Chronic Peritoneal Dialysis Patients Research Articles

Design of the standardizing care to improve outcomes in pediatric end stage renal disease collaborative.

The Standardizing Care to Improve Outcomes in Pediatric End Stage Renal Disease (SCOPE) Collaborative is a North American multi-center quality transformation effort whose primary aim is to minimize exit-site infection and peritonitis rates among pediatric chronic peritoneal dialysis patients. The project, developed by the quality improvement faculty and staff at the Children's Hospital Association's Quality Transformation Network (QTN) and content experts in pediatric nephrology and pediatric infectious diseases, is modeled after the QTN's highly successful Pediatric Intensive Care Unit and Hematology-Oncology central line-associated blood-stream infection (CLABSI) Collaboratives. Like the Association's other QTN efforts, the SCOPE Collaborative is part of a broader effort to assist pediatric nephrology teams in learning about and using quality improvement methods to develop and implement evidence-based practices. In addition, the design of this project allows for targeted research that builds on high-quality, ongoing data collection. Finally, the project, while focused on reducing peritoneal dialysis catheter-associated infections, will also serve as a model for future pediatric nephrology projects that could further improve the quality of care provided to children with end stage renal disease.

Comparison of exit site infection and peritonitis incidences between povidone-iodine and normal saline use for chronic exit site care in peritoneal dialysis patients

BackgroundCatheter-related exit site infection is a major risk factor for the development of peritonitis and can contribute to failure of treatment maintenance in peritoneal dialysis (PD) patients. Although povidone-iodine can be used for exit site care, the irritation induced by the local application of povidone-iodine could lead to secondary infection. Therefore, we evaluated the clinical effectiveness of normal saline compared with povidone-iodine as a method of exit site care in chronic PD patients. MethodsIn all, 126 patients undergoing PD treatment for>6 months between January 2006 and December 2009 were enrolled. Data were retrospectively analyzed for the incidence of exit site infection and peritonitis for 2 years prior to and after December 2007. In addition, we identified the incidences of catheter-related infections during follow-ups from January 2010 to December 2013. ResultsThe participants׳ mean age was 58.8±12.9 years. The incidences of exit site infection and peritonitis were one episode per 64.6 patients–months and one episode per 40.4 patients–months in the povidone-iodine group, respectively, whereas these were one episode per 57.5 patients–months and one episode per 45.6 patients–months in the normal saline group, respectively. Whereas Gram-positive bacteria most frequently caused catheter-related infections in both groups, culture-negative infections were dominant in the normal saline group. ConclusionExit site care using normal saline did not increase the incidence of exit site infection and peritonitis. Therefore, normal saline may be an alternative treatment for exit site care in patients receiving PD.

Association between blood cadmium levels and malnutrition in peritoneal dialysis

BackgroundMalnutrition is associated with an increased risk of cardiovascular death and may cause protein-energy wasting in individuals with chronic kidney disease. A previous study demonstrated that blood cadmium levels (BCLs) were associated with malnutrition in maintenance hemodialysis (MHD) patients. However, the correlation between cadmium exposure and malnutrition remains unclear in chronic peritoneal dialysis (CPD) patients. This study examined the possible adverse effects of environmental cadmium exposure in CPD patients.MethodsA total of 301 CPD patients were enrolled and divided into 3 study groups based on the following BCL tertiles: low (<0.19 μg/L), middle (0.19–0.39 μg/L), and high (>0.39 μg/L). Demographic, hematological, biochemical, and dialysis-related data were obtained for analysis. The analysis also included values of nutritional and inflammatory markers.ResultsThe BCLs of CPD patients were lower than those of MHD patients. At baseline, patients in the high BCL group were older and had a higher prevalence of diabetes mellitus but lower serum albumin, creatinine, and phosphate levels than the patients in the other 2 groups. After adjusting for potential variables, stepwise backward multiple linear regression analysis revealed that age and alanine aminotransferase levels were positively associated with logarithmic transformation of BCLs (log BCLs), while serum albumin levels were negatively associated with log BCLs in CPD patients. The log BCLs were a significant determinant (beta coefficient ± standard error = -0.185 ± 0.074; P = 0.013) of nutritional status and significantly associated with the presence of malnutrition (odds ratio = 2.64; 95% confidence interval: 1.07–6.48; P = 0.035) in CPD patients after adjustment for related variables.ConclusionsBCL is significantly associated with nutritional status and malnutrition in CPD patients. Therefore, it is important for CPD patients to avoid environmental exposure to cadmium such as through smoking and consumption of cadmium-rich foods.

The relationship between apelin and cardiac parameters in patients on peritoneal dialysis: is there a new cardiac marker?

BackgroundMany markers have been proposed for CVD risk assessment in dialysis population. Apelin is a peptide that has roles in cardiovascular functions and volume regulation namely vasodilation, decreased blood pressure (BP), positive inotropic effect and inhibition of antidiuretic hormone release. The aim of this study was to examine relationship of apelin levels with echocardiographic findings and laboratory parameters related with cardiovascular function and bone mineral metabolism among peritoneal dialysis (PD) patients.MethodsThis is a cross-sectional study in which chronic PD patients aged between 18 and 80 without active cardiac, infectious or malignant diseases and hypervolemia have been included. Apelin-36 levels and echocardiographic findings were recorded as well as clinical and laboratory data.ResultsOf the 53 patients, the mean age and female/male ratio was 52.8 ± 15.3 years and 30/23, respectively. Mean apelin level was 1.45 ± 0.37 ng/ml. Gender, drugs (renin-angiotensin-aldosteron inhibitors, statins), presence of left ventricular hypertrophy, diabetes mellitus, hypertension, hyperlipidemia and significant residual renal function did not affect apelin-36 levels. Apelin-36 was correlated negatively with age and left atrium diameter; and positively with diastolic BP, ejection fraction (EF), total cholesterol, LDL-cholesterol, HDL-cholesterol, parathyroid hormone and alkaline phosphatase (ALP) levels. Diastolic BP, LDL-cholesterol, ALP and EF were found to be the independent determinants of apelin-36 levels with linear regression analysis.ConclusionsApelinergic system has important roles in volume regulation, cardiovascular functions, lipid metabolism and bone mineral disorders in PD patients. Prospective studies with large population are required.

VAP-1 in peritoneally dialyzed patients

VAP-1 (vascular adhesion protein-1) possesses semicarbazide-sensitive amine oxidase (SSAO) activity. It has also been found that serum VAP-1 was elevated in acute and chronic hyperglycemia and in patients with diabetes as well as in chronic kidney disease. Renalase, with possible monoamine oxidase activity, which breaks down catecholamines such as SSAO, is expressed in the endothelium as well as in the kidney. The aim of the study was to assess serum VAP-1 levels in peritoneally dialyzed (PD) patients and factors explaining its variability. This pilot study was performed on 25 peritoneally dialyzed patients, including 4 patients with type 2 diabetes. We found that the mean VAP-1 was significantly higher in chronic ambulatory peritoneal dialysis (CAPD) patients when compared to the control group (p<0.05). Dopamine was significantly lower in PD patients when compared to the healthy volunteers (p<0.05), whereas noradrenaline was significantly higher in PD patients relative to the healthy volunteers (p<0.01). There was a significant difference in the VAP-1 concentration in the group with and without residual renal function (p<0.05) as well as between 10 patients with hyperglycemia when compared to patients with normoglycemia (p<0.05). There was no effect of gender on the serum VAP-1 levels. In PD patients VAP-1 correlated with systolic blood pressure (r=-0.4, p<005), residual renal function (r=-0.62, p<0.05), and glucose (=0.54, p<0.05). We concluded that VAP-1, elevated in patients on PD, was predominantly dependent on residual kidney function and glucose level, factors both linked to endothelial damage and cardiovascular complications.

The Factors Effective on Bone Mineral Density in Peritoneal Dialysis Patients

Bone mineral metabolism deteriorates gradually beginning from the early stages of chronic kidney disease (CKD). But, the KDIGO-2009 guideline could not provide high quality data regarding the biochemical tests related with bone mineral disorder in CKD. The aim of our study was to analyse the relationship between bone mineral densitometry and clinical and biochemical parameters in chronic peritoneal dialysis (PD) patients. Besides the demographic parameters, routine hematological and biochemical analysis results of PD patients followed up in our clinic were recorded. Bone mineral density (BMD) was measured at lumbar vertebrae and femur neck using DEXA machine. The mean lumbar T- and femur T-score were -1.03±1.20 (minimum:-3.73; maximum:+1.75) and -2.49±1.20 (minimum:-4.63; maximum:-0.51), respectively. Lumbar T score was significantly higher than fe mur T score (p<0.0001). Eight patients had BMD within normal limits; there was osteopenia in 16 and osteoporosis in 29 patients. While there was a negative correlation between femur T-score and age (r=-0.36, p=0.026), no correlation was detected between lumbar T-score and age (r=-0.17, p=0.21). With multivariate analysis of the factors related with femur T-score; age and body mass index (BMI) were the independent determinants while gender, parathyroid hormone levels and use of active vitamin D were not effective. Age was related negatively while BMI was related positively with BMD: BMD measurement at femur is more accurate than that at lumbar vertebrae in PD patients. BMD is low in most of the PD patients; and age and BMI are the major determinative factors.

Periodontal Treatment Reduces Chronic Systemic Inflammation in Peritoneal Dialysis Patients

Chronic systemic inflammation, a non traditional risk factor of cardiovascular diseases, is associated with increasing mortality in chronic kidney disease, especially peritoneal dialysis patients. Periodontitis is a potential treatable source of systemic inflammation in peritoneal dialysis patients. Clinical periodontal status was evaluated in 32 stable chronic peritoneal dialysis patients by plaque index and periodontal disease index. Hematologic, blood chemical, nutritional, and dialysis-related data as well as highly sensitive C-reactive protein were analyzed before and after periodontal treatment. At baseline, high sensitive C-reactive protein positively correlated with the clinical periodontal status (plaque index; r = 0.57, P < 0.01, periodontal disease index; r = 0.56, P < 0.01). After completion of periodontal therapy, clinical periodontal indexes were significantly lower and high sensitivity C-reactive protein significantly decreased from 2.93 to 2.21 mg/L. Moreover, blood urea nitrogen increased from 47.33 to 51.8 mg/dL, reflecting nutritional status improvement. Erythropoietin dosage requirement decreased from 8000 to 6000 units/week while hemoglobin level was stable. Periodontitis is an important source of chronic systemic inflammation in peritoneal dialysis patients. Treatment of periodontal diseases can improve systemic inflammation, nutritional status and erythropoietin responsiveness in peritoneal dialysis patients.

Correlation between iron stores and QTc dispersion in chronic ambulatory peritoneal dialysis patients

Aim: We aimed to investigate the QT dispersion and corrected QT (QTc) dispersion which are suggested as the signals of ventricular arrhythmias, in patients on maintenance CAPD and to evaluate the correlation between iron stores and these electrocardiographic parameters. Materials and method: Fifty-eight patients on maintenance CAPD and 19 healthy age- and sex-matched adults without cardiac disease were included. The PD patients were divided into two groups according to whether their computerized measurements of QTc dispersion were longer than 65 ms. Results: Although QT interval was statistically significantly shorter in control group (34 ± 28 vs. 43 ± 34 ms; p < 0.05), there was no significant difference in regards to the QTc, QT dispersion and QTc dispersion between two groups. PD patients with QTc dispersion longer than 65 ms had higher levels of serum ferritin (p = 0.038) and transferrin saturation (TSAT; p = 0.022) than the others. QTc dispersion were positively correlated with ferritin (r = 0.469, p < 0.01) and TSAT (r = 0.430, p < 0.01) in CAPD patients. Conclusion: Although prolonged QTc, QT dispersion and QTc dispersion were suggested as the markers of ventricular arrhythmias we did not find any significant difference in regards to these parameters between control patients and CAPD patients. But the high body iron stores in these patients increase the risk of increased QT dispersion. The concern over iron overload in dialysis patients is not only because of its oxidative toxicity, but also its precipitation of arrhythmias, which may be measured by the surrogate marker of QTc dispersion.

Peritonitis from Rothia mucilaginosa in a chronic peritoneal dialysis patient.

Rothia mucilaginosa is a Gram-positive, coagulase-negative, encapsulated, non-spore-forming coccus considered part of the normal flora of the upper airway in humans. It is considered to have low virulence, but has been reported to cause infections in various organs in immunocompromised patients. Only two cases of R. mucilaginosa peritonitis in chronic peritoneal dialysis (PD) patients have been reported previously, and we report the third case here in a patient with human immunodeficiency virus, who was successfully treated with intraperitoneal vancomycin.

Increasing high-sensitive C-reactive protein level predicts peritonitis risk in chronic peritoneal dialysis patients

BackgroundThe aim of this study was to evaluate whether a high baseline level of high-sensitivity C-reactive protein (hs-CRP) or changes in the level predicts the risk of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD).MethodsA prospective, cross-sectional, case–control study was conducted in a single hospital-based PD unit. A total of 327 patients were included in the study. Serum hs-CRP was measured annually for 2 years. Patients were divided into 4 groups according to the changes in annual hs-CRP levels (at baseline and at 1 year intervals): group 1 (from <5 mg/L to <5 mg/L, n = 171), group 2 (from <5 mg/L to ≥5 mg/L, n = 45), group 3 (from ≥5 mg/L to <5 mg/L, n = 45), and group 4 (from ≥5 mg/L to ≥5 mg/L, n = 80). Demographics, biochemistry results, PD adequacy indices, and peritonitis risk were compared between the groups.ResultsThe initial serum albumin level was similar in the 4 groups (p = 0.12). There was a negative linear correlation between the serial albumin change (∆alb) and serial hs-CRP change (∆hs-CRP; r = −0.154, p = 0.005). The hazard ratio (HR) for peritonitis was significantly higher in group 2 (HR = 1, reference) than in group 4 (HR = 0.401, 95% CI 0.209 − 0.769). Group 2 had a greater serum albumin decline rate (∆alb: –3% ± 9%) and hs-CRP elevation rate (∆hs-CRP: 835% ± 1232%) compared to those for the other groups.ConclusionsA progressive increase in the hs-CRP level was associated with a corresponding decline in the serum albumin level. Progressive rather than persistently high levels of serum hs-CRP predicted peritonitis risk in CAPD patients.

Lower Education Level is a Major Risk Factor for Peritonitis Incidence in Chronic Peritoneal Dialysis Patients: A Retrospective Cohort Study with 12-Year Follow-Up

Peritoneal dialysis (PD)-related peritonitis remains an important complication in PD patients, potentially causing technique failure and influencing patient outcome. To date, no comprehensive study in the Taiwanese PD population has used a time-dependent statistical method to analyze the factors associated with PD-related peritonitis. Our single-center retrospective cohort study, conducted in southern Taiwan between February 1999 and July 2010, used time-dependent statistical methods to analyze the factors associated with PD-related peritonitis. The study recruited 404 PD patients for analysis, 150 of whom experienced at least 1 episode of peritonitis during the follow-up period. The incidence rate of peritonitis was highest during the first 6 months after PD start. A comparison of patients in the two groups (peritonitis vs null-peritonitis) by univariate analysis showed that the peritonitis group included fewer men (p = 0.048) and more patients of older age (≥65 years, p = 0.049). In addition, patients who had never received compulsory education showed a statistically higher incidence of PD-related peritonitis in the univariate analysis (p = 0.04). A proportional hazards model identified education level (less than elementary school vs any higher education level) as having an independent association with PD-related peritonitis [hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.01 to 2.06; p = 0.045). Comorbidities measured using the Charlson comorbidity index (score >2 vs ≤2) showed borderline statistical significance (HR: 1.44; 95% CI: 1.00 to 2.13; p = 0.053). A lower education level is a major risk factor for PD-related peritonitis independent of age, sex, hypoalbuminemia, and comorbidities. Our study emphasizes that a comprehensive PD education program is crucial for PD patients with a lower education level.

Mesenchymal stem cell transplantation may provide a new therapy for ultrafiltration failure in chronic peritoneal dialysis

The purpose of this study was to investigate possible healing effects of intraperitoneal (IP) mesenchymal stem cell (MSC) transplantation on ultrafiltration failure (UFF) in a chronic rat model of peritoneal dialysis (PD). Rats were initially divided into two groups. The APUF group received once-daily IP injections of 20 mL of 3.86% glucose PD solution for 6 weeks to stimulate the development of UFF and a control group received noinjections. The PUF group was sub-divided into three groups: a PUF-C group, an MSC group and a Placebo (P) group. Peritoneal equilibration tests (PETs) and peritoneal biopsies were performed in the control and PUF-C groups. MSCs were administered by IP injection in the MSC group and the PUF-C and P groups received IP injection of placebo. PETs and peritoneal biopsies were performed in the MSC and P groups at the first [P-1 (and MSC-1 groups] and second [P-2 and MSC-2 groups] week after receiving MSCs or placebo. When compared with the control group, ultrafiltration capacity significantly decreased and the submesothelial thickness increased in the PUF-C and P groups (P-1, P-2) (P < 0.05), but there were no differences between the control and MSC groups (MSC-1, MSC-2). The rate of glucose transport was high in the PUF-C and P-2 groups compared with the control group, and D/PCr rates in the PUF-C and P-2 groups were lower than in the control group (P < 0.05). However, D/D0(glucose) was higher and D/P(Cr)was lower in the MSC-2 group than in the PUF-C and P-2 groups (P < 0.05). Transforming growth factor-β (TGF-β) levels were lower in the MSC groups than in the P and PUF-C groups (P < 0.05). The PUF-C group had a high permeability UFF. These results showed that MSC transplantation exerted positive effects on UFF in a chronic rat model of PD. MSC transplantation may provide new options for the renewal of the peritoneum in chronic PD patients with UFF.

Quality of life in chronic haemodialysis and peritoneal dialysis patients in Turkey and related factors

Turkey is the fifth country in Europe with regard to the number of patients receiving haemodialysis (HD). However, only a limited number of studies have comparatively investigated the factors that affect quality of life in haemodialysis and peritoneal dialysis (PD) patients in Turkey. The purpose of the study was to investigate the factors that affect quality of life in haemodialysis and peritoneal dialysis patients, as well as providing a comparison of quality of life between these groups. In this cross-sectional study, Quality of Life Scale and a data form was completed by 300 dialysis patients who received treatment at five hospital-based dialysis units in Istanbul, Turkey. The data were evaluated using arithmetic mean values, standard deviations, minimums, maximums, percentages, independent groups t-tests, Spearman correlation analyses and one-way variance analyses. The quality of life values in peritoneal dialysis patients were found to be higher than those of haemodialysis patients (P < 0.05). It was concluded that the quality of life in chronic dialysis patients was affected by various factors.

Malnutrition-inflammation score predicts long-term mortality in Chinese PD patients

Malnutrition-Inflammation Score (MIS) has proved to predict the prospective mortality in maintenance hemodialysis (MHD) patients. However, its value of long-term mortality predictability in peritoneal dialysis (PD) patients has not been adequately studied. A total of 155 chronic stable PD patients from November 2005 to December 2006 were enrolled. At baseline, the MIS, Subjective Global Assessment (SGA), as well as clinical, laboratory, and anthropometric parameters were recorded. All patients were followed until October 2009 to evaluate mortality as a primary outcome. The MIS correlated very well with SGA and other nutrition and inflammation markers. Patients with a higher MIS had a worse survival rate compared to those with lower MIS. After adjusting for potential confounding factors, one unit increase of MIS was associated with a 1.27-fold greater death risk (hazard ratio: 1.27, 95% confidence interval: 1.19 - 1.36; p < 0.001). MIS had a superior mortality predictability compared with SGA. Moreover, univariate and multivariate analyses denoted MIS, age, dialysis vintage, and comorbidities as independent predictors of total mortality. MIS is a promising marker for malnutrition inflammation assessment and an independent predictor of long-term mortality in Chinese PD patients.

Encapsulating peritoneal sclerosis in paediatric peritoneal dialysis patients: the experience of the Italian Registry of Pediatric Chronic Dialysis

Paediatric literature about encapsulating peritoneal sclerosis (EPS) is limited and comes primarily from anecdotic experiences. In this study, we described the incidence and characteristics of EPS in a large paediatric chronic peritoneal dialysis (CPD) patient population. We reviewed files of patients starting CPD at <16 years of age, recorded from January 1986 to December 2011 by the Italian Registry of Pediatric Chronic Dialysis (n = 712). Moreover, in December 2011, a survey was performed involving all the Italian Pediatric Nephrology Units to report such EPS cases that occurred after CPD withdrawal. Fourteen EPS cases were reported, resulting in a prevalence of 1.9%. The median age of EPS cases was 4.8 years (range 0.6-14.4) at the start of CPD and 14.3 years (6.5-26.8) at EPS diagnosis. Eleven EPS cases received CPD for longer than 5 years. At diagnosis, nine patients were still on CPD, two were on haemodialysis and three were transplanted. In eight patients, the primary renal disease was represented by glomerulopathy, mainly focal segmental glomerulosclerosis (n = 5). In the last 6 months prior to CPD discontinuation, 10 patients were treated with solutions containing more than 2.27% glucose. Peritonitis incidence was 1:26.8 CPD-months, similar to that calculated in children >12 months of age from the same registry (1:28.3 CPD-months). The mortality rate was 43%. A more aggressive course and an association with calcineurin inhibitors were observed in transplanted patients. Surveillance for EPS should be maintained in high-risk children who received long-term PD even after years from CPD withdrawal.

Determinants of anxiety in patients with advanced somatic disease: differences and similarities between patients undergoing renal replacement therapies and patients suffering from cancer

ObjectiveAnxiety is the most frequent emotional reaction to the chronic somatic disease. However, little is known about anxiety and coping strategies in patients with end-stage renal disease (ESRD) undergoing renal replacement therapies (RRTs). The purpose of the study was to assess the intensity and determinants of anxiety in patients treated with different RRTs in comparison with end-stage breast cancer patients and healthy controls.MethodsThe study involved (1) ESRD patients undergoing different RRTs: 32 renal transplant recipients, 31 maintenance haemodialysis and 21 chronic peritoneal dialysis patients, (2) women with end-stage breast cancer (n = 25) and (3) healthy persons (n = 55). We used State–Trait Anxiety Inventory, Scale of Personal Religiousness, Mental Adjustment to Cancer Scale, Rotterdam Symptom Checklist with reference to medical history. The data thus obtained were analysed using the analysis of variance, the Tukey’s HSD post hoc test and Spearman’s rank correlation coefficient.ResultsBoth ESRD and breast cancer patients revealed higher level of anxiety state and trait than healthy controls; however, there was no statistically significant difference found between both findings. There was a tendency towards higher levels of anxiety state in breast cancer patients when compared to ESRD patients undergoing the RRT treatment and for both groups non-constructive coping strategies correlated with the levels of anxiety state. With ESRD patients undergoing RRTs, the intensity of anxiety state did not depend on the mode of treatment but on the correlation between the levels of anxiety and the general quality of their life, psychological condition and social activity.ConclusionIn patients with advanced somatic disease (ESRD and end-stage breast cancer), non-constructive strategies of coping with the disease require further evaluation and possibly psychological support.

Risk factors associated with brachial–ankle pulse wave velocity among peritoneal dialysis patients in Macao

BackgroundCardiovascular disease is the leading cause of mortality among peritoneal dialysis (PD) patients in Macao. Increased arterial stiffness determined by pulse wave velocity (PWV) has been established as an independent predictor of cardiovascular mortality in end-stage renal disease patients. The present study aims to investigate the relationship between arterial stiffness and its associated risk factors in chronic PD patients.MethodsA total of 96 chronic PD patients (48 males/48 females) were included in the cross-sectional study. Arterial stiffness was assessed by brachial-ankle PWV (baPWV). Patients were divided into two subgroups according to mean baPWV value. On enrollment, clinical characteristics and biochemical parameters were collected.ResultsCompared with low baPWV group patients, high baPWV group patients were significant older (p<0.001) and more likely to have a high proportion of female gender (p=0.004) as well as previous CVD history (p=0.008). Serum albumin, pre-albumin levels and residual renal creatinine clearance (CCr) were significantly lower but the serum ferritin level was significantly higher in high baPWV group patients than in low baPWV group patients (all p<0.01). BaPWV was positively associated with age (r=0.534, p<0.001), Charlson comorbidity index (r=0.350, p<0.001) and serum ferritin level (r=0.340, p=0.001). Meanwhile, baPWV negatively correlated with serum albumin (r=−0.479, p<0.001), pre-albumin levels (r=−0.320, p=0.003) and residual renal CCr (r=−0.177, p=0.048). Age-adjusted partial correlation test found a significant correlation between baPWV and CRP (r=0.462, p<0.001). Multivariate regression analysis showed that baPWV was independently associated with age (p<0.001), serum albumin level (p=0.015), CRP (p=0.019) and residual renal CCr (p=0.045).ConclusionArterial stiffness, assessed by baPWV, had an independent correlation with age, serum albumin level, CRP level and residual renal CCr among PD patients in Macao.

Effect of peritoneal dialysis on antioxidant defense system and oxidative stress

In this study we investigated the effect of peritoneal dialysis (PD) on some antioxidant markers and lipid peroxidation. The levels of malondialdehyde (MDA), erythrocyte superoxide dismutase (SOD), glutathione peroxidase (GPx), vitamins A, E, and C, and total antioxidant capacity (TAC) were determined in 23 chronic ambulatory PD patients and 34 healthy controls. The results showed MDA level in patients were not significantly different from those in controls. Erythrocyte SOD and GPX activities and vitamin C level were significantly decreased in the chronic ambulatory PD group ( p < 0.0001), while the levels of TAC ( p < 0.01), uric acid, and vitamins A ( p < 0.0001) and E ( p > 0.05) were enhanced with respect to the control group. The findings suggest that despite slightly increased MDA level, patients on PD are exposed to oxidative stress, as evidenced by the decreased levels of SOD, GPx, and vitamin C. Depletion of these antioxidants may contribute to accelerated atherogenesis in these patients. 背景: 本研究旨在調查腹膜透析對抗氧化指標及脂質過氧化的影響。 方法: 我們分別在23位腹膜透析患者(CAPD組)及34位健康人士(對照組)間，測量了malondialdehyde (MDA)、紅血球superoxide dismutase (SOD)與glutathione peroxidase (GPx)(酵素指標)、vitamin A、E、與C (非酵素指標)、及總抗氧化能力(TAC)水平。 結果: 結果顯示，相比於對照組，CAPD組病人的MDA水平並無明顯差異，但具明顯較低的SOD與GPx活動及vitamin C數值(P <0.0001)。然而與對照組相比，CAPD組具較高的TAC (P < 0.01)、uric acid、及vitamin A (P<0.0001)與vitamin E (P>0.05)數值。 結論: 本研究發現，即使具稍高的MDA數值，腹膜透析患者暴露於較高的氧化壓力中(反映於較低的SOD、GPx及vitamin C水平)。相關抗氧化物的損耗可能加速這些病人的動脈粥樣化進程。

Volume Status in Patients on Peritoneal Dialysis: The Role of Apelin and Bio-Impedance Spectroscopy

One of the main factors determining the survival of peritoneal dialysis (PD) patients is volume status. We aimed to investigate hydration status of PD patients by bio-impedance spectroscopy (BIS) and echocardiography and to study the relation of them with apelin, which has effects related with volume status like vasodilation, positive inotropism, and inhibition of ADH release and RAS antagonism. Chronic PD patients without active cardiac disease or clinically prominent hypervolemia were included. Besides the demographic, clinical, and laboratory data, BIS and echocardiographic findings together with apelin levels were recorded. The study included 21 patients. Of them, eight patients were euvolemic, one patient was hypovolemic, and others have some degree of overhydration (1.1–6.8 L) with BIS, although all were euvolemic clinically. Mean apelin level was 1.49 ± 0.49 ng/mL. Apelin level was positively correlated with ejection fraction and negatively with total body water (TBW), intracellular and extracellular water, lean tissue mass, and left atrium diameter. On linear regression model, TBW was the major determinant of apelin. Although apelin is expected to increase in hypervolemic patients, the negative correlation with body water in this study may be related with yet unknown role of apelin in dialyzed patients. They may have important roles in volume status in future.

Comorbidities in Chronic Pediatric Peritoneal Dialysis Patients: A Report of the International Pediatric Peritoneal Dialysis Network

BACKGROUND, OBJECTIVES, AND METHODS: Hospitalization and mortality rates in pediatric dialysis patients remain unacceptably high. Although studies have associated the presence of comorbidities with an increased risk for death in a relatively small number of pediatric dialysis patients, no large-scale study had set out to describe the comorbidities seen in pediatric dialysis patients or to evaluate the impact of those comorbidities on outcomes beyond the newborn period. In the present study, we evaluated the prevalence of comorbidities in a large international cohort of pediatric chronic peritoneal dialysis (CPD) patients from the International Pediatric Peritoneal Dialysis Network registry and began to assess potential associations between those comorbidities and hospitalization rates and mortality. Information on comorbidities was available for 1830 patients 0 - 19 years of age at dialysis initiation. Median age at dialysis initiation was 9.1 years [interquartile range (IQR): 10.9], median follow-up for calculation of hospitalization rates was 15.2 months (range: 0.2 - 80.9 months), and total follow-up time in the registry was 2095 patient-years. At least 1 comorbidity had been reported for 602 of the patients (32.9%), with 283 (15.5%) having cognitive impairment; 230 (12.6%), motor impairment; 167 (9.1%), cardiac abnormality; 76 (4.2%), pulmonary abnormality; 212 (11.6%), ocular abnormality; and 101 (5.5%), hearing impairment. Of the 150 patients (8.2%) that had a defined syndrome, 85% had at least 1 nonrenal comorbidity, and 64% had multiple comorbidities. The presence of at least 1 comorbidity was associated with a higher hospitalization rate [hospital days per 100 observation days: 1.7 (IQR: 5.8) vs 1.2 (IQR: 3.9), p = 0.001] and decreased patient survival (4-year survival rate: 73% vs 90%, p < 0.0001). Nearly one third of pediatric CPD patients in a large international cohort had at least 1 comorbidity, and multiple comorbidities were frequently reported among patients with a defined syndrome. Preliminary analysis suggests an association between comorbidity and poor outcome in those patients. As this powerful international registry matures, further multivariate analyses will be important to more clearly define the impact of comorbidities on hospitalization rates and mortality in pediatric CPD patients.