life style, to different forms of dialysis (hemodialysis and peritoneal dialysis), and also kidney transplantation. Given the multiple oral manifestations of chronic renal failure, and the different repercussions of its treatment upon the oral cavity, these patients require special considerations and precautions in the face of dental treatment. Consultation with the nephrologist is essential before any dental treatment is carried out, in order to determine the condition of the patient, define the best moment for dental treatment, introduce the necessary pharmacological adjustments, or to establish other important aspects for preventing complications in the dental clinic. The present study reviews the characteristics of the disease, the existing therapeutic options, and the considerations of relevance for the dental professional. PMID:18587305

  6. Geographic Variation in Cardioprotective Antihypertensive Medication Usage in Dialysis Patients

    PubMed Central

    Wetmore, James B.; Mahnken, Jonathan D.; Mukhopadhyay, Purna; Hou, Qingjiang; Ellerbeck, Edward F.; Rigler, Sally K.; Spertus, John A.; Shireman, Theresa I.

    2011-01-01

    Background Despite their high risk for adverse cardiac outcomes, persons on chronic dialysis have been shown to have lower use of antihypertensive medications with cardioprotective properties, such as angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), β-blockers, and calcium channel blockers (CCBs), than might be expected. We constructed a novel database that permits detailed exploration into the demographic, clinical and geographic factors associated with the use these agents of among hypertensive chronic dialysis patients. Study Design National cross-sectional retrospective analysis linking Medicaid prescription drug claims with United States Renal Data System core data. Setting & Participants 48,882 hypertensive chronic dialysis patients who were dually-eligible for Medicaid and Medicare services in 2005. Factors Demographics, comorbidities, functional status, and state of residence. Outcomes Prevalence of cardioprotective antihypertensive agents in Medicaid pharmacy claims and state-specific observed:expected odds ratios of medication exposure. Measurements Factors associated with medication use were modeled using multi-level logistic regression models. Results In multivariable analyses, cardioprotective antihypertensive medication exposure was significantly associated with younger age, female sex, non-Caucasian race, intact functional status, and use of in-center hemodialysis. Diabetes was associated with a statistically-significant 28% higher odds of ACE inhibitor/ARB use, but congestive heart failure (CHF) was associated with only a 9% increase in the odds of β-blockers and no increase in ACE inhibitor/ARB use. There was substantial state-by-state variation in use of all classes of agents, with a greater than 2.9-fold difference in adjusted rate odds ratios between the highest- and lowest-prescribing states for ACE inhibitors/ARBs and a 3.6-fold difference for β-blockers. Limitations Limited generalizability beyond study

  7. Exploring the opinion of hemodialysis patients about their dialysis unit.

    PubMed

    Donia, Ahmed Farouk; Elhadedy, Mohamed Ahmed; El-Maghrabi, Hanzada Mohamed; Abbas, Mohamed Hamed; Foda, Mohamed Ashraf

    2015-01-01

    Hemodialysis (HD) patients are subjected to a number of physical and mental stresses. Physicians might be unaware of some of these problems. We assessed our patients' opinion about the service provided at the dialysis unit. Our unit has 89 patients on HD. A questionnaire exploring our patients' opinion relative to the service provided was prepared. The patients were asked to fill-in the questionnaire in a confidential manner. Questionnaires were then collected and examined while unaware of patient identities. Sixty-nine patients (77.5%) responded to the questionnaire. Eight patients (11.6%) revealed their names on the questionnaire. According to the questionnaire, the patients were asked to assess the service of each service by choosing one of the following grades: "excellent," "mediocre" or "bad." For the whole group of contributing patients, there were 563 "excellent," 85 "mediocre" and five "bad" choices in addition to 37 blank "no comment" choices. Food service had the least percentage (68%) of evaluation as "excellent," while doctor' performance got the highest excellent evaluation (85.5%). Thirty-five patients (50.7%) added further comment(s). An audit meeting was conducted to discuss these results. Exploring the opinion of patients on HD might uncover some areas of dissatisfaction and help in improving the provided service. We recommend widespread usage of questionnaires to assess patient satisfaction as well as to assess other health-care aspects. PMID:25579719

  8. Impact of High-Cut-Off Dialysis on Renal Recovery in Dialysis-Dependent Multiple Myeloma Patients: Results from a Case-Control Study

    PubMed Central

    Görlich, Dennis; Thölking, Gerold; Kropff, Martin; Berdel, Wolfgang E.; Pavenstädt, Hermann; Brand, Marcus; Kümpers, Philipp

    2016-01-01

    Background High-cut-off hemodialysis (HCO-HD) can effectively reduce high concentrations of circulating serum free light chains (sFLC) in patients with dialysis-dependent acute kidney injury (AKI) due to multiple myeloma (MM). Therefore, the aim of this study was to analyze renal recovery in a retrospective single-center cohort of dialysis-dependent MM patients treated with either conventional HD (conv. HD) or HCO-HD. Methods and Results The final cohort consisted of 59 patients treated with HCO-HD (n = 42) or conv. HD (n = 17). A sustained sFLC response was detected in a significantly higher proportion of HCO-HD patients (83.3%) compared with conv. HD patients (29.4%; p = 0.007). The median duration of sFLC required to reach values <1000 mg/l was 14.5 days in the HCO-HD group and 36 days in the conv. HD group. The corresponding rates of renal recovery were 64.3% and 29.4%, respectively (chi-squared test, p = 0.014). Multivariate regression and decision tree analysis (recursive partitioning) revealed HCO-HD (adjusted odds ratio [OR] 6.1 [95% confidence interval (CI) 1.5–24.5], p = 0.011) and low initial uric acid values (adjusted OR 1.3 [95%CI 1.0–1.7], p = 0.045) as independent and paramount variables associated with a favorable renal outcome. Conclusions In summary, the results from this retrospective case-control study suggest in addition to novel agent-based chemotherapy a benefit of HCO-HD in sFLC removal and renal outcome in dialysis-dependent AKI secondary to MM. This finding was especially pertinent in patients with low initial uric acid values, resulting in a promising renal recovery rate of 71.9%. Further prospective studies are warranted. PMID:27152520

  9. Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan

    PubMed Central

    Ohsawa, Masaki; Tanno, Kozo; Okamura, Tomonori; Yonekura, Yuki; Kato, Karen; Fujishima, Yosuke; Obara, Wataru; Abe, Takaya; Itai, Kazuyoshi; Ogasawara, Kuniaki; Omama, Shinichi; Turin, Tanvir Chowdhury; Miyamatsu, Naomi; Ishibashi, Yasuhiro; Morino, Yoshihiro; Itoh, Tomonori; Onoda, Toshiyuki; Kuribayashi, Toru; Makita, Shinji; Yoshida, Yuki; Nakamura, Motoyuki; Tanaka, Fumitaka; Ohta, Mutsuko; Sakata, Kiyomi; Okayama, Akira

    2016-01-01

    Background While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known. Methods Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area. Results The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88–3.19) in all dialysis patients, 1.80 (95% CI, 1.30–2.29) in male dialysis patients, and 2.13 (95% CI, 0.66–3.61) in female dialysis patients. Conclusions The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients. PMID:26804038

  10. Care of the Patient with Renal Disease: Peritoneal Dialysis and Transplants, Nursing 321A.

    ERIC Educational Resources Information Center

    Hulburd, Kimberly

    A description is provided of a course, "Care of the Patient with Renal Disease," offered at the community college level to prepare licensed registered nurses to care for patients with renal disease, including instruction in performing the treatments of peritoneal dialysis and continuous ambulatory peritoneal dialysis (CAPD). The first sections of…

  11. Relationship between Stroke and Mortality in Dialysis Patients

    PubMed Central

    Phadnis, Milind A.; Ellerbeck, Edward F.; Shireman, Theresa I.; Rigler, Sally K.; Mahnken, Jonathan D.

    2015-01-01

    Background and objectives Stroke is common in patients undergoing long-term dialysis, but the implications for mortality after stroke in these patients are not fully understood. Design, setting, participants, & measurements A large cohort of dually-eligible (Medicare and Medicaid) patients initiating dialysis from 2000 to 2005 and surviving the first 90 days was constructed. Medicare claims were used to ascertain ischemic and hemorrhagic strokes occurring after 90-day survival. A semi-Markov model with additive hazard extension was generated to estimate the association between stroke and mortality, to calculate years of life lost after a stroke, and to determine whether race was associated with differential survival after stroke. Results The cohort consisted of 69,371 individuals representing >112,000 person-years of follow-up. Mean age±SD was 60.8±15.5 years. There were 21.1 (99% confidence interval [99% CI], 20.0 to 22.3) ischemic strokes and 4.7 (99% CI, 4.2 to 5.3) hemorrhagic strokes after cohort entry per 1000 patient-years. At 30 days, mortality was 17.9% for ischemic stroke and 53.4% for hemorrhagic stroke. The adjusted hazard ratio (AHR) depended on time since entry into the cohort; for patients who experienced a stroke at 1 year after cohort entry, for example, the AHR of hemorrhagic stroke for mortality was 25.4 (99% CI, 22.4 to 28.4) at 1 week, 9.9 (99% CI, 8.4 to 11.6) at 3 months, 5.9 (99% CI, 5.0 to 7.0) at 6 months, and 1.8 (99% CI, 1.5 to 2.1) at 24 months. The corresponding AHRs for ischemic stroke were 11.7 (99% CI, 10.2 to 13.1) at 1 week, 6.6 (99% CI, 6.4 to 6.7) at 3 months, and 4.7 (99% CI, 4.5 to 4.9) at 6 months, remaining significantly >1.0 even at 48 months. Median months of life lost were 40.7 for hemorrhagic stroke and 34.6 for ischemic stroke. For both stroke types, mortality did not differ by race. Conclusions Dialysis recipients have high mortality after a stroke with corresponding decrements in remaining years of life. Poststroke

  12. The Ethics of Offering Dialysis for AKI to the Older Patient: Time to Re-Evaluate?

    PubMed Central

    Akbar, Sana

    2014-01-01

    Older patients are more susceptible to AKI. In the elderly, AKI has been associated with increased morbidity and mortality, and it is a significant risk factor for CKD and dialysis-dependent ESRD. There are now accumulating data that the start of dialysis for some older patients is associated with poor outcomes, such as high treatment intensity, suffering, and limited life prolongation, which occur at the expense of dignity and quality of life. The biomedicalization of aging is a relatively recent field of ethical inquiry with two directly relevant features to decisions about starting dialysis for older patients with AKI: (1) the routinization of geriatric clinical interventions, such as dialysis, which results in the overshadowing of patient choice, and (2) the transformation of the technological imperative into the moral imperative. A major consequence of the biomedicalization of aging is that societal expectations about standard medical care have resulted in the relatively unquestioned provision of dialysis for AKI to older patients. This paper calls for nephrologists to re-examine the data and their attitudes to offering dialysis to older patients with AKI, especially those patients with underlying CKD and significant comorbidities. Shared decision-making and the reinforcement of the right of the patient to make a choice need to slow down the otherwise ineluctable routinization of starting old and very sick patients on dialysis. In the process of shared decision-making, nephrologists should not automatically recommend dialysis for older patients; in those patients who can be predicted to do poorly, recommending against dialysis upholds the Hippocratic maxim to be of benefit and do no harm. This paper challenges the automatic transformation of the technological imperative into the moral imperative for older patients with AKI and points to the need for a re-evaluation of dialysis ethics in this population. PMID:24812422

  13. Organ Donation Campaigns: Perspective of Dialysis Patient's Family Members

    PubMed Central

    TUMIN, Makmor; RAJA ARIFFIN, Raja Noriza; MOHD SATAR, NurulHuda; NG, Kok-Peng; LIM, Soo-Kun; CHONG, Chin-Sieng

    2014-01-01

    Abstract Background Solving the dilemma of the organ shortage in Malaysia requires educating Malaysians about organ donation and transplantation. This paper aims at exploring the average Malaysian households ’ preferred channels of campaigns and the preferred campaigners in a family setting, targeting at the dialysis family members. Methods We analyzed the responses of 350 respondents regarding organ donation campaigns. The respondents are 2 family members of 175 dialysis patients from 3 different institutions. The information on respondents’ willingness to donate and preferred method and channel of organ donation campaign were collected through questionnaire. Results Malaysian families have a good tendency to welcome campaigns in both the public and private (their homes) spheres. We also found that campaigns facilitated by the electronic media (Television and Radio) and executed by experienced doctors are expected to optimize the outcomes of organ donation, in general. Chi-square tests show that there are no significant differences in welcoming campaigns among ethnics. However, ethnics preferences over the campaign methods and campaigners are significantly different (P <0.05). Conclusion Ethnic differences imply that necessary modifications on the campaign channels and campaigners should also be taken under consideration. By identifying the preferred channel and campaigners, this study hopes to shed some light on the ways to overcome the problem of organ shortage in Malaysia. PMID:25909060

  14. Caring for Older Patients on Peritoneal Dialysis at End of Life.

    PubMed

    Meeus, Frédérique; Brown, Edwina A

    2015-11-01

    End of life is the last phase of life, not merely the last few days. For many older patients on peritoneal dialysis (PD), the end-of-life phase commences with the start of dialysis. The principal aim of management of this phase should be optimizing the quality of life of the patient. Evidence suggests that patients on dialysis mostly want involvement in decisions at this stage, but most do not have the opportunity to do so. Management should therefore include discussions with the patient and their family to determine lifestyle goals, treatment wishes, and ceilings of care (including resuscitation and dialysis withdrawal). Care should also include symptom identification and management, psychosocial support, and adaptation of dialysis to the ability and needs of the patient. By doing this, quality of life at end of life is achievable. PMID:26702011

  15. Obese and diabetic patients with end-stage renal disease: Peritoneal dialysis or hemodialysis?

    PubMed

    Ekart, Robert; Hojs, Radovan

    2016-07-01

    Obesity is a chronic disease that is increasingly prevalent around the world and is a well-recognized risk factor for type 2 diabetes and hypertension, leading causes of end-stage renal disease (ESRD). The obese diabetic patient with ESRD is a challenge for the nephrologist with regard to the type of renal replacement therapy that should be suggested and offered to the patient. There is no evidence that either peritoneal dialysis or hemodialysis is contraindicated in obese ESRD patients. In the literature, we can find a discrepancy in the impact of obesity on mortality among hemodialysis vs. peritoneal dialysis patients. Several studies in hemodialysis patients suggest that a higher BMI confers a survival advantage - the so-called "reverse epidemiology". In contrast, the literature among obese peritoneal dialysis patients is inconsistent, with various studies reporting an increased risk of death, no difference, or a decreased risk of death. Many of these studies only spanned across a few years, and this is probably too short of a time frame for a realistic assessment of obesity's impact on mortality in ESRD patients. The decision for dialysis modality in an obese diabetic patient with ESRD should be individualized. According to the results of published studies, we cannot suggest PD or HD as a better solution for all obese diabetic patients. The obese patient should be educated about all their dialysis options, including home dialysis therapies. In this review, the available literature related to the dialysis modality in obese patients with diabetes and ESRD was reviewed. PMID:27067614

  16. Outpatient Dialysis for Patients with AKI: A Policy Approach to Improving Care.

    PubMed

    Heung, Michael; Faubel, Sarah; Watnick, Suzanne; Cruz, Dinna N; Koyner, Jay L; Mour, Girish; Liu, Kathleen D; Cerda, Jorge; Okusa, Mark D; Lukaszewski, Mark; Vijayan, Anitha

    2015-10-01

    The rate of AKI requiring dialysis has increased significantly over the past decade in the United States. At the same time, survival from AKI seems to be improving, and thus, more patients with AKI are surviving to discharge while still requiring dialysis. Currently, the options for providing outpatient dialysis in patients with AKI are limited, particularly after a 2012 revised interpretation of the Centers for Medicare and Medicaid Services guidelines, which prohibited Medicare reimbursement for acute dialysis at ESRD facilities. This article provides a historical perspective on outpatient dialysis management of patients with AKI, reviews the current clinical landscape of care for these patients, and highlights key areas of knowledge deficit. Lastly, policy changes that have the opportunity to significantly improve the care of this at-risk population are suggested. PMID:26220818

  17. Trajectories of Serum Albumin Predict Survival of Peritoneal Dialysis Patients

    PubMed Central

    Chiu, Ping-Fang; Tsai, Chun-Chieh; Wu, Chia-Lin; Yang, Tse-Yen; Liou, Hung-Hsiang; Chen, Hung-Lin; Kor, Chew-Teng; Chang, Chia-Chu; Chang, Horng-Rong

    2016-01-01

    Abstract Although initial serum albumin level is highly associated with overall and cardiovascular mortality in peritoneal dialysis (PD) patients, we consider that the dynamic change and trend of albumin after initiation of PD are also essential. We enrolled patients who received PD for more than 3 months from January 1999 to March 2014. We categorized these patients into 2 groups by the difference in serum albumin level (Δalbumin = difference between peak with initial albumin level = peak albumin level − initial albumin level) after PD. The patients with Δalbumin < 0.2 g/dL (median level) were considered as group A (n, number = 238) and those with Δalbumin ≥ 0.2 g/dL were considered as group B (n = 278). Further, we stratified these patients into quartiles: Q1 Δalbumin < −0.2 g/dL; Q2, −0.2 ≦∼ <0.2 g/dL; Q3, 0.2 ≦∼ <0.6 g/dL; and Q4, ≥0.6 g/dL. Regression analysis was performed to determine the correlation of initial albumin and Δalbumin. Group A patients presented with higher levels of serum albumin (3.71 ± 0.54 vs 3.04 ± 0.55 g/dL; P < 0.001) and hematocrit as well as better initial residual renal function. However, those in group A had lower serum albumin increment and downward-sloped trends after dialysis. In contrast, the albumin trend was upward sloped and the increment of albumin was remarkable in group B, despite the high prevalence of cardiovascular diseases and diabetes. Overtime, group A patients had poorer survival and experienced more frequent and longer hospitalizations. Group Q1 patients with least albumin increment had worst survival. Group Q4 patients with lowest initial albumin also had poor survival. Age, diabetes, cardiovascular diseases, BMI, initial albumin, and Δalbumin could affect patient outcomes independently. Regression analysis showed a better outcome can be obtained if the initial albumin level is at least above 3.15 g/dL. (Initial albumin level

  18. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    NASA Astrophysics Data System (ADS)

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-06-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function.

  19. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis

    PubMed Central

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-01-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1–5) and 6 to 20 (area 6–20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function. PMID:27324066

  20. Heart rhythm complexity impairment in patients undergoing peritoneal dialysis.

    PubMed

    Lin, Yen-Hung; Lin, Chen; Ho, Yi-Heng; Wu, Vin-Cent; Lo, Men-Tzung; Hung, Kuan-Yu; Liu, Li-Yu Daisy; Lin, Lian-Yu; Huang, Jenq-Wen; Peng, Chung-Kang

    2016-01-01

    Cardiovascular disease is one of the leading causes of death in patients with advanced renal disease. The objective of this study was to investigate impairments in heart rhythm complexity in patients with end-stage renal disease. We prospectively analyzed 65 patients undergoing peritoneal dialysis (PD) without prior cardiovascular disease and 72 individuals with normal renal function as the control group. Heart rhythm analysis including complexity analysis by including detrended fractal analysis (DFA) and multiscale entropy (MSE) were performed. In linear analysis, the PD patients had a significantly lower standard deviation of normal RR intervals (SDRR) and percentage of absolute differences in normal RR intervals greater than 20 ms (pNN20). Of the nonlinear analysis indicators, scale 5, area under the MSE curve for scale 1 to 5 (area 1-5) and 6 to 20 (area 6-20) were significantly lower than those in the control group. In DFA anaylsis, both DFA α1 and DFA α2 were comparable in both groups. In receiver operating characteristic curve analysis, scale 5 had the greatest discriminatory power for two groups. In both net reclassification improvement model and integrated discrimination improvement models, MSE parameters significantly improved the discriminatory power of SDRR, pNN20, and pNN50. In conclusion, PD patients had worse cardiac complexity parameters. MSE parameters are useful to discriminate PD patients from patients with normal renal function. PMID:27324066

  1. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if the services are...

  2. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment if the services are...

  3. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Program § 414.310 Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment...

  4. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Program § 414.310 Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment...

  5. 42 CFR 414.310 - Determination of reasonable charges for physician services furnished to renal dialysis patients.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... services furnished to renal dialysis patients. 414.310 Section 414.310 Public Health CENTERS FOR MEDICARE... Program § 414.310 Determination of reasonable charges for physician services furnished to renal dialysis patients. (a) Principle. Physician services furnished to renal dialysis patients are subject to payment...

  6. Impact of facility size and profit status on intermediate outcomes in chronic dialysis patients.

    PubMed

    Frankenfield, D L; Sugarman, J R; Presley, R J; Helgerson, S D; Rocco, M V

    2000-08-01

    Little information is available regarding the influence of dialysis facility size or profit status on intermediate outcomes in chronic dialysis patients. We have combined data from the Health Care Financing Administration (HCFA) Core Indicators Project; the end-stage renal disease (ESRD) facility survey; and the HCFA On-Line Survey, Certification, and Reporting System to analyze trends in this area. For hemodialysis patients, larger facilities were more likely than smaller facilities to perform dialysis on patients who were younger than 65 years of age, black, or undergoing dialysis 2 years or more (P < 0.001). Nonprofit facilities were more likely to perform dialysis on patients with diabetes mellitus as a cause of ESRD and less likely to perform dialysis on patients with hypertension as a cause of ESRD compared with for-profit units (P < 0.05). By multivariate analysis, larger facility size was modestly associated with a greater Kt/V value and urea reduction ratio, but not with hematocrit or serum albumin values. Facility profit status was not associated with these intermediate outcomes. For peritoneal dialysis patients, there were no significant differences in patient demographics based on facility size. More patients in nonprofit units had been undergoing dialysis 2 or more years than patients in for-profit units (P < 0.05). By univariate analysis, patients in larger facilities were more likely to have an adequacy measure performed than patients from smaller facilities (P < 0.05). There were few substantial differences in intermediate outcomes in chronic dialysis patients based on facility size or profit status. PMID:10922310

  7. Unusual causes of peritonitis in a peritoneal dialysis patient: Alcaligenes faecalis and Pantoea agglomerans

    PubMed Central

    2011-01-01

    An 87 -year-old female who was undergoing peritoneal dialysis presented with peritonitis caused by Alcaligenes faecalis and Pantoea agglomerans in consecutive years. With the following report we discuss the importance of these unusual microorganisms in peritoneal dialysis patients. PMID:21477370

  8. Discovering New Hope through ABE: A Program for Kidney Dialysis Patients.

    ERIC Educational Resources Information Center

    Amonette, Linda M.

    1984-01-01

    Kidney dialysis patients often suffer emotional problems and face life adjustment problems. Adult basic education can be a useful tool to address these and to make positive use of idle time during dialysis. This article describes such a program, emphasizes the self-concept gain for students, and highlights the critical role of the understanding…

  9. Peritoneal Dialysis.

    PubMed

    Al-Natour, Mohammed; Thompson, Dustin

    2016-03-01

    Peritoneal dialysis is becoming more important in the management of patients with end-stage renal disease. Because of the efforts of the "Fistula First Breakthrough Initiative," dialysis venous access in the United States has become focused on promoting arteriovenous fistula creation and reducing the number of patients who start dialysis with a tunneled catheter. This is important because tunneled catheters can lead to infection, endocarditis, and early loss of more long-term access. When planned for, peritoneal dialysis can offer patients the opportunity to start dialysis at home without jeopardizing central access or the possibilities of eventual arteriovenous fistula creation. The purpose of this review is to highlight the indications, contraindications, and procedural methods for implanting peritoneal dialysis catheters in the interventional radiology suite. PMID:27011420

  10. Cardiothoracic ratio association with mortality in patients on maintenance peritoneal dialysis.

    PubMed

    Chen, Kuan-Hsing; Hung, Cheng-Chieh; Lin-Tan, Dan-Tzu; Huang, Wen-Hung; Hsu, Ching-Wei; Weng, Shu-Man; Lin, Ja-Liang

    2011-02-01

    The cardiothoracic ratio (CTR) indicates the left ventricular size; however, the significance of the CTR in patients on maintenance peritoneal dialysis (PD) remains unclear. In this study, 335 PD patients were enrolled and demographic, biochemical, co-morbidity, and dialysis-related data were obtained. The factors determining CTR were further analyzed. All patients were followed up for two years to investigate the mortality risks. We defined a normal CTR as less than the mean CTR value, mild cardiomegaly as a CTR between the mean and mean + 1 SD, and moderate-to-severe cardiomegaly as more than the mean CTR + 1 SD. Among the 335 patients, 163 patients were classified as having a normal CTR (<49.2%), 112 patients as having mild cardiomegaly (CTR 49.2-55.7%), and 60 patients as having moderate-to-severe cardiomegaly (CTR > 55.7%). χ(2) -analysis showed that the incidences of malnutrition and anemia were significantly higher in patients with severe cardiomegaly than in patients of the other groups. The CTR was positively correlated with age, but negatively correlated with albumin and hemoglobin levels. Twenty-six patients (7.7%) had died by the end of the study. Cox multivariate analysis revealed that the CTR significantly predicts all-cause two-year mortality in PD patients on maintenance PD; therefore, the CTR correlates with the nutritional and anemic status of PD patients and is a reliable predictor for all-cause two-year mortality. The analytical results of this study support continued efforts to reduce the CTR and treat underlying causes in patients with cardiomegaly. PMID:21272257

  11. CT of acquired cystic kidney disease and renal tumors in long-term dialysis patients

    SciTech Connect

    Levine, E.; Grantham, J.J.; Slusher, S.L.; Greathouse, J.L.; Krohn, B.P.

    1984-01-01

    The kidneys of long term dialysis patients frequently demonstrate multiple small acquired cysts and renal cell tumors on pathologic examination. The original kidneys of 30 long-term dialysis patients and six renal transplant patients were evaluated by computed tomography to determine the incidence of these abnormalities. Among dialysis patients, 43.3% had diffuse bilateral cysts, while 16.7% had occasional cysts (fewer than five per kidney), and 40% showed no renal cysts. Seven solid renal tumors were detected in four dialysis patients with renal cysts. Acquired cystic kidney disease tends to result in renal enlargement, is more common in patients who have been maintained on dialysis for prolonged periods, and may lead to spontaneous renal hemorrhage. The six transplant patients showed no evidence of renal cysts, and all had markedly shrunken kidneys. Acquired cystic disease and renal cell tumors in the original kidneys of dialysis patients may be due to biologically active substances that are not cleared effectively by dialysis but that are removed by normally functioning transplant kidneys.

  12. [Concerning: aging, the beginning of dialysis, the beginning of dependence: repercussions on the psychopathology of the very old dialysis patient].

    PubMed

    Antoine, V; Edy, T; Souid, M; Barthélémy, F; Saint-Jean, O

    2004-01-01

    The incidence of psychopathology, particularly depression, is high in dialysed elderly patients whereas their perceived level of health in the mental domain is similar to that of a non-dialysed and, even younger, population. Although the losses associated with advancing years, chronic disease and then entry into dialysis renders the psyche of elderly people frail, they do not strictly add in negative terms: their psychological reserve or resignation helps very elderly people to tolerate dialysis and its constraints. However, maintaining functional autonomy (ability to provide for one's fundamental needs and preserve leisure activities) while remaining independent to take decisions (particularly in controlling ways of receiving assistance) and preserving close relationships emerge as major determinant factors of the quality of life of very elderly dialysed patients. Added to the dependency due to dialysis, losses in these domains very often represent a turning point by changing the patient's identity, predisposing to the development of relationship problems, leading the patient to question his self-esteem or even resulting in psychological dependency, which itself adversely affects the quality of life. These mechanisms of psychopathology may not hide the possibility of an underlying dementia. PMID:15185555

  13. Dialysis patients' utilization of health care services covered by long-term care insurance in Japan.

    PubMed

    Shimizu, Utako; Mitadera, Yuji; Aoki, Hagiko; Akazawa, Kouhei

    2015-01-01

    Hemodialysis patients in Japan are aging and thus more patients need support for attending hemodialysis facilities. This study aimed to clarify how dialysis patients utilize the services covered by Japan's public long-term care insurance (LTCI) system. This cross-sectional study was based on LTCI data of March 31, 2009, the latest available data provided by Niigata City, located on the northwest coast of Honshu. Among 30,349 LTCI users in Niigata City, there were 234 dialysis patients. To clarify the characteristics of the dialysis patients, we compared the utilization of LTCI services between the dialysis patients (234 users) and randomly selected 765 non-dialysis users. We also calculated the annual transportation service costs per patient for dialysis patients who continued home care (home care group) and those who switched to long-term hospital care at LTCI care levels 4 and 5 (hospital admission group). These care levels indicate difficulty in walking or maintaining a sitting posture without assistance. The dialysis group more frequently utilized home care and equipment services, such as renting or purchasing care-support products and support for home equipment repair, and utilized facility services and short-stay services (respite care) less frequently (both p < 0.001). Cost per patient was higher in the home care group than in the hospital admission group, because the transportation services for dialysis patients at care levels 4 and 5 involve higher costs. These findings indicate that LTCI services usable for dialysis patients were limited. Therefore, instead of merely subsidizing transportation expenses, transportation services must be improved. PMID:25891160

  14. Bacteria on Catheters in Patients Undergoing Peritoneal Dialysis

    PubMed Central

    Pihl, Maria; Davies, Julia R.; Johansson, Ann-Cathrine; Svensäter, Gunnel

    2013-01-01

    ♦ Background: Peritonitis is the leading cause of morbidity for peritoneal dialysis (PD) patients, and microbial biofilms have previously been identified on catheters from infected patients. However, few studies of catheters from patients without clinical signs of infection have been undertaken. The aim of the present study was to investigate the extent to which bacteria are present on catheters from PD patients with no symptoms of infection. ♦ Methods: Microbiologic culturing under aerobic and anaerobic conditions and confocal laser scanning microscopy were used to determine the distribution of bacteria on PD catheters from 15 patients without clinical signs of infection and on catheters from 2 infected patients. The 16S rRNA gene sequencing technique was used to identify cultured bacteria. ♦ Results: Bacteria were detected on 12 of the 15 catheters from patients without signs of infection and on the 2 catheters from infected patients. Single-species and mixed-microbial communities containing up to 5 species were present on both the inside and the outside along the whole length of the colonized catheters. The bacterial species most commonly found were the skin commensals Staphylococcus epidermidis and Propionibacterium acnes, followed by S. warneri and S. lugdunensis. The strains of these micro-organisms, particularly those of S. epidermidis, varied in phenotype with respect to their tolerance of the major classes of antibiotics. ♦ Conclusions: Bacteria were common on catheters from patients without symptoms of infection. Up to 4 different bacterial species were found in close association and may represent a risk factor for the future development of peritonitis in patients hosting such micro-organisms. PMID:22855889

  15. Pulmonary gas exchange during dialysis in patients with obstructive lung disease.

    PubMed

    Pitcher, W D; Diamond, S M; Henrich, W L

    1989-11-01

    Hypoxemia occurs during routine hemodialysis and may contribute to morbidity, but its cause is not well understood. We reasoned that patients with COPD would be more vulnerable to abnormalities in gas exchange with dialysis. Thus, to investigate the cause of dialysis-related hypoxemia, we measured gas exchange in a group of stable dialysis patients with normal pulmonary function (n = 6) and a group of dialysis patients with COPD (n = 6). Measurements were made predialysis, at 1 h, and postdialysis with both acetate and bicarbonate dialysates. Acetate dialysis decreased PaO2 in normal and COPD patients at 1 h and postdialysis. Acetate-induced hypoxemia was associated with reduced respiratory CO2 excretion and hypoventilation but PaCO2 did not change. This decrease in CO2 excretion resulted from CO2 fixation during acetate metabolism and modest CO2 loss across the dialyzer. Hypoxemia occurred only postdialysis with bicarbonate dialysate in normal and COPD patients. An increased P(A-a)O2 occurred postdialysis with both dialysates, and was most consistently observed in the COPD patients. In summary, at least two mechanisms contribute to dialysis hypoxemia. With acetate dialysate, alveolar hypoventilation from CO2 unloading occurs at 1 h and postdialysis due to acetate metabolism. However, abnormalities in ventilation/perfusion contribute to postdialysis hypoxemia observed with both dialysates. In addition, the decrement in PaO2 associated with dialysis is similar in normal and COPD patients, although preexisting COPD makes postdialysis changes more apparent. PMID:2805844

  16. Pharmacokinetics of piperacillin in patients on peritoneal dialysis with and without peritonitis.

    PubMed

    Debruyne, D; Ryckelynck, J P; Hurault De Ligny, B; Moulin, M

    1990-02-01

    The pharmacokinetics of piperacillin given intravenously (1 or 2 g) to nine patients with chronic renal failure and undergoing continuous ambulatory peritoneal dialysis was intermediate between values obtained in healthy volunteers and in patients with renal insufficiency studied between dialyses: half-life, 2.4 h; total clearance, 100 mL/min; urinary or peritoneal clearance, 3 mL/min. The intraperitoneal administration of piperacillin in dialysis fluid (400 mg or 1 g to five patients) increased the half-life (6 to 7 h) and decreased the volume of distribution of about two thirds. In both instances, the area under the curve was well correlated with dosage. The absorption of piperacillin by an inflamed peritoneum in eight patients suffering from peritonitis and treated with 400 mg, 1 g, or 2 g, was increased and returned to normal concurrently with care. Consequently, the recommended dosage is intravenous administration of 2 g of piperacillin every 8 h or intraperitoneal administration of 1 g every 6 h in the dialysate. With such conditions, serum concentrations greater than minimal inhibitory concentrations and sufficient to avoid dissemination of piperacillin-susceptible organisms without risk of accumulation are obtained. PMID:2324971

  17. Adequacy of solute and water removal in children treated with nightly intermittent peritoneal dialysis.

    PubMed

    Edefonti, A; Picca, M; Ghio, L; Bassi, S; Cattarelli, D; Leccese, V

    1992-01-01

    Nightly intermittent peritoneal dialysis (NIPD) is an automated form of intermittent peritoneal dialysis which has potential medical and psychosocial advantages in comparison with CAPD/CCPD due to the lack of daytime exchanges. Data on solute/water removal in children on NIPD are nevertheless scarce, so that no clear indications for NIPD can yet be formulated in pediatric age. For this reason, 12 patients, mean age 10.49 +/- 5.81, mean body weight 23.73 +/- 10.92, with a residual creatinine clearance 1.70 +/- 2.30 ml/min/1.73 sqm, on NIPD for 14.7 +/- 5.4 months, underwent clearance studies over 3 days. Mean dialysis infusion volume was 460.08 +/- 196.30 ml/kg/day, with 10.33 +/- 1.22 h dialysis time. Peritoneal creatinine and urea clearances were 6.36 +/- 2.96 and 8.49 +/- 3.35 1/day/1.73 sqm, respectively. Combined creatinine and urea clearances averaged 6.12 +/- 2.21 and 6.96 +/- 2.16 ml/min/1.73 sqm, resulting in serum creatinine and urea values of 7.78 +/- 1.90 and 115.58 +/- 29.93 mg/dl, respectively. Ultrafiltration rate was 16.94 +/- 16.34 ml/g glucose absorbed. NIPD provided similar or improved solute and water clearances compared with those reported in children and adults on CAPD/CCPD, without inconvenient long periods in bed. These data indicate that NIPD is a suitable treatment in pediatric end-stage renal disease. PMID:1361833

  18. 42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Payment for EPO furnished to a home dialysis... for EPO furnished to a home dialysis patient for use in the home. (a) Prior to January 1, 2011, payment for EPO used at home by a home dialysis patient is made only to either a Medicare approved...

  19. 42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Payment for EPO furnished to a home dialysis... for EPO furnished to a home dialysis patient for use in the home. Link to an amendment published at 75 FR 49202, Aug. 12, 2010. (a) Payment for EPO used at home by a home dialysis patient is made only...

  20. 42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 3 2014-10-01 2014-10-01 false Payment for EPO furnished to a home dialysis....335 Payment for EPO furnished to a home dialysis patient for use in the home. (a) Prior to January 1, 2011, payment for EPO used at home by a home dialysis patient is made only to either a...

  1. 42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 3 2012-10-01 2012-10-01 false Payment for EPO furnished to a home dialysis....335 Payment for EPO furnished to a home dialysis patient for use in the home. (a) Prior to January 1, 2011, payment for EPO used at home by a home dialysis patient is made only to either a...

  2. 42 CFR 414.335 - Payment for EPO furnished to a home dialysis patient for use in the home.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 3 2013-10-01 2013-10-01 false Payment for EPO furnished to a home dialysis....335 Payment for EPO furnished to a home dialysis patient for use in the home. (a) Prior to January 1, 2011, payment for EPO used at home by a home dialysis patient is made only to either a...

  3. A cross-sectional study of dialysis practice-patterns in patients with chronic kidney disease on maintenance hemodialysis.

    PubMed

    Kulkarni, Manjunath Jeevanna; Jamale, Tukaram; Hase, Niwrutti K; Jagdish, Pradeep Kiggal; Keskar, Vaibhav; Patil, Harsha; Shete, Abhijeet; Patil, Chetan

    2015-09-01

    We studied the dialysis practice-patterns with regard to various aspects of chronic kidney disease (CKD) stage 5D, like anemia, mineral bone disease, vaccination, hospitalization, hypertension and cost of therapy. Four hundred and sixty-four adult hemodialysis (HD) patients from various dialysis centers of Mumbai were included in the study. The mean age of the study patients was 47.2 years. Temporary dialysis catheters were the most common initial vascular access. Thirteen percent of prevalent HD patients were on temporary catheters; 33% of patients had history of failure of arterio-venous fistula. The most common cause of failure was access thrombosis. About 75% of the patients had hemoglobin <11 g/dL and 35% had uncontrolled blood pressure. The prevalence of positive hepatitis B surface antigen and anti-hepatitis C virus antibody was 6% and 2%, respectively. The average cost of HD treatment was approximately 6100 Indian rupees (about US $100). HD is helpful in treating many of the clinical manifestations of CKD and postpones otherwise imminent death. However, dialysis treatment is no panacea to renal failure; HD patients have higher hospitalization rates and lower quality of life than the general population. The therapy itself brings with it a unique set of problems, such as vascular access-related complications, which cause significant mortality and morbidity. This study was a study of the current HD practices. The primary goal of this cross-sectional observational study is to understand dialysis practices and obtain data that can be used to improve care in the future. PMID:26354590

  4. Missed dialysis sessions and hospitalization in hemodialysis patients after Hurricane Katrina.

    PubMed

    Anderson, Amanda H; Cohen, Andrew J; Kutner, Nancy G; Kopp, Jeffrey B; Kimmel, Paul L; Muntner, Paul

    2009-06-01

    In order to evaluate the factors that contributed to missed dialysis sessions and increased hospitalizations of hemodialysis patients after Hurricane Katrina, we contacted 386 patients from 9 New Orleans hemodialysis units. Data were collected through structured telephone interviews on socio-demographics, dialysis factors, and evacuation characteristics. Overall, 44% of patients reported missing at least one and almost 17% reported missing 3 or more dialysis sessions. The likelihood of missing 3 or more sessions was greater for those whose dialysis vintage was less than 2 years compared to those for whom it was 5 or more years, who had 38 or fewer billed dialysis sessions compared to those who had 39 or more in the 3 months before the storm, who lived alone before the storm, who were unaware of their dialysis facility's emergency plans, who did not evacuate prior to hurricane landfall, and who were placed in a shelter. The adjusted odds ratio of hospitalization among patients who missed 3 or more compared to those who did not miss any dialysis sessions was 2.16 (95% CI: 1.05-4.43). These findings suggest that when preparing for future disasters more emphasis needs to be placed on patient awareness and early execution of emergency plans. PMID:19212421

  5. Lanthanum Carbonate for Hyperphosphatemia in Patients on Peritoneal Dialysis

    PubMed Central

    Ohno, Michiya; Ohashi, Hiroshige; Oda, Hiroshi; Yokoyama, Haruko; Okada, Miho; Nagaya, Mayu; Izumi, Kumiko; Ito, Hitomi; Katoh, Shuji

    2013-01-01

    ♦ Background: The efficacy of the phosphate binder lanthanum carbonate has been demonstrated for hemodialysis patients, but no studies have focused on patients undergoing continuous ambulatory peritoneal dialysis (CAPD). We evaluated whether lanthanum carbonate could control phosphate levels in patients on CAPD. ♦ Methods: In this 48-week open-label prospective study, 28 patients on CAPD with a phosphate level of 6 mg/dL or greater were given lanthanum carbonate titrated from 750 mg to 2250 mg daily to achieve a target serum phosphate level of less than 6 mg/dL. The primary efficacy endpoint was reduction of serum phosphate to less than 6 mg/dL. Serum levels of calcium and parathyroid hormone were also evaluated, as were the Ca×P product and adverse effects. ♦ Results: From week 4 to the end of the study at week 48, we observed a significant reduction of serum phosphate to 5.25 ± 0.97 mg/dL from 6.88 ± 1.06 mg/dL at study start (p < 0.01). At the end of the study, 78.6% of participants had achieved the target of less than 6 mg/dL. Because no change of serum calcium occurred, the Ca×P product declined significantly during the study. Intact parathyroid hormone declined gradually over the study period, but the change had not reached significance at the end of the study (p = 0.11). The mean final dose of lanthanum carbonate was 946 mg daily. The only adverse effect reported was mild nausea in 1 patient. ♦ Conclusions: Lanthanum carbonate is an effective phosphate binder that can control serum phosphate and Ca×P product in CAPD patients with hyperphosphatemia. Lanthanum carbonate was well tolerated in our population. PMID:23209037

  6. Prevalence and correlates of functional dependence among maintenance dialysis patients.

    PubMed

    Kavanagh, Niall T; Schiller, Brigitte; Saxena, Anjali B; Thomas, I-Chun; Kurella Tamura, Manjula

    2015-10-01

    Functional dependence is an important determinant of longevity and quality of life. The purpose of the current study was to determine the prevalence and correlates of functional dependence among patients with end-stage renal disease (ESRD) receiving maintenance dialysis. We enrolled 148 participants with ESRD from five clinics. Functional status, as measured by basic and instrumental activities of daily living (ADL, IADL), was ascertained by validated questionnaires. Functional dependence was defined as needing assistance in at least one of seven IADLs or at least one of four ADLs. Demographic characteristics, chronic health conditions, anthropometric measurements, and laboratories were assessed by a combination of self-report and chart review. Cognitive function was assessed with a neurocognitive battery, and depressive symptoms were assessed by questionnaire. Mean age of the sample was 56.2 ± 14.6 years. Eighty-seven participants (58.8%) demonstrated dependence in ADLs or IADLs, 70 (47.2%) exhibited IADL dependence alone, and 17 (11.5%) exhibited combined IADL and ADL dependence. In a multivariable-adjusted model, stroke, cognitive impairment, and higher systolic blood pressure were independent correlates of functional dependence. We found no significant association between demographic characteristics, chronic health conditions, depressive symptoms or laboratory measurements, and functional dependence. Impairment in executive function was more strongly associated with functional dependence than memory impairment. Functional dependence is common among ESRD patients and independently associated with stroke, systolic blood pressure, and executive function impairment. PMID:25731070

  7. Adequate peritoneal dialysis: theoretical model and patient treatment.

    PubMed

    Tast, C

    1998-01-01

    The objective of this study was to evaluate the relationship between adequate PD with sufficient weekly Kt/V (2.0) and Creatinine clearance (CCR) (60l) and necessary daily dialysate volume. This recommended parameter was the result of a recent multi-centre study (CANUSA). For this there were 40 patients in our hospital examined and compared in 1996, who carried out PD for at least 8 weeks and up to 6 years. These goals (CANUSA) are easily attainable in the early treatment of many individuals with a low body surface area (BSA). With higher BSA or missing RRF (Residual Renal Function) the daily dose of dialysis must be adjusted. We found it difficult to obtain the recommended parameters and tried to find a solution to this problem. The simplest method is to increase the volume or exchange rate. The most expensive method is to change from CAPD to APD with the possibility of higher volume or exchange rates. Selection of therapy must take into consideration: 1. patient preference, 2. body mass, 3. peritoneal transport rates, 4. ability to perform therapy, 5. cost of therapy and 6. risk of peritonitis. With this information in mind, an individual prescription can be formulated and matched to the appropriate modality of PD. PMID:10392062

  8. Fat tissue and inflammation in patients undergoing peritoneal dialysis

    PubMed Central

    Rincón Bello, Abraham; Bucalo, Laura; Abad Estébanez, Soraya; Vega Martínez, Almudena; Barraca Núñez, Daniel; Yuste Lozano, Claudia; Pérez de José, Ana; López-Gómez, Juan M.

    2016-01-01

    Background Body weight has been increasing in the general population and is an established risk factor for hypertension, diabetes, and all-cause and cardiovascular mortality. Patients undergoing peritoneal dialysis (PD) gain weight, mainly during the first months of treatment. The aim of this study was to assess the relationship between body composition and metabolic and inflammatory status in patients undergoing PD. Methods This was a prospective, non-interventional study of prevalent patients receiving PD. Body composition was studied every 3 months using bioelectrical impedance (BCM®). We performed linear regression for each patient, including all BCM® measurements, to calculate annual changes in body composition. Thirty-one patients in our PD unit met the inclusion criteria. Results Median follow-up was 26 (range 17–27) months. Mean increase in weight was 1.8 ± 2.8 kg/year. However, BCM® analysis revealed a mean increase in fat mass of 3.0 ± 3.2 kg/year with a loss of lean mass of 2.3 ± 4.1 kg/year during follow-up. The increase in fat mass was associated with the conicity index, suggesting that increases in fat mass are based mainly on abdominal adipose tissue. Changes in fat mass were directly associated with inflammation parameters such as C-reactive protein (r = 0.382, P = 0.045) and inversely associated with high-density lipoprotein cholesterol (r=−0.50, P = 0.008). Conclusions Follow-up of weight and body mass index can underestimate the fat mass increase and miss lean mass loss. The increase in fat mass is associated with proinflammatory state and alteration in lipid profile. PMID:27274820

  9. Design of a multimedia PC-based telemedicine network for the monitoring of renal dialysis patients

    NASA Astrophysics Data System (ADS)

    Tohme, Walid G.; Winchester, James F.; Dai, Hailei L.; Khanafer, Nassib; Meissner, Marion C.; Collmann, Jeff R.; Schulman, Kevin A.; Johnson, Ayah E.; Freedman, Matthew T.; Mun, Seong K.

    1997-05-01

    This paper investigates the design and implementation of a multimedia telemedicine application being undertaken by the Imaging Science and Information Systems Center of the Department of Radiology and the Division of Nephrology of the Department of Medicine at the Georgetown University Medical Center (GUMC). The Renal Dialysis Patient Monitoring network links GUMC, a remote outpatient dialysis clinic, and a nephrologist's home. The primary functions of the network are to provide telemedicine services to renal dialysis patients, to create, manage, transfer and use electronic health data, and to provide decision support and information services for physicians, nurses and health care workers. The technical parameters for designing and implementing such a network are discussed.

  10. [Patients in pre-dialysis: decision taking and free choice of treatment].

    PubMed

    Sarrias Lorenz, X; Bardón Otero, E; Vila Paz, M L

    2008-01-01

    Predialysis is a clinical situation in which the patient has significant impairment of kidney function that will ultimately lead to either death or inclusion in kidney replacement therapy (dialysis and/or transplantation). Since a practical and effective dialysis technique was introduced, the length and quality of survival of patients with end-stage renal failure has constantly increased. Contraindications for dialysis are almost never of a renal origin. The obstacles are the concomitant diseases of the patient. The age of the patient may be one of these obstacles. The average age at initiation of dialysis in our country is currently 67 years and over 50% of patients are 60 years old or older. Decision making: From an ethical viewpoint, there is a consensus in stating that anything that can technically be done, should be done. The principle of nonmaleficence and respect for the autonomy of the patients are "prima facie" principles when the physician has doubts as to whether dialysis provides a benefit to the patient. The principle of autonomy, which makes the patient a competent subject of treatment, allows a framework of shared decisions to be created in which the physician uses his knowledge and experiences in assessing the risk and benefits of dialysis including the alternative of no dialysis. The competent patient, duly informed, will chose the option that is best for him and take the decision. Principle of treatment proportionality: This principle states that there is a moral obligation to implement all therapeutic measures that show a relationship of due proportion between the resources used and the expected result. Dialysis is in principle a proportional treatment for end-stage renal failure. However, it may become a disproportional treatment because of the physical and mental conditions of the elderly patient. The good that is sought with institution of treatment can cause a harm to the patient that justifies noninclusion of the patient in dialysis

  11. Choosing to live with home dialysis-patients' experiences and potential for telemedicine support: a qualitative study

    PubMed Central

    2012-01-01

    Background This study examines the patients' need for information and guidance in the selection of dialysis modality, and in establishing and practicing home dialysis. The study focuses on patients' experiences living with home dialysis, how they master the treatment, and their views on how to optimize communication with health services and the potential of telemedicine. Methods We used an inductive research strategy and conducted semi-structured interviews with eleven patients established in home dialysis. Our focus was the patients' experiences with home dialysis, and our theoretical reference was patients' empowerment through telemedicine solutions. Three informants had home haemodialysis (HHD); eight had peritoneal dialysis (PD), of which three had automated peritoneal dialysis (APD); and five had continuous ambulatory peritoneal dialysis (CAPD). The material comprises all PD-patients in the catchment area capable of being interviewed, and all known HHD-users in Norway at that time. Results All of the interviewees were satisfied with their choice of home dialysis, and many experienced a normalization of daily life, less dominated by disease. They exhibited considerable self-management skills and did not perceive themselves as ill, but still required very close contact with the hospital staff for communication and follow-up. When choosing a dialysis modality, other patients' experiences were often more influential than advice from specialists. Information concerning the possibility of having HHD, including knowledge of how to access it, was not easily available. Especially those with dialysis machines, both APD and HHD, saw a potential for telemedicine solutions. Conclusions As home dialysis may contribute to a normalization of life less dominated by disease, the treatment should be organized so that the potential for home dialysis can be fully exploited. Pre-dialysis information should be unbiased and include access to other patients' experiences. Telemedicine

  12. Pro and con arguments in using alternative dialysis regimens in the frail and elderly patients.

    PubMed

    Chazot, Charles; Farrington, Ken; Nistor, Ionut; Van Biesen, Wim; Joosten, Hanneke; Teta, Daniel; Siriopol, Dimitrie; Covic, Adrian

    2015-11-01

    In the last decade, an increasing number of patients over 75 years of age are starting renal replacement therapy. Frailty is highly prevalent in elderly patients with end-stage renal disease (ESRD) in the context of the increased prevalence of some ESRD-associated conditions: protein-energy wasting, inflammation, anaemia, acidosis or hormonal disturbances. There are currently no hard data to support guidance on the optimal duration of dialysis for frail/elderly ESRD patients. The current debate is not about starting dialysis or managing conservatory frail ESRD patients, but whether a more intensive regimen once dialysis is initiated (for whatever reasons and circumstances) would improve patients' outcome. The most important issue is that all studies performed with extended/alternative dialysis regimens do not specifically address this particular type of patients and therefore all the inferences are derived from the general ESRD population. Care planning should be responsive to end-of-life needs whatever the treatment modality. Care in this setting should focus on symptom control and quality of life rather than life extension. We conclude that, similar to the general dialysed population, extensive application of more intensive dialysis schedules is not based on solid evidence. However, after a thorough clinical evaluation, a limited period of a trial of intensive dialysis could be prescribed in more problematic patients. PMID:26377489

  13. Successful treatment of Cryptococcus laurentii peritonitis in a patient on peritoneal dialysis.

    PubMed

    Asano, Marina; Mizutani, Makoto; Nagahara, Yasuko; Inagaki, Koji; Kariya, Tetsuyoshi; Masamoto, Daijiro; Urai, Makoto; Kaneko, Yukihiro; Ohno, Hideaki; Miyazaki, Yoshitsugu; Mizuno, Masashi; Ito, Yasuhiko

    2015-01-01

    A 32-year-old man on peritoneal dialysis (PD) was hospitalized for seven days due to fever. A diagnosis of yeast-like fungal peritonitis was made by Gram staining. The patient was started on intravenous micafungin and oral fluconazole therapy following removal of the PD catheter. A fungal pathogen was isolated from the peritoneal fluid and identified as Cryptococcus species. Based on antifungal susceptibility testing, the treatment was changed to voriconazole and continued for 3 months. A genetic analysis identified the isolate as Cryptococcus laurentii (C. laurentii). This patient was diagnosed with C. laurentii PD-related peritonitis and was successfully treated with voriconazole and removal of the PD catheter. PMID:25876577

  14. Mesenteric ischemia masquerading as refractory peritonitis in continuous ambulatory peritoneal dialysis patients.

    PubMed

    Vishwakarma, K; Anandh, U

    2015-01-01

    We report two cases of mesenteric ischemia in patients on long term peritoneal dialysis both of which were associated with poor outcomes. Both were diabetic and on peritoneal dialysis for a long time. On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia. Despite adequate treatment both succumbed to their illness. Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis. PMID:26664217

  15. Understanding by Older Patients of Dialysis and Conservative Management for Chronic Kidney Failure

    PubMed Central

    Tonkin-Crine, Sarah; Okamoto, Ikumi; Leydon, Geraldine M.; Murtagh, Fliss E.M.; Farrington, Ken; Caskey, Fergus; Rayner, Hugh; Roderick, Paul

    2015-01-01

    Background Older adults with chronic kidney disease stage 5 may be offered a choice between dialysis and conservative management. Few studies have explored patients’ reasons for choosing conservative management and none have compared the views of those who have chosen different treatments across renal units. Study Design Qualitative study with semistructured interviews. Settings & Participants Patients 75 years or older recruited from 9 renal units. Units were chosen to reflect variation in the scale of delivery of conservative management. Methodology Semistructured interviews audiorecorded and transcribed verbatim. Analytical Approach Data were analyzed using thematic analysis. Results 42 interviews were completed, 4 to 6 per renal unit. Patients were sampled from those receiving dialysis, those preparing for dialysis, and those choosing conservative management. 14 patients in each group were interviewed. Patients who had chosen different treatments held varying beliefs about what dialysis could offer. The information that patients reported receiving from clinical staff differed between units. Patients from units with a more established conservative management pathway were more aware of conservative management, less often believed that dialysis would guarantee longevity, and more often had discussed the future with staff. Some patients receiving conservative management reported that they would have dialysis if they became unwell in the future, indicating the conditional nature of their decision. Limitations Recruitment of older adults with frailty and comorbid conditions was difficult and therefore transferability of findings to this population is limited. Conclusions Older adults with chronic kidney disease stage 5 who have chosen different treatment options have contrasting beliefs about the likely outcomes of dialysis for those who are influenced by information provided by renal units. Supporting renal staff in discussing conservative management as a valid

  16. Predicting One-Year Mortality in Peritoneal Dialysis Patients: An Analysis of the China Peritoneal Dialysis Registry

    PubMed Central

    Cao, Xue-Ying; Zhou, Jian-Hui; Cai, Guang-Yan; Tan, Ni-Na; Huang, Jing; Xie, Xiang-Cheng; Tang, Li; Chen, Xiang-Mei

    2015-01-01

    This study aims to investigate basic clinical features of peritoneal dialysis (PD) patients, their prognostic risk factors, and to establish a prognostic model for predicting their one-year mortality. A national multi-center cohort study was performed. A total of 5,405 new PD cases from China Peritoneal Dialysis Registry in 2012 were enrolled in model group. All these patients had complete baseline data and were followed for one year. Demographic and clinical features of these patients were collected. Cox proportional hazards regression model was used to analyze prognostic risk factors and establish prognostic model. A validation group was established using 1,764 new PD cases between January 1, 2013 and July 1, 2013, and to verify accuracy of prognostic model. Results indicated that model group included 4,453 live PD cases and 371 dead cases. Multivariate survival analysis showed that diabetes mellitus (DM), residual glomerular filtration rate (rGFR), , SBP, Kt/V, high PET type and Alb were independently associated with one-year mortality. Model was statistically significant in both within-group verification and outside-group verification. In conclusion, DM, rGFR, SBP, Kt/V, high PET type and Alb were independent risk factors for short-term mortality in PD patients. Prognostic model established in this study accurately predicted risk of short-term death in PD patients. PMID:26019685

  17. Cause-specific excess mortality among dialysis patients: comparison with the general population in Japan.

    PubMed

    Wakasugi, Minako; Kazama, Junichiro James; Yamamoto, Suguru; Kawamura, Kazuko; Narita, Ichiei

    2013-06-01

    Despite significant therapeutic advances, mortality of dialysis patients remains unacceptably high. The aim of this study is to compare mortality and its causes in dialysis patients with those in the general Japanese population. We used data for 2008 and 2009 from the Japanese Society for Dialysis Therapy registry and a national Vital Statistics survey. Cardiovascular mortality was defined as death attributed to heart failure, cerebrovascular disorders, myocardial infarction, hyperkalemia/sudden death, and pulmonary thromboembolism. Non-cardiovascular mortality was defined as death attributed to infection, malignancies, cachexia/uremia, chronic hepatitis/cirrhosis, ileus, bleeding, suicide/refusal of treatment, and miscellaneous. We calculated standardized mortality ratios and age-adjusted mortality differences between dialysis patients and the general population for all-cause, cardiovascular versus non-cardiovascular, and cause-specific mortality. During the 2-year study period, there were 2,284,272 and 51,432 deaths out of 126 million people and 273,237 dialysis patients, respectively. The standardized mortality ratio for all-cause mortality was 4.6 (95% confidence interval, 4.6-4.7) for the dialysis patients compared to the general population. Age-adjusted mortality differences for cardiovascular and non-cardiovascular disease were 33.1 and 30.0 per 1000 person-years, respectively. The standardized mortality rate ratios were significant for all cause-specific mortality rates except accidental death. Our study revealed that excess mortality in dialysis patients compared to the general population in Japan is large, and differs according to age and cause of death. Cause-specific mortality studies should be planned to improve life expectancies of dialysis patients. PMID:23735145

  18. Continuous ambulatory peritoneal dialysis and survival of HIV infected patients with end-stage renal disease.

    PubMed

    Kimmel, P L; Umana, W O; Simmens, S J; Watson, J; Bosch, J P

    1993-08-01

    As the number of human immunodeficiency virus (HIV) infected patients has increased in the U.S., the number of infected patients treated for end-stage renal disease (ESRD) has stabilized at about 1 to 2% of the hemodialyzed population. Little has been written regarding the role of continuous ambulatory peritoneal dialysis (CAPD) in the treatment of HIV infected patients with ESRD. To evaluate the effectiveness of CAPD as a long term therapy for HIV infected patients with ESRD, we reviewed our ESRD program's experience. We entered 392 patients from its inception in February 1984 until April 1992. Thirty-one, or 7.9% of our population were HIV infected. Twenty, or 64.5% had stage IV infection. Patients were entered into our chronic hemodialysis (HD) or CAPD program according to standard clinical criteria. Eight HIV infected patients elected to start CAPD, while 23 patients were treated exclusively with HD. The proportion of stage IV infected patients was similar in both treatment modality groups. HIV infected ESRD patients were younger than non-HIV infected patients (37.5 +/- 9.7 vs. 49.8 +/- 15.7 years, respectively, P < 0.0001) at the start of treatment. We used Cox regression techniques to analyze survival data. Mean survival time for our entire non-HIV infected ESRD population (N = 361) was 44.0 +/- 33.9 months. Mean survival time for HIV infected patients with ESRD was 15.5 +/- 9.9 months. Median survival for HIV infected ESRD patients was 13 months compared to 38 months for the non-infected population. As expected, mean survival time in HIV infected ESRD patients was significantly diminished compared to non-infected ESRD patients (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8377381

  19. Dialysis or conservative care for frail older patients: ethics of shared decision-making.

    PubMed

    Muthalagappan, Seetha; Johansson, Lina; Kong, Wing May; Brown, Edwina A

    2013-11-01

    Increasing numbers of frail elderly with end-stage renal disease (ESRD) and multiple comorbidities are undertaking dialysis treatment. This has been accompanied by increasing dialysis withdrawal, thus warranting investigation into why this is occurring and whether a different approach to choosing treatment should be implemented. Despite being a potentially life-saving treatment, the physical and psychosocial burdens associated with dialysis in the frail elderly usually outweigh the benefits of correcting uraemia. Conservative management is less invasive and avoids the adverse effects associated with dialysis, but unfortunately it is often not properly considered until patients withdraw from dialysis. Shared decision-making has been proposed to allow patients active participation in healthcare decisions. Through this approach, patients will focus on their personal values to receive appropriate treatment, and perhaps opt for conservative management. This may help address the issue of dialysis withdrawal. Moreover, shared decision-making attempts to resolve the conflict between autonomy and other ethical principles, including physician paternalism. Here, we explore the ethical background behind shared decision-making, and whether it is genuinely in the patient's best interests or whether it is a cynical solution to encourage more patients to consider conservative care, thus saving limited resources. PMID:23787549

  20. Comparison of five body-composition methods in peritoneal dialysis patients.

    PubMed

    Stall, S H; Ginsberg, N S; DeVita, M V; Zabetakis, P M; Lynn, R I; Gleim, G W; Wang, J; Pierson, R N; Michelis, M F

    1996-08-01

    Body-composition assessment is an important method of evaluating nutritional status in peritoneal dialysis patients. Because body-composition measurement estimates have not been fully validated in this population, we assessed five body-composition methods in 30 well-dialyzed peritoneal dialysis patients. The techniques studied included bioelectrical impedance analysis, dual-energy X-ray absorptiometry, total-body potassium counting, and anthropometry by two techniques. The dialysis patients were matched for age, race, sex, height, weight, and body mass index with 29 healthy control subjects in our laboratory database. By 5 x 2 x 2 analysis of variance, significant differences were found between results by modality (P < 0.0001) as well as by sex, with women having an increased percentage of fat (P < 0.0001). However, there was no significant intermethod difference by condition (peritoneal dialysis or control). That is, although significantly different percentage fat values were found between the body-composition techniques, this variability was independent of whether the measurement was made on control or peritoneal dialysis patients. Despite the differences between modalities, all techniques were found to correlate significantly with each other (P < 0.01 or better for men and P < 0.001 or better for women). Our experience shows that these routine techniques for measuring body composition can be readily applied to stable peritoneal dialysis patients. PMID:8694010

  1. Neighborhood Socioeconomic Status, Race, and Mortality in Young Adult Dialysis Patients

    PubMed Central

    Estrella, Michelle M.; Crews, Deidra C.; Appel, Lawrence J.; Anderson, Cheryl A.M.; Ephraim, Patti L.; Cook, Courtney; Boulware, L. Ebony

    2014-01-01

    Young blacks receiving dialysis have an increased risk of death compared with whites in the United States. Factors influencing this disparity among the young adult dialysis population have not been well explored. Our study examined the relation of neighborhood socioeconomic status (SES) and racial differences in mortality in United States young adults receiving dialysis. We merged US Renal Data System patient-level data from 11,027 black and white patients ages 18–30 years old initiating dialysis between 2006 and 2009 with US Census data to obtain neighborhood poverty information for each patient. We defined low SES neighborhoods as those neighborhoods in US Census zip codes with ≥20% of residents living below the federal poverty level and quantified race differences in mortality risk by level of neighborhood SES. Among patients residing in low SES neighborhoods, blacks had greater mortality than whites after adjusting for baseline demographics, clinical characteristics, rurality, and access to care factors. This difference in mortality between blacks and whites was significantly attenuated in higher SES neighborhoods. In the United States, survival between young adult blacks and whites receiving dialysis differs by neighborhood SES. Additional studies are needed to identify modifiable factors contributing to the greater mortality among young adult black dialysis patients residing in low SES neighborhoods. PMID:24925723

  2. Single Nucleotide Variants in the Protein C Pathway and Mortality in Dialysis Patients

    PubMed Central

    Ocak, Gürbey; Drechsler, Christiane; Vossen, Carla Y.; Vos, Hans L.; Rosendaal, Frits R.; Reitsma, Pieter H.; Hoffmann, Michael M.; März, Winfried; Ouwehand, Willem H.; Krediet, Raymond T.; Boeschoten, Elisabeth W.; Dekker, Friedo W.; Wanner, Christoph; Verduijn, Marion

    2014-01-01

    Background The protein C pathway plays an important role in the maintenance of endothelial barrier function and in the inflammatory and coagulant processes that are characteristic of patients on dialysis. We investigated whether common single nucleotide variants (SNV) in genes encoding protein C pathway components were associated with all-cause 5 years mortality risk in dialysis patients. Methods Single nucleotides variants in the factor V gene (F5 rs6025; factor V Leiden), the thrombomodulin gene (THBD rs1042580), the protein C gene (PROC rs1799808 and 1799809) and the endothelial protein C receptor gene (PROCR rs867186, rs2069951, and rs2069952) were genotyped in 1070 dialysis patients from the NEtherlands COoperative Study on the Adequacy of Dialysis (NECOSAD) cohort) and in 1243 dialysis patients from the German 4D cohort. Results Factor V Leiden was associated with a 1.5-fold (95% CI 1.1–1.9) increased 5-year all-cause mortality risk and carriers of the AG/GG genotypes of the PROC rs1799809 had a 1.2-fold (95% CI 1.0–1.4) increased 5-year all-cause mortality risk. The other SNVs in THBD, PROC, and PROCR were not associated with 5-years mortality. Conclusion Our study suggests that factor V Leiden and PROC rs1799809 contributes to an increased mortality risk in dialysis patients. PMID:24816905

  3. [99mTc-MAA peritoneal scintigraphy in pleuroperitoneal comunication in peritoneal dialysis patients].

    PubMed

    Hernández Martínez, A C; Marín Ferrer, M D; Coronado Poggio, M; Escabias Del Pozo, C; Coya Viña, J; Martín Curto, L

    2010-01-01

    Peritoneal dialysis is a fully-contrasted alternative for the treatment of end-stage renal disease although it is not exempt of complications. Peritonitis and exit-site infections are among the most frequent complications found. Pleural effusion secondary to pleuroperitoneal communication (PPC) is a serious and uncommon complication in these patients. We present the case of a 50-year old man diagnosed of end-stage renal disease undergoing treatment with peritoneal dialysis who presented progressive dyspnea and right pleural effusion. The peritoneal scintigraphy with (99m)Tc-MAA makes it possible to confirm communication of intraperitoneal dialysis fluid to the pleural cavity. PMID:20117860

  4. Association of dialysis adequacy with nutritional and inflammatory status in patients with chronic kidney failure.

    PubMed

    Hemayati, Roya; Lesanpezeshki, Mahboub; Seifi, Sepideh

    2015-11-01

    The number of patients with dialysis-dependent renal failure has increased in the past years worldwide. Several parameters have been introduced for the quantitative assessment of dialysis adequacy. The National Cooperative Dialysis Study results indicated that Kt/V and time-averaged concentration of urea (TAC) are predictors of mortality in patients who receive maintenance hemodialysis (HD). Also, the protein catabolic ratio (PCR), which is an indicator of nutritional status, can predict patients' mortality. Our aim was to assess the impact of parameters that show dialysis adequacy on indices of nutrition or inflammation. A total of 46 patients were included in the study; eight patients were excluded during the course of the study and 38 patients were enrolled in the final analysis. All patients were receiving HD for at least for three months. HD was administered three times per week and the study lasted for two months. Kt/V, TAC and PCR were assessed at the beginning of the study based on patients' urea and blood urea nitrogen in the first week of our study; these calculations were repeated at the end of the first and second months using the mean of the mentioned values in the month. Both adequacy indices significantly and positively correlated with changes in PCR (P <0.001). However, no significant correlation was detectable between Kt/V and TAC with either body mass index and albumin or C-reactive protein. Based on the Kt/V values, patients with adequate dialysis had slower decrease in the PCR (P <0.001). Our results indicate that adequacy of dialysis is correlated with patients' nutritional status. No correlation was observed between dialysis adequacy and inflammatory status. PMID:26586053

  5. Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study

    PubMed Central

    Krause, Irit; Dagan, Amit; Cleper, Roxana; Falush, Yafa; Davidovits, Miriam

    2016-01-01

    Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995–2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5.27 yrs. (range: 1 month–24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25–17.54 years). Mean follow-up was 13.5 ± 5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90% for patients older than 5 years and 61% for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications. PMID:27597898

  6. Impact of Pediatric Chronic Dialysis on Long-Term Patient Outcome: Single Center Study.

    PubMed

    Levy Erez, Daniella; Krause, Irit; Dagan, Amit; Cleper, Roxana; Falush, Yafa; Davidovits, Miriam

    2016-01-01

    Objective. Owing to a shortage of kidney donors in Israel, children with end-stage renal disease (ESRD) may stay on maintenance dialysis for a considerable time, placing them at a significant risk. The aim of this study was to understand the causes of mortality. Study Design. Clinical data were collected retrospectively from the files of children on chronic dialysis (>3 months) during the years 1995-2013 at a single pediatric medical center. Results. 110 patients were enrolled in the study. Mean age was 10.7 ± 5.27 yrs. (range: 1 month-24 yrs). Forty-five children (42%) had dysplastic kidneys and 19 (17.5%) had focal segmental glomerulosclerosis. Twenty-five (22.7%) received peritoneal dialysis, 59 (53.6%) hemodialysis, and 6 (23.6%) both modalities sequentially. Median dialysis duration was 1.46 years (range: 0.25-17.54 years). Mean follow-up was 13.5 ± 5.84 yrs. Seventy-nine patients (71.8%) underwent successful transplantation, 10 (11.2%) had graft failure, and 8 (7.3%) continued dialysis without transplantation. Twelve patients (10.9%) died: 8 of dialysis-associated complications and 4 of their primary illness. The 5-year survival rate was 84%: 90% for patients older than 5 years and 61% for younger patients. Conclusions. Chronic dialysis is a suitable temporary option for children awaiting renal transplantation. Although overall long-term survival rate is high, very young children are at high risk for life-threatening dialysis-associated complications. PMID:27597898

  7. Successful pregnancy in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy.

    PubMed

    Abu-Zaid, Ahmed; Nazer, Ahmed; Alomar, Osama; Al-Badawi, Ismail A

    2013-01-01

    Frequency of pregnancy among childbearing age women with end-stage renal disease (ESRD) undergoing long-term periodic dialysis ranges from 1% to 7%. Although pregnancy in dialysis women with ESRD is considered a largely high-risk pregnancy, occurrence of successful pregnancy is not impossible with success rates approaching 70%. Rates of successful pregnancy are greatly impacted by early pregnancy diagnosis and preserved residual renal functions. Herein, to the best of our knowledge, we report the first case of successful pregnancy (despite late diagnosis at 14 weeks of gestation) in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy and no whatsoever preserved residual renal function. Moreover, a literature review on pregnancy in dialysis patients is presented. PMID:24198990

  8. Successful Pregnancy in a 31-Year-Old Peritoneal Dialysis Patient with Bilateral Nephrectomy

    PubMed Central

    Nazer, Ahmed; AlOmar, Osama; Al-Badawi, Ismail A.

    2013-01-01

    Frequency of pregnancy among childbearing age women with end-stage renal disease (ESRD) undergoing long-term periodic dialysis ranges from 1% to 7%. Although pregnancy in dialysis women with ESRD is considered a largely high-risk pregnancy, occurrence of successful pregnancy is not impossible with success rates approaching 70%. Rates of successful pregnancy are greatly impacted by early pregnancy diagnosis and preserved residual renal functions. Herein, to the best of our knowledge, we report the first case of successful pregnancy (despite late diagnosis at 14 weeks of gestation) in a 31-year-old peritoneal dialysis patient with bilateral nephrectomy and no whatsoever preserved residual renal function. Moreover, a literature review on pregnancy in dialysis patients is presented. PMID:24198990

  9. Impact of dialysis modality on technique survival in end-stage renal disease patients

    PubMed Central

    Lee, Jong-Hak; Park, Sun-Hee; Lim, Jeong-Hoon; Park, Young-Jae; Kim, Sang Un; Lee, Kyung-Hee; Kim, Kyung-Hoon; Park, Seung Chan; Jung, Hee-Yeon; Kwon, Owen; Choi, Ji-Young; Cho, Jang-Hee; Kim, Chan-Duck; Kim, Yong-Lim

    2016-01-01

    Background/Aims: This study analyzed the risk factors for technique survival in dialysis patients and compared technique survival rates between hemodialysis (HD) and peritoneal dialysis (PD) in a prospective cohort of Korean patients. Methods: A total of 1,042 patients undergoing dialysis from September 2008 to June 2011 were analyzed. The dialysis modality was defined as that used 90 days after commencing dialysis. Technique survival was compared between the two dialysis modalities, and the predictive risk factors were evaluated. Results: The dialysis modality was an independent risk factor predictive of technique survival. PD had a higher risk for technique failure than HD (hazard ratio [HR], 10.8; 95% confidence interval [CI], 1.9 to 62.0; p = 0.008) during a median follow-up of 11.0 months. In the PD group, a high body mass index (BMI) was an independent risk factor for technique failure (HR, 1.3; 95% CI, 1.0 to 1.8; p = 0.036). Peritonitis was the most common cause of PD technique failure. The difference in technique survival between PD and HD was more prominent in diabetic patients with a good nutritional status and in non-diabetic patients with a poor nutritional status. Conclusions: In a prospective cohort of Korean patients with end-stage renal disease, PD was associated with a higher risk of technique failure than HD. Diabetic patients with a good nutritional status and non-diabetic patients with a poor nutritional status, as well as patients with a higher BMI, had an inferior technique survival rate with PD compared to HD. PMID:26767864

  10. Skin Autofluorescence and Mortality in Patients on Peritoneal Dialysis

    PubMed Central

    Mácsai, Emília; Benke, Attila; Kiss, István

    2015-01-01

    Abstract Skin autofluorescence (SAF) is a proven prognostic factor of mortality in hemodialysis patients. Traditional and nontraditional risk factors are almost equivalent in peritoneal dialysis (PD), and cardiovascular disease (CVD) is the leading cause of death. Moreover, peritoneal glucose absorption accelerates the degenerative processes of connective tissues as in diabetes. In our study, we examined the predictive value of SAF for total mortality in the PD population. Data were collected from 198 prevalently adult Caucasian PD patients. One hundred twenty-six patients (mean age 66.2 y, men [n = 73], diabetes ratio 75/126) had anamnestic CVD (coronary heart disease, cerebrovascular disease, peripheral arterial disease). Initially, we evaluated factors affecting SAF and CVD by multivariate linear regression. Survival rates were estimated by recording clinical and demographic data associated with mortality during a 36-month follow-up using the Kaplan–Meier method. Analyses were further stratified based on the presence or absence of CVD and SAF levels above or below the upper tercile 3.61 arbitrary units. Skin autofluorescence was influenced by CVD (P < 0.01, 95% confidence interval [CI] 0.1–0.5) and white blood cell counts (P < 0.001, 95% CI 0.031–0.117). According to the Spearman correlation, SAF correlated with peritoneal cumulative glucose exposure (P = 0.02) and elapsed time in PD (P = 0.008). CVD correlated with age (P < 0.001, 95% CI 1.24–1.65) and diabetes (P < 0.001, 95% CI 2.58–10.66). More deaths were observed in the high SAF group than in the low SAF group (34/68 vs 44/130; P = 0.04). Comparing the CVD(−) low SAF group survival (mean 33.9 mos, standard error [SE] 1.39) to CVD(+) low SAF (mean 30.5 mos, SE 1.37, P = 0.03) and to CVD(+) high SAF group (mean 27.1 mos, SE 1.83, P = 0.001), the difference was significant. In conclusion, among PD patients, SAF values over 3.61 arbitrary units seem to be a

  11. Incidence of stroke before and after dialysis initiation in older patients.

    PubMed

    Murray, Anne M; Seliger, Stephen; Lakshminarayan, Kamakshi; Herzog, Charles A; Solid, Craig A

    2013-06-01

    The incidence of stroke is substantially higher among hemodialysis patients than among patients with earlier stages of CKD, but to what extent the initiation of dialysis accelerates the risk for stroke is not well understood. In this cohort study, we analyzed data from incident hemodialysis and peritoneal dialysis patients in 2009 who were at least 67 years old and had Medicare as primary payer. We noted whether each of the 20,979 hemodialysis patients initiated dialysis as an outpatient (47%) or inpatient (53%). One year before initiation, the baseline stroke rate was 0.15%-0.20% of patients per month (ppm) for both outpatient and inpatient initiators. Among outpatient initiators, stroke rates began rising approximately 90 days before initiation, reached 0.5% ppm during the 30 days before initiation, and peaked at 0.7% ppm (8.4% per patient-year) during the 30 days after initiation. The pattern was similar among inpatient initiators, but the stroke rate peaked at 1.5% ppm (18% per patient-year). For both hemodialysis groups, stroke rates rapidly declined by 1-2 months after initiation, fluctuated, and stabilized at approximately twice the baseline rate by 1 year. Among the 620 peritoneal dialysis patients, stroke rates were slightly lower and variable, but approximately doubled after initiation. In conclusion, these data suggest that the process of initiating dialysis may cause strokes. Further studies should evaluate methods to mitigate the risk for stroke during this high-risk period. PMID:23620399

  12. Incidence of Stroke Before and After Dialysis Initiation in Older Patients

    PubMed Central

    Seliger, Stephen; Lakshminarayan, Kamakshi; Herzog, Charles A.; Solid, Craig A.

    2013-01-01

    The incidence of stroke is substantially higher among hemodialysis patients than among patients with earlier stages of CKD, but to what extent the initiation of dialysis accelerates the risk for stroke is not well understood. In this cohort study, we analyzed data from incident hemodialysis and peritoneal dialysis patients in 2009 who were at least 67 years old and had Medicare as primary payer. We noted whether each of the 20,979 hemodialysis patients initiated dialysis as an outpatient (47%) or inpatient (53%). One year before initiation, the baseline stroke rate was 0.15%–0.20% of patients per month (ppm) for both outpatient and inpatient initiators. Among outpatient initiators, stroke rates began rising approximately 90 days before initiation, reached 0.5% ppm during the 30 days before initiation, and peaked at 0.7% ppm (8.4% per patient-year) during the 30 days after initiation. The pattern was similar among inpatient initiators, but the stroke rate peaked at 1.5% ppm (18% per patient-year). For both hemodialysis groups, stroke rates rapidly declined by 1–2 months after initiation, fluctuated, and stabilized at approximately twice the baseline rate by 1 year. Among the 620 peritoneal dialysis patients, stroke rates were slightly lower and variable, but approximately doubled after initiation. In conclusion, these data suggest that the process of initiating dialysis may cause strokes. Further studies should evaluate methods to mitigate the risk for stroke during this high-risk period. PMID:23620399

  13. Dialysis-related factors affecting quality of life in patients on hemodialysis.

    PubMed

    Anees, Muhammad; Hameed, Farooq; Mumtaz, Asim; Ibrahim, Muhammad; Saeed Khan, Muhammad Nasir

    2011-01-01

    INTRODUCTION. Treatment modalities for end-stage renal disease affect quality of life (QOL) of the patients. This study was conducted to assess the QOL of patients on hemodialysis and compare it with caregivers of these patients. Cause of ESRD and dialysis-related factors affecting QOL were also examined. MATERIALS AND METHODS. This cross-sectional study was conducted on patient on maintenance hemodialysis for more than 3 months at 3 dialysis centers of Lahore. Fifty healthy individuals were included as controls from among the patients' caregivers. The QOL index was measured using the World Health Organization QOL questionnaire, with higher scores corresponding to better QOL of patients. RESULTS. Eighty-nine patients (71.2%) were men, 99 (79.2%) were married, 75 (60.0%) were older than 45 years, and 77 (61.6%) were on dialysis for more than 8 months. Patients on hemodialysis had a poorer QOL as compared to their caregivers in all domains except for domain 4 (environment). There was no difference in the QOL between the three dialysis centers of the study, except for domain 3 (social relationship) of the patients at Mayo Hospital (a public hospital), which was significantly better. Nondiabetic patients had a better QOL in domain 1 (physical health) as compared to diabetic patients. Duration of dialysis had a reverse correlation with the overall QOL. CONCLUSIONS. We found that QOL of hemodialysis patients was poor as compared to caregivers of the patients, especially that of diabetics. Also, duration of dialysis had a reverse correlation with QOL. PMID:21189427

  14. Symptom management in patients with established renal failure managed without dialysis.

    PubMed

    Murtagh, F E M; Addington-Hall, J M; Donohoe, P; Higginson, I J

    2006-01-01

    Increasing numbers of patients with chronic kidney disease Stage 5 (GFR <15ml/minute) are being managed without dialysis, either through their own preference or because dialysis is unlikely to benefit them. This growing group of patients has extensive health care needs. Their overall symptom burden is high, and symptom prevalence matches or exceeds that in other end of life populations, both with cancer and other non-cancer diagnoses. These symptoms may often go unrecognised and under-treated. Regular symptom assessment is necessary, together with pro-active management of identified symptoms. Pain can be managed using the principles of the World Health Organisation analgesic ladder. Not all opioid medications are recommended for these patients. Paracetamol, tramadol, and fentanyl are the most appropriate medications for steps 1, 2 and 3 respectively. There is limited evidence on the use of buprenorphine, oxycodone and hydromorphone. Methadone is safe but should only be prescribed by a clinician experienced in its use. Morphine and diamorphine are not recommended because of metabolite accumulation. Pruritus is also challenging to manage. The evidence for pharmacological interventions to alleviate pruritus is summarized, and a pragmatic approach to management suggested. Emollients, capsaisin cream, antihistamines, thalidomide and ondansetron may be helpful, according to the extent and pattern of pruritus. Symptoms may frequently be due to co-morbid conditions, not renal disease itself, and managing them is difficult because of the constraints on the use of medication which kidney failure imposes. Collaboration between renal and palliative specialists can help identify ways to achieve best care for these patients. PMID:16898102

  15. Frailty and comorbidity are independent predictors of outcome in patients referred for pre-dialysis education

    PubMed Central

    Pugh, Julia; Aggett, Justine; Goodland, Annwen; Prichard, Alison; Thomas, Nerys; Donovan, Kieron; Roberts, Gareth

    2016-01-01

    Background The incidence of chronic kidney disease (CKD) is rising and is likely to continue to do so for the foreseeable future, with the fastest growth seen among adults ≥75 years of age. Elderly patients with advanced CKD are likely to have a higher burden of comorbidity and frailty, both of which may influence their disease outcome. For these patients, treatment decisions can be complex, with the current lack of robust prognostic tools hindering the shared decision-making process. The current study aims to assess the impact of comorbidity and frailty on the outcomes of patients referred for pre-dialysis education. Methods We performed a single-centre study of patients (n = 283) referred for pre-dialysis education between 2010 and 2012. The Charlson Comorbidity Index (CCI) and Clinical Frailty Scale (CFS) were used to assess comorbid disease burden and frailty, respectively. Follow-up data were collected until February 2015. Results The CCI and CFS scores at the time of referral to the pre-dialysis service were independent predictors of mortality. Within the study follow-up period, 76% of patients with a high CFS score at the time of pre-dialysis education had died, with 63% of these patients not commencing dialysis before death. Conclusion A relatively simple frailty scale and comorbidity score could be used to predict survival and better inform the shared decision-making process for patients with advanced kidney disease. PMID:26985387

  16. Geriatric Assessment, Falls and Rehabilitation in Patients Starting or Established on Peritoneal Dialysis.

    PubMed

    Jassal, Sarbjit Vanita

    2015-11-01

    Individuals aged over 70 years at the time of starting dialysis have a varied and often challenging existence on dialysis. Canadian data suggest those starting dialysis between the ages of 75 and 79 years will have an average life expectancy of 3.2 years, while based on US data, patients can expect an average life expectancy of 25 months. A substantial proportion of these patients will, however, experience transient or permanent loss of personal independence within the first few months to years on dialysis. Preliminary data from patients recently started on peritoneal dialysis (PD) suggest patients and families adapt, but that the adaptation often involves limiting activities and altering the social role the patient has within the family. As data emerge, it will be possible to hypothesize whether this adaptation is beneficial in the long term, or whether these adaptations are permissive, allowing the patient to play a sick role leading to an accelerated transition to frailty and possibly death. Future research will hopefully inform us whether the functional dependency can be identified early and whether it is preventable. In the interim, repair rather than prevention is possible through rehabilitation. We therefore advocate that programs providing PD care consider the integration of protocols whereby patients may undergo formal evaluation to identify those who would benefit from walking or personal care aids, rehabilitation interventions, and, when needed, personal support. PMID:26702003

  17. Nocardia asteroides peritoneal dialysis-related peritonitis: First case in pediatrics, treated with protracted linezolid.

    PubMed

    El-Naggari, Mohamed; El Nour, Ibtisam; Al-Nabhani, Dana; Al Muharrmi, Zakaria; Gaafar, Heba; Abdelmogheth, Anas A W

    2016-01-01

    Nocardia asteroides is a rare pathogen in peritoneal dialysis-related peritonitis. We report on a 13-year-old female with Nocardia asteroides peritonitis complicated by an intra-abdominal abscess. Linezolid was administered intravenously for 3 months and followed by oral therapy for an additional 5 months with close monitoring for adverse effects. The patient was discharged after 3 months of hospitalization on hemodialysis. The diagnosis and management of such cases can be problematic due to the slow growth and difficulty of identifying Nocardia species. The optimal duration of treatment for Nocardia peritonitis is not known. Linezolid can be used for prolonged periods in cases of trimethoprim/sulfamethoxazole-resistant cases with close monitoring for adverse effects. PMID:26768669

  18. Psychological characteristics of patients treated by chronic maintenance hemodialysis.

    PubMed

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (p<0.05) as well as with educational level, and negatively with the duration of dialysis. Specific characteristics of personality obtained with MMPI are hypersensitivity, depressive mood, and withdrawal from friends and relatives. More specific emotional traits are the accentuated anxiety, low level of hostility, but very high passive aggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  19. Metachronous urothelial carcinoma of whole urinary tract in a dialysis-dependent patient: A case report

    PubMed Central

    WANG, YIMIN; JIN, BAIYE; YAO, XIAOLIN

    2016-01-01

    Numerous studies have reported an association between end-stage renal disease (ESRD) and malignancy. The predominant malignant tumor that occurs in patients with ESRD in Asian countries is urothelial carcinoma (UC). According to recent research, cases of UC in dialysis-dependent patients are associated with higher recurrence rates and more aggressive biological behavior compared with patients without ESRD. The necessity of 1-step total urinary tract exenteration for dialysis-dependent patients with UC is advocated by certain studies. The current study reports a case of metachronous bladder cancer and bilateral upper urinary tract tumor in a dialysis-dependent patient. Three separate surgeries were performed to remove the bladder, and left and right urinary tract, respectively. The question of whether the stepwise strategy or the 1-step surgery should be selected for such special cases remains in debate. PMID:27313734

  20. Accuracy and limitations of the diagnosis of malnutrition in dialysis patients.

    PubMed

    Kovesdy, Csaba P; Kalantar-Zadeh, Kamyar

    2012-07-01

    Uremic malnutrition, also known as protein-energy wasting (PEW), is a common phenomenon in maintenance dialysis patients and a risk factor for poor clinical outcomes including worse quality of life and increased hospitalization and mortality. The paradoxical association between traditional cardiovascular risk factors and better outcomes in dialysis patients also referred to as "reverse epidemiology," is a good example of the powerful effect-modifying impact of the nutritional status in this population. Measures of food intake, body composition tools, nutritional scoring systems, and laboratory values such as serum albumin are used to diagnose PEW and to assess the degree of severity of PEW without clearly validated diagnostic criteria. Some observational studies suggest that inflammation is a missing link between the PEW and poor clinical outcomes in dialysis patients, although PEW per se may also predispose to illness and inflammation. Ongoing debate as to whether such surrogates as serum albumin or prealbumin concentrations are markers of nutritional status, inflammation, comorbidity, or other conditions has led to confusion and diagnostic and therapeutic nihilism. Irrespective of the cause of hypoalbuminemia in dialysis patients, evidence suggests that nutritional interventions can increase serum albumin in dialysis patients. Hence, we should continue assessing serum albumin and other surrogates of nutritional status to risk-stratify patients and to allocate nutritional therapy, while well-designed, large-scale, randomized, controlled trials of the effects of nutritional intake on clinical outcomes are awaited. PMID:22731746

  1. Factors Associated with the Choice of Peritoneal Dialysis in Patients with End-Stage Renal Disease

    PubMed Central

    Chiang, Pei-Chun; Hou, Jia-Jeng; Jong, Ing-Ching; Hung, Peir-Haur; Hsiao, Chih-Yen

    2016-01-01

    Background. The purpose of this study was to analyze the factors associated with receiving peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) in a hospital in Southern Taiwan. Methods. The study included all consecutive patients with incident ESRD who participated in a multidisciplinary predialysis education (MPE) program and started their first dialysis therapy between January 1, 2008, and June 30, 2013, in the study hospital. We provided small group teaching sessions to advanced CKD patients and their family to enhance understanding of various dialysis modalities. Multivariate logistic regression models were used to analyze the association of patient characteristics with the chosen dialysis modality. Results. Of the 656 patients, 524 (80%) chose hemodialysis and 132 chose PD. Our data showed that young age, high education level, and high scores of activities of daily living (ADLs) were positively associated with PD treatment. Patients who received small group teaching sessions had higher percentages of PD treatment (30.5% versus 19.5%; P = 0.108) and preparedness for dialysis (61.1% versus 46.6%; P = 0.090). Conclusion. Young age, high education level, and high ADL score were positively associated with choosing PD. Early creation of vascular access may be a barrier for PD. PMID:27042665

  2. Factors Associated with the Choice of Peritoneal Dialysis in Patients with End-Stage Renal Disease.

    PubMed

    Chiang, Pei-Chun; Hou, Jia-Jeng; Jong, Ing-Ching; Hung, Peir-Haur; Hsiao, Chih-Yen; Ma, Tsung-Liang; Hsu, Yueh-Han

    2016-01-01

    Background. The purpose of this study was to analyze the factors associated with receiving peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD) in a hospital in Southern Taiwan. Methods. The study included all consecutive patients with incident ESRD who participated in a multidisciplinary predialysis education (MPE) program and started their first dialysis therapy between January 1, 2008, and June 30, 2013, in the study hospital. We provided small group teaching sessions to advanced CKD patients and their family to enhance understanding of various dialysis modalities. Multivariate logistic regression models were used to analyze the association of patient characteristics with the chosen dialysis modality. Results. Of the 656 patients, 524 (80%) chose hemodialysis and 132 chose PD. Our data showed that young age, high education level, and high scores of activities of daily living (ADLs) were positively associated with PD treatment. Patients who received small group teaching sessions had higher percentages of PD treatment (30.5% versus 19.5%; P = 0.108) and preparedness for dialysis (61.1% versus 46.6%; P = 0.090). Conclusion. Young age, high education level, and high ADL score were positively associated with choosing PD. Early creation of vascular access may be a barrier for PD. PMID:27042665

  3. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling

    PubMed Central

    Wares, Joanna R.; Lawson, Barry; Shemin, Douglas; D’Agata, Erika M. C.

    2016-01-01

    Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies. PMID:27195984

  4. Evaluating Infection Prevention Strategies in Out-Patient Dialysis Units Using Agent-Based Modeling.

    PubMed

    Wares, Joanna R; Lawson, Barry; Shemin, Douglas; D'Agata, Erika M C

    2016-01-01

    Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO. We also hypothesize that environmental contamination plays a role in the dissemination of MDRO in the dialysis unit. To address our hypotheses, we built an agent-based model to simulate different treatment strategies in a dialysis unit. Our results suggest that reducing antimicrobial treatment, either by reducing the number of patients receiving treatment or by reducing the duration of the treatment, markedly reduces overall colonization rates and also the levels of environmental contamination in the dialysis unit. Our results also suggest that improving the environmental decontamination efficacy between patient dialysis treatments is an effective method for reducing colonization and contamination rates. These findings have important implications for the development and implementation of future infection prevention strategies. PMID:27195984

  5. Safety of Regular-Dose Imatinib Therapy in Patients with Gastrointestinal Stromal Tumors Undergoing Dialysis

    PubMed Central

    Niikura, Ryota; Serizawa, Takako; Yamada, Atsuo; Yoshida, Shuntaro; Tanaka, Mariko; Hirata, Yoshihiro; Koike, Kazuhiko

    2016-01-01

    The number of cancer patients undergoing dialysis has been increasing, and the number of these patients on chemotherapy is also increasing. Imatinib is an effective and safe therapy for KIT-positive gastrointestinal stromal tumors (GIST), but the efficacy and safety of imatinib in dialysis patients remain unclear. Because clinical trials have not been conducted in this population, more investigations are required. We report on a 75-year-old Japanese man undergoing dialysis who presented with massive tarry stool from a duodenal GIST. The duodenal GIST was 14 cm in diameter with multiple liver and bone metastases. The patient underwent an urgent pancreaticoduodenectomy to achieve hemostasis. After surgery, he was administered imatinib 400 mg/day. No severe adverse event including myelosuppression, congestive heart failure, liver functional impairment, intestinal pneumonia, or Steven-Johnson syndrome occurred, and the liver metastasis remained stable for 4 months. During chemotherapy, hemodialysis continued three times per week without adverse events. We suggest that regular-dose imatinib is an effective and safe treatment in patients with GIST undergoing dialysis. In addition, we present a literature review of the effectiveness and safety of imatinib treatment in dialysis patients. PMID:27403097

  6. Changes in biochemical, hemodynamic, and dialysis adherence parameters in hemodialysis patients during Ramadan.

    PubMed

    Alshamsi, Shaikha; Binsaleh, Fatima; Hejaili, Fayez; Karkar, Ayman; Moussa, Dujana; Raza, Hamad; Parbat, Parkash; Al Suwida, Abdulkareem; Alobaili, Saad; AlSehli, R; Al Sayyari, Abdulla

    2016-04-01

    This paper aimed to study the effect of Ramadan fasting on biochemical and clinical parameters and compliance for dialysis. A prospective multicenter observational cross-sectional study comparing fasting with a non-fasting stable adult hemodialysis patients for demographic and biochemical parameters, compliance with dialysis, inter-dialytic weight gain, pre- and post-blood pressure, and frequency of intradialytic hypotensive episodes was carried out. Six hundred thirty-five patients, of whom 64.1% fasted, were studied. The fasters were younger (53.3 ± 16.2 vs. 58.4 ± 16.1 years; P = 0.001) but had similar duration on dialysis (P = 0.35). More fasters worked (22.0% vs. 14.6%; P = 0.001) and missed dialysis sessions during Ramadan. No differences were noted between groups in sex, diabetic status, or dialysis shift or day. There were no differences in the pre- and post-dialysis blood pressure; serum potassium, albumin or weight gain; diabetic status; sex; and dialysis shift time or days. However, serum phosphorous was significantly higher in the fasting group (2.78 ± 1.8 vs. 2.45 ± 1.6 mmol/L; P = 0.045). There were no intragroup differences in any of the parameters studied when comparing the findings during Ramadan with those in the month before Ramadan. Fasters were significantly younger and more likely to be working, to miss dialysis sessions, and to have higher serum phosphorous levels. No other differences were observed. PMID:26420510

  7. A Rare Reason of Ileus in Renal Transplant Patients With Peritoneal Dialysis History: Encapsulated Peritoneal Sclerosis.

    PubMed

    Gökçe, Ali Murat; Özel, Leyla; İbişoğlu, Sevinç; Ata, Pınar; Şahin, Gülizar; Gücün, Murat; Kara, V Melih; Özdemir, Ebru; Titiz, M İzzet

    2015-12-01

    Encapsulating peritoneal sclerosis is a rare complication of long-term peritoneal dialysis ranging from moderate inflammation of peritoneal structures to severe sclerosing peritonitis and encapsulating peritoneal sclerosis. Complicated it, ileus may occur during or after peritoneal dialysis treatment or after kidney transplant. We sought to evaluate 3 posttransplant encapsulating peritoneal sclerosis through clinical presentation, radiologic findings, and outcomes. We analyzed 3 renal transplant patients with symptoms of encapsulating peritoneal sclerosis admitted posttransplant to our hospital with ileus between 2012 and 2013. Conservative treatment was applied to the patients whenever necessary to avoid surgery. One patient improved with medical therapy. Surgical treatment was delayed and we decided it as a last resort, in 2 cases with no response to conservative treatment for a long time. Finally, patients with peritoneal dialysis history should be searched carefully before renal transplant for intermittent bowel obstruction story. PMID:25343532

  8. Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis

    PubMed Central

    MOLDOVAN, DIANA; RUSU, CRINA; KACSO, INA MARIA; POTRA, ALINA; PATIU, IOAN MIHAI; GHERMAN-CAPRIOARA, MIRELA

    2016-01-01

    Background and aim In spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients. Methods This prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC). Results All-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher

  9. Pleuro-Peritoneal Fistula – An Important Condition to Consider in Patients using Peritoneal Dialysis.

    PubMed

    Shah, Shreena; Robson, Natalie; Sajid, Salman

    2015-01-01

    Pleural effusions are a common finding in patients admitted on the medical take. This case decribes a patient using peritoneal dialysis who presented with progressive dyspnoea. Clinical examination and chest x-ray confirmed the presence of a pleural effusion. Thoracocentesis confirmed a 'sweet' effusion (higher pleural: serum glucose content), suggesting a pleuro-peritoneal leak. Optimal management involved switch from peritoneal to haemodialysis and referral to a specialised renal unit. This case highlights the need to consider the diagnosis of pleuro-peritoneal leak in patients using peritoneal dialysis who present to the acute medical unit with pleural effusion. PMID:26305084

  10. Dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis

    PubMed Central

    2013-01-01

    Background Dialysis disequilibrium syndrome is characterized by neurological symptoms resulting from cerebral edema, which occurs as a consequence of hemodialysis. Dialysis disequilibrium syndrome most often occurs in patients who have just started hemodialysis, during hemodialysis, or soon after hemodialysis; although it may also occur in patients who are under maintenance hemodialysis with pre-existing neurological disease. Case presentation A 70-year-old woman, who had been receiving maintenance hemodialysis for one year, was diagnosed with ovarian cancer by ascites cytological examination. Two years later, she reported severe headache and nausea during hemodialysis and was diagnosed with dialysis disequilibrium syndrome. Although brain images revealed mild hydrocephalus without any mass lesions, poorly differentiated adenocarcinoma cells were detected in her cerebrospinal fluid. These findings indicated that DDS was induced by neoplastic meningitis due to ovarian cancer metastasis. Conclusion Neoplastic meningitis should be considered and excluded in hemodialysis patients with dialysis disequilibrium syndrome and malignancy by cytological examination of the cerebrospinal fluid even if cerebral imaging shows no obvious lesions. This is the first reported case of dialysis disequilibrium syndrome induced by neoplastic meningitis in a patient receiving maintenance hemodialysis. PMID:24238645

  11. Outcome Comparisons Between Patients on Peritoneal Dialysis With and Without Polycystic Kidney Disease

    PubMed Central

    Yang, Ju-Yeh; Chen, Likwang; Chao, Chia-Ter; Peng, Yu-Sen; Chiang, Chih-Kang; Kao, Tze-Wah; Chien, Kuo-Liong; Wu, Hon-Yen; Huang, Jenq-Wen; Hung, Kuan-Yu

    2015-01-01

    Abstract Polycystic kidney disease (PCKD) is the most common hereditary cause of end-stage renal disease. The complications associated with this disease may affect the performance of peritoneal dialysis (PD). The aim of this study was to compare the outcomes between patients on PD with PCKD and without PCKD. We extracted an incident cohort of adult (≥20 years old) patients on long-term PD from the Taiwan National Health Insurance Research Database. Patients with PCKD were identified by specific diagnosis codes. We recorded baseline comorbidities, socioeconomic status, timing of referral to a nephrologist, prior hemodialysis history before PD, and the type of PD modalities. We compared the risk of death, technique failure, peritonitis, hospitalization, and outpatient visiting as well as overall medical expenditure between the patients with PCKD and a groups of patients without PCKD who were propensity-score matched (1:3). The analysis was carried out by various Cox regression models that considered competing risk and time-varying coefficients. We enrolled 139 patients with PCKD and 7739 patients without PCKD who started long-term PD between 1999 and 2010. Patients with PCKD were less comorbid and more often treated with automated PD. In the propensity-score matched analysis, both overall survival and technique survival did not differ between the patients and the result was similar for hospitalization and peritonitis after adjusting for the application of automated PD. Furthermore, the overall annual medical expenditures were similar between the patients with and without PCKD. PD patients with PCKD are comparable to PD patients without PCKD in terms of risk of death, peritonitis, technique failure, and hospitalization in the present study. Furthermore, the medical expenses of the 2 groups after initiation of PD are also indistinguishable. PMID:26632899

  12. Glycemic Control Modifies Difference in Mortality Risk Between Hemodialysis and Peritoneal Dialysis in Incident Dialysis Patients With Diabetes: Results From a Nationwide Prospective Cohort in Korea.

    PubMed

    Lee, Mi Jung; Kwon, Young Eun; Park, Kyoung Sook; Kee, Youn Kyung; Yoon, Chang-Yun; Han, In Mee; Han, Seung Gyu; Oh, Hyung Jung; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae-Hyun; Kim, Yong-Lim; Kim, Yon Su; Yang, Chul Woo; Kim, Nam-Ho; Kang, Shin-Wook

    2016-03-01

    Although numerous studies have tried to elucidate the best dialysis modality in end-stage renal disease patients with diabetes, results were inconsistent and varied with the baseline characteristics of patients. Furthermore, none of the previous studies on diabetic dialysis patients accounted for the impact of glycemic control. We explored whether glycemic control had modifying effect on mortality between hemodialysis (HD) and peritoneal dialysis (PD) in incident dialysis patients with diabetes. A total of 902 diabetic patients who started dialysis between August 2008 and December 2013 were included from a nationwide prospective cohort in Korea. Based on the interaction analysis between hemoglobin A1c (HbA1c) and dialysis modalities for patient survival (P for interaction = 0.004), subjects were stratified into good and poor glycemic control groups (HbA1c< or ≥8.0%). Differences in survival rates according to dialysis modalities were ascertained in each glycemic control group after propensity score matching. During a median follow-up duration of 28 months, the relative risk of death was significantly lower in PD compared with HD in the whole cohort and unmatched patients (whole cohort, hazard ratio [HR] = 0.65, 95% confidence interval [CI] = 0.47-0.90, P = 0.01; patients with available HbA1c [n = 773], HR = 0.64, 95% CI = 0.46-0.91, P = 0.01). In the good glycemic control group, there was a significant survival advantage of PD (HbA1c <8.0%, HR = 0.59, 95% CI = 0.37-0.94, P = 0.03). However, there was no significant difference in survival rates between PD and HD in the poor glycemic control group (HbA1c ≥8.0%, HR = 1.21, 95% CI = 0.46-2.76, P = 0.80). This study demonstrated that the degree of glycemic control modified the mortality risk between dialysis modalities, suggesting that glycemic control might partly contribute to better survival of PD in incident dialysis patients with diabetes. PMID:26986162

  13. Serum vitamin A levels and associated abnormalities in patients on regular dialysis treatment.

    PubMed

    Werb, R; Clark, W F; Lindsay, R M; Jones, E O; Linton, A L

    1979-08-01

    Multivitamin preparations are commonly administered to regular dialysis treatment (RDT) patients. Serum Vitamin A was measured in 72 patients on RDT. Elevated serum Vitamin A levels (102.29 +/- 26.95 microgram/dl [3.57 +/- 0.94 mumoles/l]) were found in the dialysis population (normal 40.98 +/- 6.71 microgram/dl [1.43 +/- 0.23 mumoles/l]; P less than 0.0005). Serum Vitamin A levels increased with duration (months) of dialysis but not with frequency of dialysis (twice or thrice weekly). Patients taking a VitaminA-containing multivitamin preparation had higher serum Vitamin A levels than those on a non-Vitamin A supplemented diet. Bilaterally nephrectomized patients had the highest serum Vitamin A levels while patients with obstructive uropathy had the lowest levels. Serum Vitamin A levels did not correlate with symptoms of uremia. Positive correlations were found with serum levels of calcium, cholesterol and triglycerides. Patients receiving a Vitamin A supplement had higher serum cholesterol levels than non-supplemented patients. Vitamin A might be a factor in the high incidence of cardiovascular disease in RDT patients. We therefore advise discontinuing the long-term administration of Vitamin A-containing multivitamin supplements to patients on RDT. PMID:527272

  14. Peritonitis and catheter exit-site infection in patients on peritoneal dialysis at home1

    PubMed Central

    Abud, Ana Cristina Freire; Kusumota, Luciana; dos Santos, Manoel Antônio; Rodrigues, Flávia Fernanda Luchetti; Damasceno, Marta Maria Coelho; Zanetti, Maria Lúcia

    2015-01-01

    Objective: to analyze the complications related to peritonitis and catheter exit-site infections, in patients on peritoneal dialysis at home. Method: quantitative and cross-sectional study, carried out with 90 patients on peritoneal dialysis at home, in a municipality in the Northeast region of Brazil. For data collection, it was used two structured scripts and consultation on medical records. Descriptive analysis and comparison tests among independent groups were used, considering p<0.05 as level of statistical significance. Results: by comparing the frequency of peritonitis and the length of treatment, it was found that patients over two years of peritoneal dialysis were more likely to develop peritonitis (X²=6.39; p=0.01). The number of episodes of peritoneal catheter exit-site infection showed association with the length of treatment (U=224,000; p=0.015). Conclusion: peritonitis and catheter exit-site infection are associated with the length of treatment. PMID:26487141

  15. Repeated Burkholderia cepacia Peritonitis in a Patient Undergoing Continuous Ambulatory Peritoneal Dialysis

    PubMed Central

    Apostolovic, BL; Velickovic-Radovanovic, RM; Andjelkovic-Apostolovic, MR; Cvetkovic, TP; Dinic, MM; Radivojevic, JD

    2015-01-01

    ABSTRACT Burkholderia cepacia (B cepacia) is a rare opportunistic pathogen in continuous ambulatory peritoneal dialysis (CAPD) peritonitis. We describe the first case of repeated B cepacia CAPD peritonitis, occurring in an outpatient environment, treated with antimicrobial medication without peritoneal catheter removal. B cepacia may lead to repeat infection, therefore, we should insist on catheter removal during each peritonitis episode. PMID:26426187

  16. Improving Outcomes in Patients Receiving Dialysis: The Peer Kidney Care Initiative.

    PubMed

    Wetmore, James B; Gilbertson, David T; Liu, Jiannong; Collins, Allan J

    2016-07-01

    The past decade has witnessed a marked reduction in mortality rates among patients receiving maintenance dialysis. However, the reasons for this welcome development are uncertain, and greater understanding is needed to translate advances in care into additional survival gains. To fill important knowledge gaps and to enable dialysis provider organizations to learn from one another, with the aim of advancing patient care, the Peer Kidney Care Initiative (Peer) was created in 2014 by the chief medical officers of 14 United States dialysis provider organizations and the Chronic Disease Research Group. Areas of particular clinical importance were targeted to help shape the public health agenda in CKD and ESRD. Peer focuses on the effect of geographic variation on outcomes, the implications of seasonality for morbidity and mortality, the clinical significance of understudied disorders affecting dialysis patients, and the debate about how best to monitor and evaluate progress in care. In the realm of geovariation, Peer has provided key observations on regional variation in the rates of ESRD incidence, hospitalization, and pre-ESRD care. Regarding seasonality, Peer has reported on variation in both infection-related and non-infection-related hospitalizations, suggesting that ambient environmental conditions may affect a range of health outcomes in dialysis patients. Specific medical conditions that Peer highlights include Clostridium difficile infection, which has become strikingly more common in patients in the year after dialysis initiation, and chronic obstructive pulmonary disease, the treatments for which have the potential to contribute to sudden cardiac death. Finally, Peer challenges the nephrology community to consider alternatives to standardized mortality ratios in assessing progress in care, positing that close scrutiny of trends over time may be the most effective way to drive improvements in patient care. PMID:27006497

  17. Tumoral calcinosis (Teutschlander disease) in a dialysis patient.

    PubMed

    Binnani, P; Aggarwal, V; Bahadur, M M; Fulara, N

    2008-07-01

    Tumoral calcinosis is an uncommon and severe complication of hemodialysis therapy. It is generally associated with the presence of the high serum calcium-and-phosphorus product. We report here a case of a patient on hemodialysis who presented with progressively increasing, multiple, tumor-like, subcutaneous swellings. These are rare manifestations of extraosseous calcification in uremic patients that are termed as tumoral calcinosis. A 25 year-old male presented with multiple, nodular, painful, cutaneous swellings all over his body that had been progressively increasing over the last four years. He was a known case of chronic glumerulonephritis who was on regular hemodialysis. The patient was investigated and diagnosed as having tumoral calcinosis and was treated with a low calcium dialysate of pure reverse osmosis water. PMID:20142918

  18. The Effects of Aquatic Exercises on Physical Fitness and Muscle Function in Dialysis Patients

    PubMed Central

    Dziubek, Wioletta; Bulińska, Katarzyna; Rogowski, Łukasz; Gołębiowski, Tomasz; Kusztal, Mariusz; Grochola, Monika; Markowska, Dominika; Zembroń-Łacny, Agnieszka; Weyde, Wacław; Klinger, Marian; Woźniewski, Marek

    2015-01-01

    Purpose. The aim of this study was to assess the impact of a 3-month physical training program, conducted in an aquatic environment with end-stage renal disease patients (ESRD), on the physical fitness and functional parameters of the knee joint muscles. Patients and Methods. The study included 20 ESDR patients with mean age 64.2 ± 13.1 y. treated with hemodialysis in Dialysis Center of the University Hospital in Wroclaw. Before and 3 months after the physical training in water, a test was performed to evaluate the physical fitness of each patient; additionally, a measurement was taken of force-velocity parameters. The 3-month training program took place on nonhemodialysis days, in the recreational pool of the University of Physical Education in Wroclaw. Results. After aquatic training cycle, an improvement was observed in all parameters measured using the Fullerton test. The value of peak torque and its relation to body mass increased in the movement of flexors and extensors of left and right lower extremities in all tested velocities. Conclusions. In assessing the physical fitness of studied women, the biggest improvement was achieved in tests assessing the strength of upper and lower extremities as well as lower body flexibility. Higher values of force-velocity parameters are conducive to women achieving better physical fitness test results. PMID:26161421

  19. Low serum testosterone increases mortality risk among male dialysis patients.

    PubMed

    Carrero, Juan Jesús; Qureshi, Abdul Rashid; Parini, Paolo; Arver, Stefan; Lindholm, Bengt; Bárány, Peter; Heimbürger, Olof; Stenvinkel, Peter

    2009-03-01

    Men treated with hemodialysis (HD) have a very poor prognosis and an elevated risk of premature cardiovascular disease (CVD). In the general population, associations between low testosterone concentrations and cardiovascular risk have been suggested. We performed a prospective observational study involving a well characterized cohort of 126 men treated with HD to examine the relationship between testosterone concentration and subsequent mortality during a mean follow-up period of 41 mo. Independent of age, serum creatinine, and sexual hormone binding globulin (SHBG), testosterone levels inversely and strongly associated with the inflammatory markers IL-6 and CRP. Patients with a clinical history of CVD had significantly lower testosterone levels. During follow up, 65 deaths occurred, 58% of which were a result of CVD. Men with testosterone values in the lowest tertile had increased all-cause and CVD mortality (crude hazard ratios [HRs] 2.03 [95% CI 1.24 to 3.31] and 3.19 [1.49 to 6.83], respectively), which persisted after adjustment for age, SHBG, previous CVD, diabetes, ACEi/ARB treatment, albumin, and inflammatory markers, but was lost after adjustment for creatinine. In summary, among men treated with HD, testosterone concentrations inversely correlate with all-cause and CVD-related mortality, as well as with markers of inflammation. Hypogonadism may be an additional treatable risk factor for patients with chronic kidney disease. PMID:19144759

  20. Tailoring dialysis and resuming low-protein diets may favor chronic dialysis discontinuation: report on three cases.

    PubMed

    Piccoli, Giorgina Barbara; Guzzo, Gabriella; Vigotti, Federica Neve; Capizzi, Irene; Clari, Roberta; Scognamiglio, Stefania; Consiglio, Valentina; Aroasio, Emiliano; Gonella, Silvana; Veltri, Andrea; Avagnina, Paolo

    2014-07-01

    Renal function recovery (RFR), defined as the discontinuation of dialysis after 3 months of replacement therapy, is reported in about 1% of chronic dialysis patients. The role of personalized, intensive dialysis schedules and of resuming low-protein diets has not been studied to date. This report describes three patients with RFR who were recently treated at a new dialysis unit set up to offer intensive hemodialysis. All three patients were females, aged 73, 75, and 78 years. Kidney disease included vascular-cholesterol emboli, diabetic nephropathy and vascular and dysmetabolic disease. At time of RFR, the patients had been dialysis-dependent from 3 months to 1 year. Dialysis was started with different schedules and was progressively discontinued with a "decremental" policy, progressively decreasing number and duration of the sessions. A moderately restricted low-protein diet (proteins 0.6 g/kg/day) was started immediately after dialysis discontinuation. The most recent update showed that two patients are well off dialysis for 5 and 6 months; the diabetic patient died (sudden death) 3 months after dialysis discontinuation. Within the limits of small numbers, our case series may suggest a role for personalized dialysis treatments and for including low-protein diets in the therapy, in enhancing long-term RFR in elderly dialysis patients. PMID:24785135

  1. Uric acid: association with rate of renal function decline and time until start of dialysis in incident pre-dialysis patients

    PubMed Central

    2014-01-01

    Background In patients with chronic kidney disease (CKD) hyperuricemia is common. Evidence that hyperuricemia might also play a causal role in vascular disease, hypertension and progression of CKD is accumulating. Therefore, we studied the association between baseline uric acid (UA) levels and the rate of decline in renal function and time until start of dialysis in pre-dialysis patients. Methods Data from the PREPARE-2 study were used. The PREPARE-2 study is an observational prospective cohort study including incident pre-dialysis patients with CKD stages IV-V in the years between 2004 and 2011. Patients were followed for a median of 14.9 months until start of dialysis, kidney transplantation, death, or censoring. Main outcomes were the change in the rate of decline in renal function (measured as estimated glomerular filtration rate (eGFR)) estimated using linear mixed models, and time until start of dialysis estimated using Cox proportional hazards models. Results In this analysis 131 patients were included with a baseline UA level (mean (standard deviation (SD)) of 8.0 (1.79) mg/dl) and a mean decline in renal function of -1.61 (95% confidence interval (CI), -2.01; -1.22) ml/min/1.73 m2/year. The change in decline in GFR associated with a unit increase in UA at baseline was -0.14 (95% CI -0.61;0.33, p = 0.55) ml/min/1.73 m2/year. Adjusted for demography, comorbidities, diet, body mass index (BMI), blood pressure, lipids, proteinuria, diuretic and/or allopurinol usage the change in decline in eGFR did not change. The hazard ratio (HR) for starting dialysis for each mg/dl increase in UA at baseline was 1.08 (95% CI, 0.94;1.24, p = 0.27). After adjustment for the same confounders the HR became significant at 1.26 (95% CI, 1.06;1.49, p = 0.01), indicating an earlier start of dialysis with higher levels of UA. Conclusion Although high UA levels are not associated with an accelerated decline in renal function, a high serum UA level in incident pre-dialysis

  2. Speech and Language Disorders in a Dialysis Encephalopathy Patient and the Effect of Desferrioxamine and Reverse-Osmosis Water Treatment.

    ERIC Educational Resources Information Center

    Lehtihalmes, Matti; And Others

    Dialysis encephalopathy is a progressive neurological disorder occurring after long-term hemodialysis in some renal failure patients. Accumulation of aluminum in the brain is suspected as its cause, and the use of reverse osmosis of the dialysis water and administration of desferrioxamine to the patient have been successful in reducing the…

  3. Selective plasma exchange with dialysis in patients with acute liver failure.

    PubMed

    Nakae, Hajime; Igarashi, Toshiko; Tajimi, Kimitaka

    2012-10-01

    Selective plasma exchange with dialysis is a blood purification therapy in which simple plasma exchange is performed using a selective membrane plasma separator while the dialysate flows out of the hollow fibers. To evaluate the effect of plasma exchange with dialysis, biochemical examination of the blood, for example, the oxidative stress regulation system and interleukin 18 levels, was performed in patients with acute liver failure. We studied four patients with acute liver failure in whom the therapy was performed (nine times in total). The degree of hepatic encephalopathy and interleukin 18 levels decreased significantly after treatment. However, total protein levels did not change significantly. The level of reactive oxygen species and total antioxidant capacity did not change significantly. Plasma exchange with dialysis may be a useful blood purification therapy in cases of acute liver failure in terms of the removal of water-soluble and albumin-bound toxins. PMID:23046372

  4. Depression, anxiety and stress among patients with dialysis and the association with quality of life.

    PubMed

    Bujang, Mohamad A; Musa, Ramli; Liu, Wen J; Chew, Thian F; Lim, Christopher T S; Morad, Zaki

    2015-12-01

    Studies addressing the nature of relationship between psychological symptoms and quality of life among dialysis patients in Malaysia are scarce. Hence, this study is intended to investigate the association between psychological symptoms such as depression, anxiety and stress on the quality of life in dialysis patients. A cross sectional multicentre study was conducted from May to October 2012 at 15 centres that provide haemodialysis and/or peritoneal dialysis. Apart from socio-demographic profile data collection, WHOQOL-BREF and DASS21 questionnaires were administered to study subjects. All three psychological symptoms had significant impact on quality of life domains of physical health, psychological health, social impact, perceived environment and overall quality of life. These findings suggest that subjects with symptoms of depression, anxiety and stress had poorer quality of life than those without, highlighting the negative impact of psychological symptoms. PMID:26549864

  5. Prevention of sudden cardiac death in dialysis patients: drugs, defibrillators or what else.

    PubMed

    Passman, Rod

    2013-01-01

    Death from cardiovascular disease in general and sudden cardiac arrest (SCA) in particular are exponentially proportional to declining renal function and are a major cause of mortality among those with chronic kidney disease (CKD). The greatest risk, however, is reserved for those patients on chronic dialysis. These individuals have an extraordinarily high rate of death, with cardiac disease accounting for 45% and SCA responsible for 25% of all-cause mortality. Once cardiac arrest occurs, survival is extremely poor. Thus, reducing mortality from cardiovascular disease and SCA in dialysis patients is a global health challenge. The main objectives of this review are to elucidate the nature of SCA in the dialysis population, describe possible mechanisms and risk factors, and discuss options for prevention. PMID:23343546

  6. Plasma ghrelin levels in association with left ventricular function and nutritional status in dialysis patients

    PubMed Central

    XU, LIBIN; YU, LEI; CHI, NING; WANG, WENHAO; LIU, GUOPING; SHI, WEI

    2016-01-01

    The present study investigated the association between ghrelin levels and the cardiac function and malnutrition of dialysis patients. The aim was to examine the conducive use of exogenous ghrelin to improve the malnutrition, protect the cardiovascular function with dialysis patients in the future. The study included 30 continuous ambulatory peritoneal dialysis (CAPD) patients and 30 hemodialysis (HD) patients undertaking treatment between March 2013 and March 2014. The control group included a total of 30 healthy physical examinees. The plasma ghrelin levels were measured by the enzyme-linked immunosorbent assay to collect the clinical materials and biochemical parameters. The plasma ghrelin levels were 4.28±1.07, 4.63±1.08 and 2.00±0.48 ng/ml in the CAPD, HD and control groups, respectively, and statistical significance was identified between the three groups; F=75.106, P<0.0001. The plasma ghrelin levels in the CAPD group were positively correlated with left ventricular ejection fraction (LVEF) (r=0.506, P=0.004) and were negatively correlated with body mass index (BMI) (r=−0.556, P=0.001). The plasma ghrelin levels in the CAPD and HD groups were positively correlated with serum creatinine (Scr) and blood urea nitrogen (BUN). In conclusion, the plasma ghrelin levels of patients in the CAPD and HD groups were higher compared to those of the control group, which demonstrated that dialysis patients could not effectively remove the plasma ghrelin. The present study found that the plasma ghrelin levels were positively correlated with LVEF, and high levels of ghrelin will exhibit protective effects on the cardiovascular function of CAPD patients. Plasma ghrelin levels were positively correlated with Scr and BUN levels in CAPD and HD patients, and were negatively correlated with BMI in CAPD patients, which showed that ghrelin was correlated with malnutrition of dialysis patients. PMID:27347404

  7. The Effect of Intradialytic Aerobic Exercise on Dialysis Efficacy in Hemodialysis Patients: A Randomized Controlled Trial

    PubMed Central

    Mohseni, Raheleh; Emami Zeydi, Amir; Ilali, Ehteramosadat; Adib-Hajbaghery, Mohsen; Makhlough, Atieh

    2013-01-01

    Objective This study was conducted to determine the impact of an 8-week intradialytic exercise program (consisting of 15 minutes low-intensity exercise during the first 2 hours of dialysis) on dialysis efficacy. Methods In an open randomized controlled trial, a total of 50 clinically stable hemodialysis patients were enrolled into the study and randomly allocated into two groups: the aerobic exercise group (n=25) and the control group (n=25). Aerobic exercises were done in the intervention group for 15 min/day, three times a week for 2 months. The dialysis efficacy was assessed prior to and at the end of each month of the program. Results The efficacy of dialysis increased at the end of the first month and remained elevated for the duration of the program in the exercise group (p<0.05). Conclusion A simplified aerobic exercise program has increased the efficacy of dialysis and may be considered as a safe, complementary and effective modality for hemodialysis patients. PMID:24044062

  8. Should an Elderly Patient with Stage V CKD and Dementia Be Started on Dialysis?

    PubMed Central

    Ying, Irene; Levitt, Zoe

    2014-01-01

    The burden of cognitive impairment appears to increase with progressive renal disease, such that the prevalence of dementia among those starting dialysis, or those already established on dialysis, is high. The appropriateness of dialysis initiation in this population has been questioned, and current Renal Physician Association guidelines suggest forgoing dialysis in individuals who have dementia and lack awareness of self and environment. Patients are, however, also entitled to equal rights and respect, equal access to health care services, and an opportunity to engage in shared decision-making processes, particularly if there is concern over reversibility of disease. This article discusses, on the basis of principles of beneficence and nonmaleficence, the arguments in favor of and against dialysis use, and the process of determining an appropriate care plan. Factors discussed include the current societal trend toward a technological imperative, premature fatalism, survival benefits, and the implications of providing care to patients who are unable to express their tolerance for symptoms associated with the treatment or lack of treatment. PMID:24235287

  9. Risk factor and cost accounting analysis for dialysis patients in Taiwan.

    PubMed

    Su, Bin-Guang; Tsai, Kai-Li; Yeh, Shu-Hsing; Ho, Yi-Yi; Liu, Shin-Yi; Rivers, Patrick A

    2010-05-01

    According to the 2004 US Renal Data System's annual report, the incidence rate of chronic renal failure in Taiwan increased from 120 to 352 per million populations between 1990 and 2003. This incidence rate is the highest in the world. The prevalence rate, which ranks number two in the world (Japan ranks number one), also increased from 384 to 1630 per million populations. Based on 2005 Taiwan national statistics, there were 52,958 end-stage renal disease (ESRD) patients receiving routine dialysis treatment. This number, which comprised less than 0.2% of the total population and consumed $2.6 billion New Taiwan dollars, was more than 6.12% of the total annual spending of national health insurance during 2005. Dialysis expenditures for patients with ESRD rank the highest among all major injuries (traumas) and diseases. This article identifies and discusses the risk factors associated with consumption of medical resources during dialysis. Instead of using reimbursement data to estimate cost, as seen in previous studies, this study uses cost data within organizations and focuses on evaluating and predicting the resource consumption pattern for dialysis patients with different risk factors. Multiple regression analysis was used to identify 23 risk factors for routine dialysis patients. Of these risk factors, six were associated with the increase of dialysis cost: age (i.e. 75 years old and older), liver function disorder, hypertension, bile-duct disorder, cancer and high blood lipids. Patients with liver function disorder incurred much higher costs for injection medication and supplies. Hypertensive patients incurred higher costs for injection medication, supplies and oral medication. Patients with bile-duct disorder incurred a significant difference in check-up costs (i.e. costs were higher for those aged 75 years and older than those who were younger than 30 years of age). Cancer patients also incurred significant differences in cost of medical supplies. Patients

  10. Carpal tunnel syndrome in hemodialysis patients as a dialysis-related amyloidosis manifestation – incidence, risk factors and results of surgical treatment

    PubMed Central

    Kopeć, Jerzy; Gądek, Artur; Drożdż, Maciej; Miśkowiec, Krzysztof; Dutka, Julian; Sydor, Antoni; Chowaniec, Eve; Sułowicz, Władysław

    2011-01-01

    Summary Background Carpal tunnel syndrome (CTS) is the most common complication of dialysis-related amyloidosis (DRA) developing in patients on long-term dialysis therapy. The aim of this study was to evaluate the incidence of CTS and identify factors influencing the development of CTS in patients on maintenance hemodialysis, as well as results of its surgical treatment. Material/Methods The study included 386 patients, among whom CTS was diagnosed in 40 patients (10.4%) on the basis of signs and physical symptoms, as well as by nerve conduction. The group of patients with CTS and the group of patients without CTS were compared according to age (mean 54.50 vs. 56.48 years) and duration of dialysis treatment. Initial analysis of CTS incidence by sex, presence of anti-HCV antibodies, and location of arterio-venous fistula (AV fistula) was undertaken. Results Duration of dialysis treatment was the statistically significant risk factor for the development of CTS (16.05 vs. 4.51 years; p<0.0001). Among patients treated for a long period on hemodialysis (20–30 years), 100% required surgical release procedures, while 66.66% of those treated for 15–19 years, 42.1% of those treated for 10–14 years, and 1.6% of those treated for less than 10 years. CTS was diagnosed more often in anti-HCV-positive patients as compared with anti-HCV-negative patients (47.5 vs. 6.9%; p<0.0001). No significant differences were found when comparing CTS incidence by sex or between the development of CTS requiring surgical release intervention and location of the AV fistula. Conclusions Surgical release procedure of the carpal tunnel gave good treatment results in patients with CTS. PMID:21873947

  11. Medication reconciliation and therapy management in dialysis-dependent patients: need for a systematic approach.

    PubMed

    Pai, Amy Barton; Cardone, Katie E; Manley, Harold J; St Peter, Wendy L; Shaffer, Rachel; Somers, Michael; Mehrotra, Rajnish

    2013-11-01

    Patients with ESRD undergoing dialysis have highly complex medication regimens and disproportionately higher total cost of care compared with the general Medicare population. As shown by several studies, dialysis-dependent patients are at especially high risk for medication-related problems. Providing medication reconciliation and therapy management services is critically important to avoid costs associated with medication-related problems, such as adverse drug events and hospitalizations in the ESRD population. The Medicare Modernization Act of 2003 included an unfunded mandate stipulating that medication therapy management be offered to high-risk patients enrolled in Medicare Part D. Medication management services are distinct from the dispensing of medications and involve a complete medication review for all disease states. The dialysis facility is a logical coordination center for medication management services, like medication therapy management, and it is likely the first health care facility that a patient will present to after a care transition. A dedicated and adequately trained clinician, such as a pharmacist, is needed to provide consistent, high-quality medication management services. Medication reconciliation and medication management services that could consistently and systematically identify and resolve medication-related problems would be likely to improve ESRD patient outcomes and reduce total cost of care. Herein, this work provides a review of available evidence and recommendations for optimal delivery of medication management services to ESRD patients in a dialysis facility-centered model. PMID:23990162

  12. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study

    PubMed Central

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck’s Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  13. Elderly Peritoneal Dialysis Compared with Elderly Hemodialysis Patients and Younger Peritoneal Dialysis Patients: Competing Risk Analysis of a Korean Prospective Cohort Study.

    PubMed

    Kim, Hyunsuk; An, Jung Nam; Kim, Dong Ki; Kim, Myoung-Hee; Kim, Ho; Kim, Yong-Lim; Park, Ki Soo; Oh, Yun Kyu; Lim, Chun Soo; Kim, Yon Su; Lee, Jung Pyo

    2015-01-01

    The outcomes of peritoneal dialysis (PD) in elderly patients have not been thoroughly investigated. We aimed to investigate the clinical outcomes and risk factors associated with PD in elderly patients. We conducted a prospective observational nationwide adult end-stage renal disease (ESRD) cohort study in Korea from August 2008 to March 2013. Among incident patients (n = 830), patient and technical survival rate, quality of life, and Beck's Depression Inventory (BDI) scores of elderly PD patients (≥65 years, n = 95) were compared with those of PD patients aged ≤49 years (n = 205) and 50~64 years (n = 192); and elderly hemodialysis (HD) patients (n = 315). The patient death and technical failure were analyzed by cumulative incidence function. Competing risk regressions were used to assess the risk factors for survival. The patient survival rate of elderly PD patients was inferior to that of younger PD patients (P<0.001). However, the technical survival rate was similar (P = 0.097). Compared with elderly HD patients, the patient survival rate did not differ according to dialysis modality (P = 0.987). Elderly PD patients showed significant improvement in the BDI scores, as compared with the PD patients aged ≤49 years (P = 0.003). Low albumin, diabetes and low residual renal function were significant risk factors for the PD patient survival; and peritonitis was a significant risk factor for technical survival. Furthermore, low albumin and hospitalization were significant risk factors of patient survival among the elderly. The overall outcomes were similar between elderly PD and HD patients. PD showed the benefit in BDI and quality of life in the elderly. Additionally, the technical survival rate of elderly PD patients was similar to that of younger PD patients. Taken together, PD may be a comparable modality for elderly ESRD patients. PMID:26121574

  14. [Clinical and biological forms of secondary hyperparathyroidism in dialysis patients].

    PubMed

    Jean, Guillaume; Souberbielle, Jean-Claude; Lorriaux, Christie; Mayor, Brice; Hurot, Jean-Marc; Deleaval, Patrick; Chazot, Charles

    2012-02-01

    The diagnosis and treatment of hyperparathyroidism (HPT) are not yet well standardized in chronic renal failure patients. The aim of this study was to identify the main types of HPT on the basis of clinical and biological findings in a haemodialysis population. Between 2004 and 2010, all patients undergoing haemodialysis were observed and treated using the same strategy: conventional therapy with vitamin D supplements, phosphate binders, dialysate calcium adjusted to serum parathyroid hormone (PTH) level and calcitriol analogues (CA), along with regular bone marker analysis. Wherever required, cinacalcet (CC) was administered and parathyroidectomy (PTX) was performed. Of the 520 patients, 158 were classified as having HPT (30%) with a serum PTH level greater than 300 pg/mL. From this population, we identified five main types of HPT: (1) HPT with 'no bone impact' had normal or low bone marker levels (n=28, 17.7%); (2) 'secondary' HPT had elevated bone marker levels, but showed favorable response to CT (n=59, 37.7%); (3) 'tertiary' HPT was accompanied with hypercalcemia and required CC or PTX in case of CT failure (n=11, 6.9%); (4) 'mixed' HPT could not be completely treated with CT and required CC or PTX (n=57, 36%); (5) 'resistant' HPT did not show hypercalcemia, but required PTX after CT and CC failure (n=3, 1.8%). CC was prescribed in 51% cases, CA in 76%, and PTX in 7% of cases. We typified HPT on the basis of physiopathology and stages of HPT progression. Further studies on HPT that focus on bone marker levels are required to establish well-defined treatment strategies. In our study, HPT cases did not show uniform findings in Hémodialyse (HD) patients because of the variation in the stages of the disease at the time of diagnosis. PMID:21741337

  15. Comparing the frequency of hypertension determined by peri-dialysis measurement and ABPM in hemodialysis patients.

    PubMed

    Abbasi, Mohammad-Reza; Lessan-Pezeshki, Mahboob; Najafi, Mohammad-Taghi; Gatmiri, Seyed-Mansour; Karbakhsh, Mojgan; Mohebi-Nejad, Azin

    2014-06-01

    Controlling blood pressure in hemodialysis patients is crucial but not always easy. The most common blood pressure measurement method is peri-dialysis measurement, but due to interdialytic blood pressure fluctuations, we are unsure if it is the proper way for evaluating blood pressure. Some studies have shown the superiority of 24-h ambulatory blood pressure monitoring over peri-dialysis blood pressure measurement. We aimed to compare the consistency of these methods in determining hypertension among hemodialysis patients. We studied 50 patients (mean age: 55.8 years) on regular hemodialysis in Imam Khomeini University Hospital, Tehran, Iran. Peri-dialysis blood pressure and interdialytic 24-h ambulatory blood pressure monitoring were recorded for each patient. Patients' demographic data and peri-dialysis weight were recorded too. All data were analyzed using the PASW Statistics 18.0, SPSS Inc. (Chicago, IL). There was a significant difference between pre-dialysis mean systolic blood pressure (146.1 ± 23.3 mmHg) and mean systolic blood pressure recorded by ambulatory blood pressure monitoring (135.3 ± 19.3 mmHg) (p = 0.001). There was also a significant difference between pre-dialysis mean diastolic blood pressure (83 ± 14 mmHg) and mean diastolic blood pressure recorded by ambulatory blood pressure monitoring (77.3 ± 10 mmHg) (p = 0.003). But the frequencies of hypertension measured with both methods were significantly consistent and the Kappa agreement coefficient was 0.525 (p = 0.001). Considering ambulatory blood pressure monitoring as the gold standard for blood pressure measurement, our recommendation for the best cutoff point to diagnose hypertension, with the highest sensitivity and specificity would be 135/80 mmHg for pre-dialysis blood pressure and 115/70 mmHg for post-dialysis blood pressure. PMID:24502240

  16. [Cardiac arrest in dialysis patients: Risk factors, preventive measures and management in 2015].

    PubMed

    Luque, Yosu; Bataille, Aurélien; Taldir, Guillaume; Rondeau, Éric; Ridel, Christophe

    2016-02-01

    Patients undergoing hemodialysis have a 10 to 20 times higher risk of sudden cardiac arrest (SCA) than the general population. Sudden cardiac death is a rare event (approximately 1 event per 10,000 sessions) but has a very high mortality rate. Epidemiological data comes almost exclusively from North American studies; there is a great lack of European data on the subject. Ventricular arrhythmia is the main mechanism of sudden cardiac deaths in dialysis patients. These patients develop increased sensitivity mainly due to a high prevalence of severe ischemic heart disease and left ventricular hypertrophy and to a frequent trigger event: electrolytic and plasma volume shifts during dialysis sessions. Unfortunately, accurate predictive markers of SCA do not exist, however some primary prevention trials using beta-blockers or angiotensin II receptor blockers are encouraging, while the use of implantable cardioverter defibrillators in the population of chronic dialysis patients remains controversial. Identification of patients at risk, minimizing trigger events such as electrolytic shifts and improving team skills in the diagnosis and initial resuscitation with the latest recommendations from 2010 seem necessary to reduce incidence and improve survival in this high risk population. Organization of European studies would also allow a more accurate view of this reality in our dialysis units. PMID:26547563

  17. The relationships between activation of non-specific inflammatory process and malnutrition in patients on peritoneal dialysis.

    PubMed

    Wójcik, Katarina; Stompór, Tomasz; Krzanowski, Marcin; Miarka, Przemysław; Zdzienicka, Anna; Sułowicz, Wladyslaw

    2007-01-01

    Malnutrition is a frequent complication among patients on chronic peritoneal dialysis and early recognition of malnutrition can be a key factor in successful treatment. The aim of the study was to assess the nutritional status of patients on peritoneal dialysis and to search for the relationships between activation of non-specific inflammatory process and progression of malnutrition. The study group included 60 patients (age 50.4+/-14 years) on peritoneal dialysis for 17.6+/-20 months. Fourty-six patients completed the entire 24-month observation period. Nutritional status was assessed using SGA scale, anthropometric measures, bioimpendance, and several biochemical parameters. Inflammatory markers included: IL-6, TNFalpha, fibrinogen and CRP. Severe malnutrition was observed in the range between 8.4% (5 subjects, group C in SGA scale) to 11.7% (7 subjects, BMI <20 kg/m2) of patients. The nutritional status of the entire cohort was constant over 2 years of observation (based on SGA scale), although the mean albumin level decreased significantly after 24 months of observation (from 39.55+/-3.5 to 37.63+/-3.7 g/l; p<0.01). The mean concentrations of CRP (4.8 and 5.25 mg/l), IL-6 (3.45 and 6.8 pg/ml) and leptin (22.95 and 22.2 ng/ml) were above reference ranges both at the initial and final assessment. Moreover, the concentration of IL-6 significantly increased (p<0.001) after 24 months of observation. Patients treated with PD are frequently affected by malnutrition. Our results indicate a strong association between nutritional indices and markers of inflammation. PMID:18928174

  18. Considerations in Starting a Patient with Advanced Frailty on Dialysis: Complex Biology Meets Challenging Ethics

    PubMed Central

    2013-01-01

    Summary Nephrologists have focused on the uremic syndrome as an indication for dialysis. The elderly frail renal patient approaching ESRD represents a complex biologic system that is already failing. This patient phenotype exhibits progressive geriatric disabilities and dependence interspersed with shrinking periods of stability regardless of whether dialysis is started. Consequently, the frail renal patient faces challenging treatment choices underpinned by ethical tensions. Identifying the advanced frail renal patient and optimizing the shared decision-making process will enable him or her to make well informed choices based on an understanding of his or her overall condition and personal values and preferences. This approach will also permit nephrologists to fulfill their ethical obligations to respect patient autonomy, promote patient benefit, and minimize patient harm. PMID:23788617

  19. Combination therapy with daclatasvir and asunaprevir for dialysis patients infected with hepatitis C virus.

    PubMed

    Sato, Ken; Yamazaki, Yuichi; Ohyama, Tatsuya; Kobayashi, Takeshi; Horiguchi, Norio; Kakizaki, Satoru; Kusano, Motoyasu; Yamada, Masanobu

    2016-03-16

    The standard antiviral therapy for dialysis patients infected with hepatitis C virus (HCV) is (pegylated) interferon monotherapy, but its efficacy is insufficient. Oral direct-acting antiviral agents (DAAs) have recently been developed for chronic hepatitis C patients. However, some DAAs have contraindications for chronic renal failure (CRF). Daclatasvir and asunaprevir are metabolized largely in the liver and are not contraindicated in CRF. Combination therapy with daclatasvir and asunaprevir was used for 4 dialysis patients infected with genotype 1b HCV. One patient had viral breakthrough, and the 3 others had sustained virological response 12. One patient was admitted for heart failure and percutaneous coronary intervention due to concomitant ischemic disease. Heart failure was unlikely to be caused by the combination therapy, as it was probably due to water overload. The patient continued to receive the combination therapy after the remission of the heart failure. The combination therapy was well tolerated in the other patients. PMID:26989674

  20. Combination therapy with daclatasvir and asunaprevir for dialysis patients infected with hepatitis C virus

    PubMed Central

    Sato, Ken; Yamazaki, Yuichi; Ohyama, Tatsuya; Kobayashi, Takeshi; Horiguchi, Norio; Kakizaki, Satoru; Kusano, Motoyasu; Yamada, Masanobu

    2016-01-01

    The standard antiviral therapy for dialysis patients infected with hepatitis C virus (HCV) is (pegylated) interferon monotherapy, but its efficacy is insufficient. Oral direct-acting antiviral agents (DAAs) have recently been developed for chronic hepatitis C patients. However, some DAAs have contraindications for chronic renal failure (CRF). Daclatasvir and asunaprevir are metabolized largely in the liver and are not contraindicated in CRF. Combination therapy with daclatasvir and asunaprevir was used for 4 dialysis patients infected with genotype 1b HCV. One patient had viral breakthrough, and the 3 others had sustained virological response 12. One patient was admitted for heart failure and percutaneous coronary intervention due to concomitant ischemic disease. Heart failure was unlikely to be caused by the combination therapy, as it was probably due to water overload. The patient continued to receive the combination therapy after the remission of the heart failure. The combination therapy was well tolerated in the other patients. PMID:26989674

  1. Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis.

    PubMed

    Ha, Il-Soo; Yap, Hui K; Munarriz, Reyner L; Zambrano, Pedro H; Flynn, Joseph T; Bilge, Ilmay; Szczepanska, Maria; Lai, Wai-Ming; Antonio, Zenaida L; Gulati, Ashima; Hooman, Nakysa; van Hoeck, Koen; Higuita, Lina M S; Verrina, Enrico; Klaus, Günter; Fischbach, Michel; Riyami, Mohammed A; Sahpazova, Emilja; Sander, Anja; Warady, Bradley A; Schaefer, Franz

    2015-09-01

    In dialyzed patients, preservation of residual renal function is associated with better survival, lower morbidity, and greater quality of life. To analyze the evolution of residual diuresis over time, we prospectively monitored urine output in 401 pediatric patients in the global IPPN registry who commenced peritoneal dialysis (PD) with significant residual renal function. Associations of patient characteristics and time-variant covariates with daily urine output and the risk of developing oligoanuria (under 100 ml/m(2)/day) were analyzed by mixed linear modeling and Cox regression analysis including time-varying covariates. With an average loss of daily urine volume of 130 ml/m(2) per year, median time to oligoanuria was 48 months. Residual diuresis significantly subsided more rapidly in children with glomerulopathies, lower diuresis at start of PD, high ultrafiltration volume, and icodextrin use. Administration of diuretics significantly reduced oligoanuria risk, whereas the prescription of renin-angiotensin system antagonists significantly increased the risk oligoanuria. Urine output on PD was significantly associated in a negative manner with glomerulopathies (-584 ml/m(2)) and marginally with the use of icodextrin (-179 ml/m(2)) but positively associated with the use of biocompatible PD fluid (+111 ml/m(2)). Children in both Asia and North America had consistently lower urine output compared with those in Europe perhaps due to regional variances in therapy. Thus, in children undergoing PD, residual renal function depends strongly on the cause of underlying kidney disease and may be modifiable by diuretic therapy, peritoneal ultrafiltration, and choice of PD fluid. PMID:25874598

  2. Risk factors for loss of residual renal function in children treated with chronic peritoneal dialysis

    PubMed Central

    Ha, Il-Soo; Yap, Hui K; Munarriz, Reyner L; Zambrano, Pedro H; Flynn, Joseph T; Bilge, Ilmay; Szczepanska, Maria; Lai, Wai-Ming; Antonio, Zenaida L; Gulati, Ashima; Hooman, Nakysa; van Hoeck, Koen; Higuita, Lina M S; Verrina, Enrico; Klaus, Günter; Fischbach, Michel; Riyami, Mohammed A; Sahpazova, Emilja; Sander, Anja; Warady, Bradley A; Schaefer, Franz

    2015-01-01

    In dialyzed patients, preservation of residual renal function is associated with better survival, lower morbidity, and greater quality of life. To analyze the evolution of residual diuresis over time, we prospectively monitored urine output in 401 pediatric patients in the global IPPN registry who commenced peritoneal dialysis (PD) with significant residual renal function. Associations of patient characteristics and time-variant covariates with daily urine output and the risk of developing oligoanuria (under 100 ml/m2/day) were analyzed by mixed linear modeling and Cox regression analysis including time-varying covariates. With an average loss of daily urine volume of 130 ml/m2 per year, median time to oligoanuria was 48 months. Residual diuresis significantly subsided more rapidly in children with glomerulopathies, lower diuresis at start of PD, high ultrafiltration volume, and icodextrin use. Administration of diuretics significantly reduced oligoanuria risk, whereas the prescription of renin–angiotensin system antagonists significantly increased the risk oligoanuria. Urine output on PD was significantly associated in a negative manner with glomerulopathies (−584 ml/m2) and marginally with the use of icodextrin (−179 ml/m2) but positively associated with the use of biocompatible PD fluid (+111 ml/m2). Children in both Asia and North America had consistently lower urine output compared with those in Europe perhaps due to regional variances in therapy. Thus, in children undergoing PD, residual renal function depends strongly on the cause of underlying kidney disease and may be modifiable by diuretic therapy, peritoneal ultrafiltration, and choice of PD fluid. PMID:25874598

  3. Sexual dysfunction in dialysis patients: does vitamin D deficiency have a role?

    PubMed Central

    Kidir, Veysel; Altuntas, Atila; Inal, Salih; Akpinar, Abdullah; Orhan, Hikmet; Sezer, Mehmet Tugrul

    2015-01-01

    Introduction: Sexual dysfunction and vitamin D deficiency are highly prevalent in dialysis patients. Low levels of vitamin D have been linked to many diseases. To the best of our knowledge, the relationship between vitamin D and sexual dysfunction in dialysis patients has not been previously reported in the literature. Materials and methods: Cholecalciferol, 50,000 IU/week, was orally administered to 37 dialysis patients with vitamin D insufficiency for 3 months followed by dosage of 10,000 IU every other week for 3 months. The Arizona Sexual Experiences Scale (ASEX), Hospital Anxiety and Depression Scale and Pittsburgh Sleep Quality Index questionnaires were filled out by all patients at baseline and at the sixth month of the study. Results: Sexual dysfunction, poor sleep quality, anxiety and depression rates were 83.7%, 45.9%, 18.9% and 48.6%, respectively in all patients. ASEX total score was found to be positively correlated with age and was negatively correlated with serum 25(OH)D level and serum albumin level. After cholecalciferol treatment, 25(OH)D levels increased significantly, however no significant change was observed in any of the parameters. In multivariate linear regression analysis, age and 25(OH)D level were found to be independent predictors of ASEX total score. Conclusions: Vitamin D deficiency seems to contribute to sexual dysfunction in dialysis patients. However, it was observed in this study that; cholecalciferol replacement given to dialysis patients with vitamin D insufficiency did not result in any significant changes in sexual functions. PMID:26885232

  4. Comparative Study of Outcomes among Patients with Polycystic Kidney Disease on Hemodialysis and Peritoneal Dialysis.

    PubMed

    Yang, Ju-Yeh; Chen, Likwang; Chao, Chia-Ter; Peng, Yu-Sen; Chiang, Chih-Kang; Kao, Tze-Wah; Chien, Kuo-Liong; Wu, Hon-Yen; Huang, Jenq-Wen; Hung, Kuan-Yu

    2015-01-01

    Polycystic kidney disease (PCKD) is the most common hereditary cause of end-stage renal disease, the complications of which may prevent the choice of peritoneal dialysis (PD). The aim of this study was to explore the effects of dialysis modality on outcomes in patients with PCKD. We extracted a cohort of 1417 adult patients with PCKD initiating long-term dialysis therapy in 1999-2010 from the Taiwan National Health Insurance Research Database, among which 125 patients chose PD. The patients on HD were older and had a higher comorbidity index compared to those on PD. We compared the risks for death, hospitalization and medical expenditures between the patients on PD and propensity-score matched patients on hemodialysis (HD). The overall survival did not differ between the patients on PD and HD. The patients on PD tended to have higher hazard ratios (HR) for the first episode of hospitalization (adjusted HR 1.34 [95% CI, 1.04-1.79]). The annual medical expenses were 10% lower for the patients on PD. PD is an equivalent choice of renal replacement therapy to HD for patients with PCKD in terms of survival. Although the patients on PD had a higher risk for hospitalization, the medical expenditure for PD was 10% lower. PMID:26245766

  5. Laboratory diagnosis of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis

    PubMed Central

    Fenton, Patricia

    1982-01-01

    A simple laboratory method for culture of continuous ambulatory peritoneal dialysis (CAPD) fluids is described. Guidelines for antimicrobial therapy are discussed based on results from 18 patients studied over an 11-week period. Cephalosporins appeared to be a rational choice for therapy while awaiting laboratory results. PMID:6754760

  6. HEALTH EFFECTS ASSOCIATED WITH SUBLETHAL EXPOSURE TO MICROCYSTINS AMONG DIALYSIS PATIENTS, BRAZIL, 2001-2002

    EPA Science Inventory

    Background: During winter 2001-2002, an episode of microcystin exposure occurred among dialysis patients in Rio de Janiero, Brazil. During late November 2001, a cyanobacterial water bloom was detected in the Funil reservoir and the Guandu River, both of which supply drinking wate...

  7. Dietary Restrictions in Dialysis Patients: Is There Anything Left to Eat?

    PubMed Central

    Kalantar-Zadeh, Kamyar; Brown, Amanda; Chen, Joline L. T.; Kamgar, Mohammad; Lau, Wei-Ling; Moradi, Hamid; Rhee, Connie M.; Streja, Elani; Kovesdy, Csaba P.

    2015-01-01

    A significant number of dietary restrictions are imposed traditionally and uniformly on maintenance dialysis patients, whereas there is very little data to support their benefits. Recent studies indicate that dietary restrictions of phosphorus may lead to worse survival and poorer nutritional status. Restricting dietary potassium may deprive dialysis patients of heart-healthy diets and lead to intake of more atherogenic diets. There is little data about the survival benefits of dietary sodium restriction, and limiting fluid intake may inherently lead to lower protein and calorie consumption, when in fact dialysis patients often need higher protein intake to prevent and correct protein-energy wasting. Restricting dietary carbohydrates in diabetic dialysis patients may not be beneficial in those with burnt-out diabetes. Dietary fat including omega-3 fatty acids may be important caloric sources and should not be restricted. Data to justify other dietary restrictions related to calcium, vitamins and trace elements are scarce and often contradictory. The restriction of eating during hemodialysis treatment is likely another incorrect practice that may worsen hemodialysis induced hypoglycemia and nutritional derangements. We suggest careful relaxation of most dietary restrictions and adoption of a more balanced and individualized approach, thereby easing some of these overzealous restrictions that have not been proven to offer major advantages to patients and their outcomes and which may in fact worsen patients’ quality of life and satisfaction. This manuscript critically reviews the current paradigms and practices of recommended dietary regimens in dialysis patients including those related to dietary protein, carbohydrate, fat, phosphorus, potassium, sodium, and calcium, and discusses the feasibility and implications of adherence to ardent dietary restrictions. PMID:25649719

  8. Preliminary evaluation of a microbial fuel cell treating artificial dialysis wastewater using graphene oxide

    NASA Astrophysics Data System (ADS)

    Goto, Yuko; Yoshida, Naoko

    2016-02-01

    Artificial dialysis wastewater (ADWW) generally contains 800-2,200 mg L-1 of organic matter. Prior to its discharge to the sewage system, ADWW must be treated in order to reduce organic matter to less than 600 mg L-1. This study assesses the applicability of a microbial fuel cell (MFC) to the reduction of organic matter in ADWW as an alternative pre-treatment system to aeration. In the MFC, conductive floccular aggregates microbially produced from graphene oxide (GO-flocs) were applied as an anode material in the MFC. The GO-flocs were obtained by anaerobic incubation of graphene oxide (GO) with microorganisms in ADWW at 28 °C for a minimum of 10 days. During incubation, GO in the mixture was transformed into black conductive floccular aggregates having 0.12 mS cm-1, suggesting the microbial reduction of GO to the reduced form. The produced GO-flocs were then used as the anode material in a cylindrical MFC, which was filled with ADWW and covered with a floating, platinum (Pt)-coated carbon cathode. The MFC was polarized via an external resistance of 10 Ω and applied for 120 days by replacing half of the supernatant of the MFC with fresh ADWW, every 6-9 days. As a result, the MFC achieved a 128 mg L-1 d-1 chemical oxygen demand (CODCr) removal rate. For example, the MFC contained 1,500 mg-CODCr L-1 just after replacement, with this concentration being reduced to 1,000 mg-CODCr L-1 after 6-9 days of incubation. At the same time, the MFC showed an average power density of 28 mW m-2 and a maximum power density of 291 mW m-2. These results suggest that a MFC packed with GO-flocs can be used as an alternative biotreatment system, replacing the energy-intensive aeration process.

  9. Moderator's view: Pretransplant weight loss in dialysis patients: cum grano salis.

    PubMed

    Sever, Mehmet Sukru; Zoccali, Carmine

    2015-11-01

    A high Body Mass Index (BMI) predicts delayed graft function, all cause and cardiovascular death after transplantation but such risk excess is apparently confined to patients included in studies performed before 2000. Perhaps with the exception of morbid obesity (BMI > 40), clinical outcomes in transplanted obese patients are definitely better than in listed dialysis patients who don't receive a renal transplant. Furthermore the new Scientific Registry of Transplant Recipients (SRTR) risk calculator incorporates BMI into the prediction model of the global risk for the graft's and patient's survival appropriately framing the risk of obesity in a multidimensional risk context. In the aggregate, available knowledge suggests that clinical decisions on weight loss before transplantation should be context specific. Renal transplant patients from living donors have substantial better survival in comparison to well matched dialysis patients listed for the same intervention at all BMI categories. Therefore renal transplantation in obese patients with a living donor may be prioritized. The attitude of fully informed obese patients at accepting the risk driven by transplantation, the experience of the surgical team with obese patients (including also robotic surgery) are of obvious importance. Renal transplantation should be timely considered when reasonable attempts at weight loss failed or appear overtly unrealistic. Transplantation in morbidly obese patients with BMI > 40, a category where the survival advantage of transplantation vs dialysis is probably small and still uncertain, particularly so in African-Americans, should be deferred until significant weight loss is achieved. PMID:26359198

  10. Should we screen for coronary artery disease in asymptomatic chronic dialysis patients?

    PubMed

    De Vriese, An S; Vandecasteele, Stefaan J; Van den Bergh, Barbara; De Geeter, Frank W

    2012-01-01

    The hemodialysis population is characterized by a high prevalence of 'asymptomatic' coronary artery disease (CAD), which should be interpreted differently from asymptomatic disease in the general population. A hemodynamically significant stenosis may not become clinically apparent owing to impaired exercise tolerance and autonomic neuropathy. The continuous presence of silent ischemia may cause heart failure, arrhythmias, and sudden death. Whether revascularization of an asymptomatic dialysis patient improves outcome remains a moot point, although several observational studies and one small RCT suggest a benefit. It can therefore be defended to screen asymptomatic dialysis patients for CAD. A number of noninvasive screening tests are available, but none has proved equally practical and reliable in the dialysis population as in the general population. Myocardial perfusion scintigraphy (MPS) before and after a pharmacological stress such as dipyridamole can reveal both ischemia and myocardial scarring. When compared with coronary angiography, low sensitivities were reported and attributed to impaired vasodilation to dipyridamole in dialysis patients. A more likely explanation is that not every anatomical stenosis will lead to impaired coronary blood flow on MPS. Numerous studies have shown an incremental prognostic value of dipyridamole-MPS over clinical data for prediction of adverse cardiac events, in some studies even over coronary angiography. Pending the availability of high-quality evidence, in our opinion asymptomatic dialysis patients could undergo dipyridamole-MPS, followed by coronary angiography in case of an abnormal scan. This combined physiological and anatomical evaluation of the coronary circulation allows us to determine which coronary stenosis is clinically relevant and therefore should be revascularized. PMID:21956188