Continous Ambulatory Peritoneal Dialysis Research Articles

Differences in Nutritional Status and Quality of Life in Hemodialysis Patients Compared to CAPD

Background: Patients with chronic kidney disease who undergo hemodialysis and CAPD (Continous Ambulatory Peritoneal Dialysis) modalities often experience disturbances in nutritional status and quality of life. The condition is affected by the chosen modalities and duration. Aim: This study assesses the differences in nutritional status and quality of life in individuals undergoing hemodialysis therapy with a duration of 4-hour, hemodialysis with a duration of 5-hour, and CAPD in order to determine the best modalities for patients with chronic kidney disease. Methods: Data were collected with cross-sectional from patients with chronic kidney disease at the hemodialysis polyclinic at RSUD dr. Saiful Anwar Malang, Panti Nirmala Hospital Malang, Wava Husada Kepanjen Hospital, and the CAPD polyclinic at RSUD dr. Saiful Anwar Malang. Classified into CAPD group, 4-hour hemodialysis group, and 5-hour hemodialysis group. Assessment with a questionnaire consisting of the patient’s baseline characteristics, subjective global assessment (SGA), and SF-36 are used to assess and analyze differences in nutritional status and quality of life of patients with chronic kidney disease against the selected dialysis modality. Results: The physical health of the 5-hour hemodialysis group showed significant results compared to the 4-hour hemodialysis and CAPD (p <0.05). Mental health in the 5-hour hemodialysis procedure showed significant results compared to the 4-hour hemodialysis and CAPD (p <0.05). The nutritional status of 5-hour of hemodialysis was better than 4-hour of hemodialysis and CAPD (p<0.05). Conclusion: Hemodialysis with a duration of 5-hour has a better nutritional status and quality of life compared to a duration of 4-hour or CAPD.

A STUDY OF EVALUATION OF THYROID FUNCTION STATUS IN CONTINOUS AMBULATORY PERITONEAL DIALYSIS PATIENTS

Background/Aim: End-stage-renal-disease (ESRD) patients/CAPD have a high rate of abnormal thyroid hormone (include subclinical hypothyroidism and non-thyroidal illness syndrome) compared with those without kidney disease. These thyroid dysfunctions are associated with higher death risk due to cardiovascular disease in the general population, little is known about the effect of thyroid disease in patients received peritoneal dialysis. Methods: Cross-sectional research, 118 participants (59 healthy people, 57 CAPD patients) were enrolled. We examined the association of thyroid status, assessed by serum TSH, free T3, free T4 levels which were measured by immunoassay method. Results: Mean serum TSH level of patients were higher than those of control group, p<0.05 (3.15±2.28 μUI/mL versus 1.65±0.82 μUI/mL); mean FT3 level of patients were lower than those of control group, p<0.05 (2.42±0.46 pg/mL versus 3.01±0.41 pg/mL); mean FT4 level of patients were lower than those of control group, p>0.05(1.26±0.24 ng/dL vs 1.18±0.18 ng/dL). Among 57 CAPD patients, 35.1% abnormal thyroid function; 19.3% subclinical hypothyroidism; 15.8% low FT3; 1 patient has low FT4. Mean serum TSH level of patients were higher than those of control group, p<0.05 (3.15±2.28 μUI/mL versus 1.65±0.82 μUI/mL); mean FT3 level of patients were lower than those of control group, p<0.05 (2.42±0.46 pg/mL versus 3.01±0.41 pg/mL); mean FT4 level of patients were lower than those of control group, (p>0.05, 1.26±0.24 ng/dL vs 1.18±0.18 ng/dL). Conclusion: Subclinical hypothyroidism and low FT3syndrome are high in CAPD patients. Additionally, FT4 serum concentration is associated with PD duration and serum creatinine; FT3 is dependent risk factor of rate Kt/V Urea weekly, also cardiovascular disease. Key words: ambulatory peritoneal dialysis, continous ambulatory peritoneal dialysis patients (CAPD), abnormal thyroid function, subclinical hypothyroidism

POS-642 MINERAL BONE DISEASE IN PATIENT CHRONIC KIDNEY DISEASE WITH CONTINUOUS AMBULATORY PERITONEAL DIALYSIS: A CASE REPORT

Chronic Kidney Disease related Mineral Bone Disease (CKD-MBD) can occur in all patients with CKD and leads to a variety of clinical manifestations, including bone pain and fractures characterized by abnormalities in the metabolism of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D, abnormalities in bone turnover, mineralization, volume, growth, or strength. We report one case, a 41-year-old man with CKD G5D on CAPD (Continous Ambulatory Peritoneal Dialysis) during the last 4 years, fracture of the vertebra with changes in body shape.

P1180EVOLUTION OF SERUM B2MICROGLOBULIN LEVELS IN INCIDENT PERITONEAL DIALYSIS PATIENTS

Abstract Background and Aims Retention of ß2microglobulin (ß2M), an uremic toxin in the middle molecular range, has been associated with cardiovascular morbidity and mortality in dialysis patients. Although ß2M levels are usually measured in hemodialysis patients, this practice is not common among peritoneal dialysis (PD) patients. The aim of this study is to evaluate the evolution of serum ß2M levels in incident PD patients. Method Prospective, observational study including incident PD patients in our hospital from January 2015 to October 2019. Patients with cardiorrenal syndrome or patients coming from hemodialysis were excluded. Serum ß2M levels were collected before starting PD and during follow up. Weekly KtV, residual renal function and cardiovascular events were also collected during follow up. Results We included 30 patients with a mean age of 57 +/- 17 years. 56.3% were male and 15.6% were diabetic. Mean follow up was 19.8 +/- 16.9 months. 18 patients were on continous ambulatory PD and 12 in automated PD. Mean serum ß2M levels before starting PD were 12.8 +/- 6.6 mg/l and they remained stable during follow up (12.9 +/- 5.2 mg/l, 15 +/- 4.2 mg/l, 14.3 +/- 6.9 mg/l, 10.2+/- 4.5 mg/l at month 6, 12, 24 and 36, respectively; p NS). No differences in serum ß2M levels were observed between continous ambulatory PD and automated PD. Serum ß2M levels were inversely and significantly correlated with weekly KtV (r= -0.943; p 0.009) and residual renal function (r= -0.829; p 0.042). One cardiovascular event was recorded during follow up. Conclusion Serum ß2M levels remain stable during follow up in our cohort of incident PD patients and is significantly and inversely correlated with weekly KtV and residual renal function. Serum ß2M levels monitoring could be helpful in these patients and would yield important information in this population.

The Different of Quality of Life Between Patient with Kidney Failure Undergoing Hemodialysis and Continous Ambulatory Peritoneal Dialysis (CAPD)

Dialysis is a therapy that aims to remove waste and excess fluid from the body. This method replaces the main function of the kidney. Two types of dialysis are known, namely Peritoneal Dialysis and Hemodialysis. Patients with chronic kidney failure are faced with these two treatment options. Both types of dialysis therapy have a risk of complications during the treatment period that can affect the quality of life of patients. The purpose of this study was to determine the differences in dialysis methods of patients with chronic kidney failure with CAPD (continuous ambulatory peritoneal dialysis) and hemodialysis in terms of quality of life as a basis for palliative care. The research design uses a cross-sectional comparative analytical research design. The independent variable is the action of hemodialysis and CAPD. The dependent variable is quality of life.

Effects of Oral Paricalcitol and Calcitriol Treatment on Peritoneal Membrane Characteristics of Peritoneal Dialysis Patients - A Pilot Study.

Long-term peritoneal dialysis (PD) is frequently complicated by technique failure preceded by peritoneal remodeling. Vitamin D has potent immunomodulatory characteristics: anti-inflammatory, anti-angiogenic, anti-fibrotic properties, and influences on the macrophage phenotype. Little is known about the relation between pleiotropic effects attributed to vitamin D3 and the peritoneal membrane and what is the most appropriate vitamin D sterol in prevention of peritoneal remodeling in PD patients. Animal studies have suggested that paricalcitol has advantageous effects: decrease in plasma markers of inflammation, less peritoneal fibrosis, less pronounced PD-induced omental angiogenesis, and prevention of loss of ultrafiltration. We investigated whether paricalcitol is advantageous over calcitriol in PD patients. A multicenter open-label 1:1 randomized non-blinded clinical pilot study enrolled prevalent continous ambulatory PD (CAPD) patients for a period of 6 months comparing paricalcitol with calcitriol. All patients were treated with biocompatible PD fluids. The primary endpoint was peritoneal transport parameters, exploratory endpoints were biomarkers of peritoneal damage and cell analysis (including M1/M2 macrophages), and safety endpoints were metabolic parameters. Twenty-seven patients were included. Fourteen were randomized to treatment with paricalcitol. There was no difference in peritoneal transport parameters between the groups. We found similar Kt/V, D/P creatinine, D/D0 glucose, ultrafiltration, residual renal function and 24-h urine volume during the study. There was no difference in biomarker concentrations in peritoneal effluents, and no difference in leucocyte differentiation or mesothelial cells between the groups at any time point. Parathyroid hormone (PTH) levels decreased after administration of calcitriol after 12 and 24 weeks compared with baseline (p = 0.001; p = 0.025). Parathyroid hormone levels in the paricalcitol group did not change significantly. In this pilot study we investigated the effect of active vitamin D in PD patients. We found no specific benefit of active vitamin D3 in vitamin D3-sufficient PD patients. Additional studies in preferably incident patients, with an adequate PTH suppression in the intervention groups and during a longer period, are required to test the beneficial effects of active vitamin D3 over no treatment and to investigate whether in 25(OH)D3-deficient PD patients the type of active vitamin D3 matters.

Influence of peritoneal dialysis solution biocompatibility on long-term survival of patients on continuous ambulatory peritoneal dialysis and the technique itself

Morbidity and mortality of continous ambulatory peritoneal dialysis (CAPD) patients is still very high. The aim of the study was to evaluate the effects of peritoneal dialysis (PD) solutions (standard vs biocompatible) on long-term patients' and the techique survival. A total of 42 stable patients on CAPD participated in this cross-sectional study. They were prospectively followed-up during the twelve years. Patients with severe anemia (Hb < 10 g/L) and malignant disease ware excluded. Twenty one (50%/0) patients were treated with the standard PD solutions (CAPDP-1) while the other 21 (500/0) were treated with biocompatible PD solutions [(lower level of glucose degradation products, lower concentration of Ca(2+) and neutral pH (CAPDP-2)]. All patients were analyzed for a presence of vascular calcification, nutrition status, and parameters of inflammation after 2.5 +/- 0.6 years of starting CAPD, and these variables considered in the analysis as risk factors. The patients from the group CAPDP-2 compared to those from the group CAPDP-1 had lower level of high-sensitivity C-reactive protein (hs-CRP) (p = 0.003), and better nutritional status as confirmed by the mid-arm circumference (p = 0.015), and mid-arm muscle circumference (p = 0.002) and subjective global assessment (p = 0.000). Also, they had lower vascular calcifications as confirmed by intima media thickness (IMT) (p = 0.003), degree of carotid narrowing (p = 0.001) and calcified plaques of common carotid arteries (CCA) (p = 0.008). Kaplan-Meier analysis confirmed better survival of patients from the group CAPDP-2 than those from the group CAPDP-1 (1-, 5-, and 10-year patients survival rate was: 100%, 61.9% and 14.3% for the group CAPDP-1, and 100%, 85.7%, and 52.4% for the group CAPDP-2, respectively; p = 0.0345). The 1-, 5-, and 10-year technique survival rate was: 100%, 71.4%, and 38.1% for the group CAPDP-1, and 100%, 85.7%, and 76.2% for the group CAPDP-2, respectively; (p = 0.0719). Duration of dialysis, serum triglyceride and cardiovascular score (quantitative scoring system consisting of: ejection fraction (EF) of left ventricle < 50%; IMT > 1 mm; carotid narrowing degree > 50%, presence of carotid plaques in both common carotide, ischaemic heart disease, cerebrovascular event and peripheral vascular disease with or without amputation) were independent predictors of overall patient survival. Duration of dialysis was only independent predictor of overall technique survival. Although patients treated with biocompatible solutions showed significantly better survival, the role of biocompatibility of CAPD solutions in patients and technique survival have to be confirmed. Namely, multivariate analysis confirmed that duration of dialysis, serum triglyceride and cardiovascular score significantly predicted overall CAPD patients survival, while only duration of dialysis was found to be independent predictor of overall techique survival.

Analysis on the related factors of reoccurence of peritonitis in pateints with peritoneal dialysis

Objective To explore the related factors of reoccurence of peritonitis in pateints with continous ambulatory peritoneal dialysis in order to provide ehnical basis for preventing the reoccurence of peritonitis.Methods The eduction degree,primary diseases,ages,Hb,Alb,the possible reason of peritonitis,dialysis time and payment method of medical expenses of 12 cases with peritoneal dialysis-ralted peritonitis for 32 times and operators were retrospectively analyzed.The correlation between the above factors and the occurrence of peritonitis was compared.Results The reoccurrence of peritonitis among pateitns with the peritoneal dialysis-related peritonitis was related with the ages,the education degrees of operators,Hb,Alb,the dialysis time and the primary diseases(P 0.05).The main reasons for reoccurence of peritonitis were non-standard operation,constipation and diarrhea.Conclusions The pateints with advanced ages,lower Alb and Hb,lower education degrees of patients and operators,diabetes mellitus,and dialysis times of 1 to 3 years,especially the family member operators,should be strenghtened the follow-up management and re-training,thereby preventing the reoccurence of peritonitis. Key words: Peritoneal dialysis; Peritonitis; Risk factors; Investigation

Long-term survival rates in haemodialysis patients treated with strict volume control

We analysed the survival of 218 patients (132 male, 86 female, age 48 +/- 15 years) who were treated in our dialysis units since we adopted the strategy of strict volume control without antihypertensive drugs. The mean observation period was 47 +/- 34 (6-140) months. Follow-up was ended because of death (57 patients), transfer to another center (35 patients), continous ambulatory peritoneal dialysis (CAPD) (15 patients) or transplantation (23 patients), while 88 were still under our treatment at the time of writing. Blood pressure (BP) decreased from a mean of 150 +/- 31/89 +/- 16 at the start to 121 +/- 14/75 +/- 8 mmHg at the end of observation (P < 0.001). Only nine patients needed a drug (enalapril) to reach this goal. Cardiothoracic index (CTI) dropped from 0.50 +/- 0.06 to 0.46 +/- 0.05 (P < 0.001). Interdialytic weight gain decreased from 1440 +/- 360 to 930 +/- 240 g/day (P < 0.001). Mortality rate was 68, 2 per 1000 patient-years, better than in most published series. There was a striking influence of age, but also of CTI and systolic BP on survival rate. Patients with CTI > or = 0.48 showed mortality 3.8 times higher than CTI < 0.48 (log rank P < 0.001). Consequently, the mean CTI of the deceased patients was much higher (0.50) than the average of the group (0.46) while their mean BP (123 +/- 16/75 +/- 9 mmHg) was not significantly different from the other patients. We found no increased mortality at low-normal pressure levels (systolic BP between 100 and 130 mmHg), but mortality was increased in small groups of patients whose pressures were lower or higher than these values. Thus, the curve, relating mortality to blood pressure was shifted markedly to the left. These results strongly suggest that the strategy of 'volume control', also when applied with conventional dialysis times, normalizes BP and increases survival of dialysis patients. Cardiomegaly, as evidenced on the chest X-ray despite normal BP, had a strong negative influence on survival. The large majority of the patients had low-normal BP after long periods of treatment and showed the lowest mortality, favouring the view that target BP should be lower than advised by most authors.

A detailed analysis of sodium removal by peritoneal dialysis: comparison with predictions from the three-pore model of membrane function

The development of fluid and salt retention is a potential problem for all peritoneal dialysis (PD) patients. Sodium removal by the peritoneum is predominantly determined by convective fluid loss but influenced by diffusion and sieving due to free water transport as predicted by the three-pore model (TPM). The aim of the study was to establish the effect of transport status, dwell length and glucose concentration on observed ultrafiltration (UF), dialysate sodium concentration ([Na(+)](D)) and removal, and compare this with that predicted by a computer program based on the principles of the TPM. This was a cross-sectional study of UF and [Na(+)](D) collected prospectively from dwells classified by length, glucose concentration and membrane transport characteristics. Solute transport, converted to area parameter and UF capacity, was measured on each occasion by the peritoneal equilibration test. These parameters, along with plasma [Na(+)], were entered into the computer model. Fixed values for other parameters, e.g. hydraulic conductance and lymphatic absorption and sump volume, were used. A total of 1853 dwells from 182 patients [10% were on automated PD (APD)] were analysed. There was a high degree of correlation (r = 0.83-95, P<0.001) between the observed and predicted values for UF, [Na(+)](D) and sodium removal across the full range of dwell categories. The model overpredicted UF as the net volume increased with increasing glucose concentration, independently of solute transport. This bias was not fully explained by the preferential use of hypertonic dialysate by patients with reduced UF capacity. The prediction of [Na(+)](D) described sodium sieving, which was overestimated in a small number of patients with UF failure. There were no discrepancies between continous ambulatory PD (CAPD) and APD patients. This analysis endorses the TPM as a description of membrane function, particularly in relation to sodium sieving and removal. The relationship between dialysate glucose concentration and achieved UF appears to be more complex; even accounting for extended time on treatment and reduction in the osmotic conductance in patients preferentially using hypertonic exchanges, further adjustments may be needed to account for the tendency to overestimate UF.

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g ‐) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g ‐ isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.

Day-night differences of ambulatory blood pressure monitoring in normotensive patients in continous ambulatory peritoneal dialysis (CAPD)

Day-night differences of ambulatory blood pressure monitoring in normotensive patients in continous ambulatory peritoneal dialysis (CAPD)

Quantitative and qualitative changes of apolipoprotein AI-containing lipoproteins in patients on continuous ambulatory peritoneal dialysis

Using immunoaffinity chromatography, two species of apo-AI containing lipoproteins (AILp); lipoprotein containing apo-AI and apo-AII (Lp-AI/AII), and lipoprotein containing apo-AI, but no apo-AII (Lp-AI) were isolated from 13 female patients on continous ambulatory peritoneal dialysis (CAPD), then characterized. The results were compared with findings obtained in agematched normolipidemic (control I) and mild hypertriglyceridemic (control II) female subjects. In comparison with control I: In AILp, the levels of total cholesterol (TC), cholesteryl ester (CE) and phospholipid (PL), and the levels of apoE were significantly lower in the CAPD patients while the levels of triglyceride (TG) and apo-CIII were significantly higher in these patients. The levels of apo-AI and apo-AII did not differ between the CAPD and control subjects. In Lp-AI/AII, changes of TC, CE, PL, TG, and apolipoproteins were similar to those of AILp, except for the ratio of apo-AI/apo-AII and the level of apo-CII, which was higher in the CAPD patients. In Lp-AI, changes of TC, CE, PL, and TG were also similar to those of AILp and Lp-AI/AII, but the apo-AI level was significantly lower in the CAPD patients. In comparison with control II: In AILp, the levels of PL, apo-AI, apo-AII, and apo-E were significantly lower in CAPD patients, but the apo-CIII levels were significantly higher. In Lp-AI/AII, the levels of PL and apo-E were significantly lower in CAPD patients. Other apolipoprotein levels were significantly higher in the CAPD patients. In Lp-AI, the levels of PL, apo-AI, and apo-E were significantly lower, but the in apo-CIII level was significantly higher in CAPD patients. Activities of lipoprotein lipase (LPL) and hepatic triglyceride lipase (HTGL) in the CAPD patients were significantly lower than those in control I and control II. These findings suggest that differences in TC, CE, and TG between the CAPD patients and control I are a reflection of the higher triglyceride levels, whereas changes of PL and apolipoproteins are unique to CAPD patients. These qualitative and quantitative changes may be linked with lower activities of LPL and HTGL in the CAPD patients. The CAPD patients may well be at a high risk for atherosclerotic coronary heart diseases.

Vitamin B-6 status of children undergoing continous ambulatory peritoneal dialysis

The purpose of this study was to evaluate the vitamin B-6 status of children undergoing continuous ambulatory peritoneal dialysis (CAPD) and to determine the renal and peritoneal clearance of vitamin B-6 in these children. Eight children, mean age 12 years, were included in the first study. Urine, dialysate and plasma were analyzed for total vitamin B-6 and pyridoxal 5′-phosphate (PLP). Dialysate total protein and serum alkaline phosphatase were also measured and a three day dietary record was obtained. Plasma PLP was measured in six subjects one year following the first study after they had been receiving daily pyridoxine supplements for one year. Mean plasma total vitamin B-6 and PLP were 304 and 25.5 nM, respectively, in the first study. The mean ratio of plasma PLP/total vitamin B-6 was 0.146. Mean plasma PLP in supplemented subjects was 60.4nM. Renal and dialysate clearance of vitamin B-6 was 0.41 and 0.90 mls/min, respectively. Mean dietary intake of vitamin B-6 was 59% of the RDA. CAPD treated children appear to be deficient in vitamin B-6 although dialysate losses are minimal. Pyridoxine supplements of at least 2mg/day are necessary to increase plasma PLP to normal concentrations in these children.

Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids.

Steroid metabolites enriched from urine, haemofiltrate, and CAPD-dialysate (Continuous Ambulatory Peritoneal Dialysis) were identified by gas chromatography-mass spectrometry and quantified by capillary gas chromatography. The study included twenty healthy controls, twenty-six non-dialysed uraemics, thirty-nine patients on regular dialysis treatment, and twenty-two allograft recipients. Compared to the 24 h urinary excretion rates of controls the excretion rates of androsterone and etiocholanolone were in the lower normal range up to significantly decreased in the body fluids of all patients, and those of the corticoid metabolites were also significantly decreased. 11-Oxygenated androstanolones in urine from non-dialysed uraemics correlated significantly decreased. 11-oxygenated androstano-levels and were significantly increased, but normal in haemofiltrate and CAPD-dialysate, while in urine of allograft recipients the values were significantly lower.