Dialysis Patients Research Articles

Assessment of iron metabolism and iron deficiency in incident patients on incident continuous ambulatory peritoneal dialysis.

The aim of this study was to investigate iron status and iron deficiency in incident continuous ambulatory peritoneal dialysis (CAPD) patients and identify influencing factors. Patients with end-stage renal disease were enrolled. Clinical data of iron metabolism and biochemical and dialysis parameters during the first peritoneal dialysis evaluation were collected. Serum ferritin (SF) and transferrin saturation (TSAT) levels were evaluated, and independent influencing factors were identified by correlation and regression analyses. Of 1,128 adult CAPD patients, 41.2% had iron deficiency (ID), 15.7% had absolute iron deficiency, and 8.2% had functional iron deficiency. The average SF level was (276.8 ± 277.9) μg/L, and iron saturation was (29.8 ± 12.7)%. Additionally, 50.2 and 69.3% of patients reached targets in SF level and iron saturation recommended by the Chinese Society of Nephrology. SF level and TSAT were not correlated with estimated glomerular filtration rate, whereas negatively correlated with platelet count and inflammatory factors. Low platelet count, presence of diabetes mellitus and high interleukin 6 levels were independent factors of lower TSAT. ID is common in patients with CAPD. Women and those with thrombocytopenia, diabetes, and inflammation are at higher risk for iron storage or reduced iron utilization. In the initial CAPD stage, a reasonable iron supplement strategy may be established for CAPD patients with high-risk factors.

Prevalence of Depression among Dialysis Patients in Iran: A Systematic Review and Meta-Analysis of Observational Studies

Context: Depression is a common issue among patients with chronic kidney disease, particularly those undergoing hemodialysis, and it can significantly impact their quality of life, treatment adherence, and disease progression. Objectives: The purpose of this study was to determine the prevalence of depression among dialysis patients in Iran using the Beck Depression Inventory (BDI) questionnaire. Data Sources: This study was a systematic review and meta-analysis. Six databases and Google Scholar were searched to identify all publications on the prevalence of depression among Iranian dialysis patients up until April 19, 2024. The quality of the identified articles was assessed, and the heterogeneity of the studies was evaluated using the I² Index. Publication bias was assessed using Egger's regression test and Sensitivity Analysis. Additionally, a meta-regression model was employed to evaluate variables suspected of contributing to heterogeneity at the 0.05 significance level. In the end, 17 articles were analyzed using Comprehensive Meta-Analysis software (ver. 2.2.064). Results: The prevalence of depression among dialysis patients, after sensitivity analysis using the random-effects model, was estimated at 0.564 (95% Confidence Interval [CI]: 0.524 - 0.603). The highest prevalence rate was reported in the eastern region of Iran, at 0.705 (95% CI: 0.051 - 0.991). Sample size, year, and mean age were significantly associated with the prevalence of depression among dialysis patients (P < 0.05). Conclusions: Depression is highly prevalent among dialysis patients in Iran, with approximately half of them having experienced it. Therefore, policymakers and health system managers must take serious measures to address this significant issue.

Factors affecting intraperitoneal pressure (IPP) and its prognostic value in predicting leak risk and gastrointestinal symptoms in adult peritoneal dialysis patients: a systematic review and meta-analysis.

Intraperitoneal pressure measurementoffers therapeutic and prognostic benefits in predicting leak risks and gastrointestinal symptoms in Peritoneal Dialysis (PD) patients. This systematic review aims to evaluate the prognostic utility of intraperitoneal pressure measurements and different estimated intraperitoneal pressure equations in predicting the risk of non-infectious complications in PD patients. Databases including MEDLINE, EMBASE and Cochrane were searched up to July 2023. Randomised and non-randomised trials were included, focusing on End-Stage Kidney Disease (ESKD) patients undergoing PD. Primary outcomes were variables associated with intraperitoneal pressure, while secondary outcomes included PD-related non-infectious complications and gastrointestinal symptoms. Data synthesis combined meta-analysis with narrative synthesis.This review has been registered on PROSPERO (CRD42023475138). Out of 1828 identified studies, 12 were included for systematic review and 10 for meta-analysis. Body Mass Index (BMI) and Body Surface Area (BSA) showed a consistent positive correlation with intraperitoneal pressure (BMI: r = 0.49, 95% CI 0.35-0.61, I2 = 67.39%, p = 0.003; BSA: r = 0.2, 95% CI 0.08-0.31, I2 = 14.10%, p = 0.324). Conversely, the association between intraperitoneal pressure and age, intraperitoneal volume, and Charlson Comorbidity Index were less consistent. Subgroup analysis demonstrated an association between higher intraperitoneal pressure in patients with increased BMI and BSA. However, the relationship between intraperitoneal pressure and non-infectious mechanical complications remained inconclusive. This review underscores a significant association between intraperitoneal pressure and anthropometric measures (BMI and BSA). The majority of the studies identified included a small sample and considerable bias. However, the association between intraperitoneal pressure and clinically relevant outcomes was not clear. While increasing body mass index and body surface areas are associated with increasing intraperitoneal pressure, the clinical relevance of measuring intraperitoneal pressure in an adult population remains unclear, particularly given the absence of an association with clinically relevant non-infectious outcomes.

Use of the Omaha System nursing model on nutritional status outcomes in peritoneal dialysis patients.

To construct and apply a risk screening and intervention system for malnutrition in peritoneal dialysis patients based on the Omaha System. A total of 75 peritoneal dialysis patients were randomly divided into control (38 cases) and intervention group (37 cases). The control group received routine operation training and health education, and the intervention group implemented a nutritional management plan based on the Omaha System. The modified quantitative subjective comprehensive nutritional scale (MQSGA) score, kidney disease dietary compliance attitude (RAAQ) and behavior (RABQ) score, body mass index (BMI), serum albumin (ALB), prealbumin (PA), and hemoglobin (Hb) were observed. Before intervention, there was no significant difference in these indicators between the two groups (p>0.05). After 6months, the MQSGA score in the intervention group was significantly lower than that in the control group (p<0.05). RAAQ score and RABQ score in the intervention group were higher than those in the control group and (p<0.05), and the nutritional indicators in the intervention group, such as BMI, ALB, PA, and Hb, were higher than those in the control group (p<0.05). A nutritional management plan based on the Omaha System can help improve the nutrition condition of peritoneal dialysis patients, and improve the dietary compliance of chronic kidney disease patients.

Comparison of outcomes of incremental vs. standard peritoneal dialysis: a systematic review and meta-analysis

BackgroundIncremental peritoneal dialysis (IPD) refers to the use of less than standard full-dose peritoneal dialysis (SPD) in end-stage renal disease patients. While the use of IPD is being reported in the literature, its safety and efficacy vs. SPD is unclear. We hereby performed a systematic review of studies comparing mortality, peritonitis, technique survival, anuria-free survival and residual renal function (RRF) between IPD and SPD.MethodsAll comparative studies published on PubMed, Embase, CENTRAL, Scopus, and Web of Science databases from inception to 5th September 2023 and reporting on given outcomes were eligible.ResultsTen studies were included. Definitions of IPD were heterogenous and hence mostly a qualitative synthesis was undertaken. Majority of studies found no difference in patient survival between IPD and SPD. Meta-analysis of crude mortality data also presented no significant difference. Peritonitis and technique survival were also not significantly different between IPD and SPD in the majority of studies. Data on RRF was conflicting. Some studies showed that IPD was associated with the preservation of RRF while others found no such difference.ConclusionIPD may be a safe alternative to SPD in incident dialysis patients. There seems to be no difference in patient survival, peritonitis, and technique survival between the two modalities. However, the impact of IPD on RRF is still questionable. Evidence is heterogeneous and conflicting to derive firm conclusions.

Clinical significance of normohydration state in peritoneal dialysis patients

Introduction: Assessing the fluid status of dialysis patients is crucial, as overhydration can lead to hypertension and left ventricular hypertrophy. Objectives: We aimed to determine the hydration of peritoneal dialysis (PD) patients by using a bioimpedance device and performing concomitant echocardiographic measurements. Patients and Methods: In our cohort, we enrolled PD patients in the study group and kidney transplantation waitlisted patients on hemodialysis (HD) or with stage 4-5 chronic kidney disease (CKD) in the control group. Fluid status was measured with a Fresenius Body Composition Monitor (BCM), and we performed an echocardiography examination. For statistical analysis, we used the Fisher’s exact test for categorical variables and the Kruskal-Wallis test for continuous variables to compare groups. Results: The patients’ average age was 47 (SD 9.45), with a mild female predominance (54.3%). Overhydration was only found in 8 (12%) patients and was related to non-significantly lower ejection fraction (EF). Follow-up found that preserved EF was a non-significantly better outcome (HR: 0.881, 95% CI interval: 0.776; 1.001, P=0.0514). PD patients had significantly lower potassium levels (P=0.0006) and more angiotensin-converting-enzyme inhibitors (ACEis) (46%) and mineralocorticoid receptor antagonists (MRAs) (26%). Conclusion: Lower potassium levels in continuous ambulatory peritoneal dialysis (CAPD) patients allow for the administration of drugs to treat cardiac remodeling and volume overload, which can help reduce patient mortality. The possible usage of MRAs in CKD could reduce cardiovascular mortality effectively.

Evaluation of Inflammatory Status in Chronic Kidney Disease Patients and a Comparison Between Hemodialysis and Peritoneal Dialysis Patients.

Introduction Inflammation is a common denominator in patients with chronic kidney disease (CKD), which is not explained by the pre-morbid risk factors and can lead to atherosclerosis and increased cardiovascular mortality. We have compared inflammatory markers like high-sensitive C-reactive protein (hs-CRP) and interleukin-6 (IL-6) in patients with CKD undergoing continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) in both pre-dialysis phase at baseline and post-dialysis phase at three months to determine which dialysis has a more inflammatory burden on the patient. Materials and methods Fifty CKD patients diagnosed with end-stage renal disease (ESRD) who fulfilled eligibility criteria were recruited in this prospective observational study over two years. We measured levels of IL-6, hs-CRP, serum albumin, and body mass index (BMI) in both pre-dialysis and post-dialysis phases. Our results were obtained by analyzing 50 patients of ESRD who were planned for renal replacement therapy in the form of bridge dialysis, out of which 25 were put on HD and CAPD each. Pre-dialysis assessment was done at baseline and post-dialysis at three months. Each group served as its own control. IL-6 and hs-CRP levels were performed using commercially available kits employing the enzyme-linked immunosorbent assay (ELISA) method. Results Inflammatory markers (hs-CRP, IL-6) were elevated in both the pre-dialysis and post-dialysis phases of CKD, regardless of the dialysis modality. hs-CRP was significantly elevated in the HD group as compared to the CAPD group; however, the difference in IL-6 between the two groups was not significant. Albumin and BMI were significantly low in both groups from baseline, with patients on HD exhibiting lower albumin than the CAPD group, although the result was insignificant. Conclusion Markers of inflammation, like hs-CRP and low albumin, are more pronounced in HD than in CAPD. We conclude that the inflammatory burden is higher in patients undergoing HD.

Pretransplant cardiac stress testing and transplant wait time in kidney transplantation candidates

ObjectiveRoutine screening for cardiovascular disease before kidney transplantation remains controversial. This study aims to compare cardiac testing rates in patients with end-stage renal disease, referred and not referred for transplantation,...

Prediction of Vascular Access Stenosis by Lightweight Convolutional Neural Network Using Blood Flow Sound Signals.

This research examines the application of non-invasive acoustic analysis for detecting obstructions in vascular access (fistulas) used by kidney dialysis patients. Obstructions in these fistulas can interrupt essential dialysis treatment. In this study, we utilized a condenser microphone to capture the blood flow sounds before and after angioplasty surgery, analyzing 3819 sound samples from 119 dialysis patients. These sound signals were transformed into spectrogram images to classify obstructed and unobstructed vascular accesses, that is fistula conditions before and after the angioplasty procedure. A novel lightweight two-dimension convolutional neural network (CNN) was developed and benchmarked against pretrained CNN models such as ResNet50 and VGG16. The proposed model achieved a prediction accuracy of 100%, surpassing the ResNet50 and VGG16 models, which recorded 99% and 95% accuracy, respectively. Additionally, the study highlighted the significantly smaller memory size of the proposed model (2.37 MB) compared to ResNet50 (91.3 MB) and VGG16 (57.9 MB), suggesting its suitability for edge computing environments. This study underscores the efficacy of diverse deep-learning approaches in the obstructed detection of dialysis fistulas, presenting a scalable solution that combines high accuracy with reduced computational demands.

The Time Has Come: The Case for Initiating Pilot Clinical Trials of Pig Kidney Xenotransplantation.

In vitro studies indicate that kidney transplantation from gene-edited pigs in which expression of all three of the known glycan xenoantigens has been deleted may be more challenging in nonhuman primates (NHPs) than it will be in human recipients. Furthermore, pig-to-human xenotransplantation offers several other advantages - (i) the patient can communicate with the surgical team; (ii) recipient microbiological monitoring and environment will be clinical-grade; and (iii) sophisticated graft monitoring and imaging techniques, (v) therapeutic interventions, e.g., dialysis, plasmapheresis, and (v) intensive care can be deployed that are not easily available in NHP laboratory models. We suggest, therefore, that progress to develop safe, informative human clinical trials will be accelerated if pilot clinical cases are initiated. The selection of patients for kidney xenotransplantation can include those who are at high risk of dying imminently, e.g., those experiencing increasing vascular access challenges with no realistic alternative therapy available, and those who have been accepted onto the waitlist for an allograft, but who are unlikely ever to receive one. Patients with an increased risk of dying include those with (i) age >60 years, (ii) blood groups O or B, and (iii) diabetic nephropathy. UNOS data indicate that an average of 25 patients on the kidney waitlist in the USA die or are removed from the list every day (i.e., >9,000 each year). Given the improved xenograft survival observed in preclinical studies, we suggest that it is time to plan a small pilot clinical trial for healthy dialysis patients who understand the risks and potential benefits of kidney xenotransplantation.

Effect of the geometry and severity of left ventricular hypertrophy on cardiovascular mortality in dialysis patients.

Left ventricular hypertrophy (LVH) is a vital risk factor for mortality of dialysis patients. The association of the geometry and severity of LVH with cardiovascular and all-cause mortality in hemodialysis (HD) patients remains unknown. This study investigated clinical outcomes among HD patients with different LVH geometric patterns and severity. The monocentric retrospective cohort study enrolled chronic HD patients who underwent echocardiography for the assessment of LVH. The patients with LVH were divided into concentric and eccentric groups and then subdivided into four groups based on LVH severity: mild-to-moderate eccentric, mild-to-moderate concentric, severe eccentric, and severe concentric LVH. The risks of cardiovascular and all-cause mortality between groups were evaluated using Cox proportional hazard analysis. Of the 237 patients on HD with LVH, 131 had concentric LVH, and 106 had eccentric LVH, with 33, 44, 73, and 87 having mild-to-moderate eccentric, mild-to-moderate concentric, severe eccentric, and severe concentric LVH, respectively. Compared with eccentric LVH, the crude hazard ratio (cHR) of cardiovascular mortality of concentric LVH was 2.03 (95% confidence interval [CI], 1.13-3.65). Severe concentric LVH was a significant risk factor for all-cause and cardiovascular mortality compared with mild-to-moderate eccentric LVH (cHR: 2.58 [95% CI, 1.00-6.65] and 3.73 [95% CI, 1.13-12.33], respectively). After adjustment for all variables, concentric LVH and severe concentric LVH remained significant risk factors for cardiovascular mortality (adjusted HR: 2.13 [95% CI, 1.13-4.01] and 3.71 [95% CI, 1.07-12.82], respectively). Concentric LVH, especially severe concentric LVH, was associated with a high risk of cardiovascular mortality among patients with chronic HD.

Copper Serum Levels in the Hemodialysis Patient Population.

Copper is an essential element in the diet of mammals, including humans. It plays an important role in the physiological regulation of various enzymes and is consequently involved in several biological processes such as angiogenesis, oxidative stress regulation, neuromodulation, and erythropoiesis. Copper is essential for facilitating the transfer of iron from cells to the bloodstream, which is necessary for proper absorption of dietary iron and the distribution of iron throughout the body. In particular, patients with end-stage renal failure who require renal replacement therapy are at increased risk for disorders of copper metabolism. Many studies on hemodialysis, peritoneal dialysis, and kidney transplant patients have focused on serum copper levels. Some reported mild deficiency, while others reported elevated levels or even toxicity. In some cases, it has been reported that alterations in copper metabolism lead to an increased risk of cardiovascular disease, malnutrition, anemia, or mielopathy. The aim of this review is to evaluate the role of copper in patients undergoing hemodialysis and its potential clinical implications.

Social and humanitarian issues in nephrology and hypertension.

Chronic kidney disease and hypertension, two widely prevalent conditions worldwide, present an urgent and pressing need for immediate action. The review describes how social conditions and humanitarian issues can influence hypertension and kidney disease. Undoubtedly, social determinants of health (SDoH) are key influencers in the development of many noncommunicable diseases, including hypertension and kidney disease. Healthcare professionals, including public health workers, play a crucial role in addressing these issues. Poverty, low education level, poor nutrition, housing, exposure to environmental hazards, and stress-related disorders are all factors that can be addressed, either directly or indirectly, through improved awareness and access to proper healthcare services. Besides personal factors, national, regional, or global factors cause serious apprehension. Disasters, whether natural or man-made, can lead to significant aftermaths on the healthy person and certainly on kidney disease and hypertensive patients. A Global Overview Report, 2023 turned out to be one of the most violent years since the end of the Cold War. In 2023, 59 state-based conflicts were recorded in 34 countries, the highest number registered since 1946. The wars in Ukraine and Gaza were the primary contributors with a significant impact on the kidney population, especially people living on dialysis and transplantation patients. They also yielded many refugees or displaced persons with ongoing suffering. It is crucial to recognize that social and humanitarian conditions can quickly exacerbate the health of vulnerable populations, particularly those with noncommunicable diseases like hypertension and chronic kidney disease. These patients, who often require continuous follow-up, especially those on dialysis, are particularly vulnerable during difficult times. Their lives depend on uninterrupted access to dialysis or transplantation medications, making the need for special attention and care more pressing. Further research and advocacy are needed to address these issues and ensure the health and well being of these populations.

Investigating the Effect of a PRECEDE-PROCEED Model-Based Educational Program on Improving the Quality of Life and Laboratory Indicators of Dialysis Patients: A Randomized Training Trial Study

Background: Chronic renal failure is a progressive and irreversible disease that significantly affects the quality of life in its final stage. Objectives: This study was conducted to determine the effect of an educational program based on the PRECEDE-PROCEED Model on improving the quality of life and laboratory indicators of hemodialysis patients. Methods: This study is an educational intervention study. The research was conducted in the hemodialysis departments of Imam Khomeini and Ayatollah Boroujerdi hospitals in Boroujerd city. In this 2021 study, 80 hemodialysis patients who met the inclusion criteria were randomly divided into two groups: Intervention and control (40 people in each group). The educational content was taught face-to-face by the researcher in four sessions over four weeks, according to the initial needs assessment. Information and laboratory indicators were collected and analyzed based on a researcher-made questionnaire and the standard quality of life questionnaire for kidney patients, both before and one month after the intervention. Results: The average age in the intervention and control groups was 56.55 ± 15.99 and 56.12 ± 15.99, respectively. The average quality of life score one month after the educational intervention was significantly higher in the intervention group than in the control group (P &lt; 0.001). The constructs of awareness, attitude, and self-efficacy were significant predictors of behavioral factors. The average scores for awareness, attitude, self-efficacy, behavioral factors, and reinforcing factors one month after the educational intervention were higher in the intervention group than in the control group (P &lt; 0.001). Additionally, the average laboratory indices of hemoglobin (P &lt; 0.001) and hematocrit (P &lt; 0.001) were higher in the intervention group than in the control group one month after the educational intervention. Fasting blood sugar (P &lt; 0.005), sodium (P &lt; 0.020), and cholesterol (P &lt; 0.007) showed a significant decrease after the educational intervention compared to before the intervention. Conclusions: The results of this study showed that the implementation of an educational program based on the PRECEDE-PROCEED model can improve the quality of life and laboratory indicators in hemodialysis patients. These findings can be utilized by researchers to enhance the quality of life of hemodialysis patients.

Pregnancy and pre-term delivery in a peritoneal dialysis patient in a public hospital in Peru. Case report

Pregnancy and pre-term delivery in a peritoneal dialysis patient in a public hospital in Peru. Case report

Propionic acid supplementation promotes the expansion of regulatory T cells in patients with end-stage renal disease but not in renal transplant patients.

In a previous study, we showed an anti-inflammatory effect of propionic acid supplementation in dialysis patients. The present study intends to analyze the effect of propionic acid on the chronic inflammatory state and T-cell composition in kidney transplant patients compared to dialysis patients. A total of 10 dialysis patients and 16 kidney transplant patients under immunosuppressive standard triple immunosuppressive therapy received 2 × 500 mg propionic acid per day for 30 days. The cellular immune system was analyzed before and after the propionic acid supplementation and 30-90 days thereafter as a follow-up. We measured the main immune cell types and performed an in-depth characterization of T cells including regulatory T cells (Tregs), B cells, and dendritic cells. In addition, we assessed the functional activity and antigenic responsiveness by analysis of third-party antigen-specific T cells after their stimulation by recall (tetanus diphtheria vaccine) antigen. In dialysis patients, we observed an expansion of CD25highCD127- Tregs after propionic acid intake. In contrast, the same supplementation did not result in any expansion of Tregs in transplant patients under immunosuppressive therapy. We also did not observe any changes in the frequencies of the main immune cell subsets except for CD4+/CD8+ distribution with an increase of CD4+ T cells and decrease of CD8+ T cells in the transplant population. Our data suggest that dietary supplements containing propionate might have a beneficial effect decreasing systemic inflammation in dialysis patients through Treg expansion. However, this effect was not observed in transplant patients, which could be explained by counteracting effect of immunosuppressive drugs preventing Treg expansion.

Exploring the Impact of Narrative Nursing on Anxiety, Depression, and Quality of Life in Middle-aged and Young Dialysis Patients

Objective: To explore the impact of narrative nursing on anxiety, depression, and quality of life in middle-aged and young dialysis patients. Method: Eighty-six middle-aged and young dialysis patients admitted from January 2023 to December 2023 were selected and divided into a control group and a study group, with 43 patients in each group. The control group received general nursing interventions, while the study group received narrative nursing in addition to the general interventions. The levels of anxiety and depression before and after the intervention were compared, and the quality-of-life scores of the two groups were analyzed. Results: After comprehensive intervention, the scores of both groups significantly decreased (P &lt; 0.05). After intervention, the scores of the study group were more significant compared to the control group (P &lt; 0.05). Compared with the control group, the quality-of-life score of the study group showed a significant upward trend, and this difference was statistically significant (P &lt; 0.05). Conclusion: Comprehensive narrative nursing can effectively reduce anxiety in middle-aged and young dialysis patients, further enhance their quality of life, and is worth promoting in clinical practice.

Associations between different insulin resistance indices and the risk of all-cause mortality in peritoneal dialysis patients

BackgroundInsulin resistance (IR) is prevalent in individuals undergoing peritoneal dialysis (PD) and is related to increased susceptibility to coronary artery disease and initial peritonitis. In recent investigations, correlations have been found between indices of IR and the incidence of all-cause mortality in various populations. However, such correlations have not been detected among individuals undergoing PD. Hence, the present study’s aim was to explore the connections between IR indices and the incidence of all-cause mortality in PD patients.MethodsPeritoneal dialysis patients (n = 1736) were recruited from multiple PD centres between January 2010 and December 2021. Cox proportional hazards and restricted cubic spline regression models were used to evaluate the connections between the triglyceride–glucose (TyG) index, triglyceride–glucose/body mass index (TyG–BMI), and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) ratio and the occurrence of all-cause mortality. All three IR indices were integrated into the same model to assess the predictive stability. Furthermore, a forest plot was employed to display the findings of the subgroup analysis of PD patients.ResultsOverall, 378 mortality events were recorded during a median follow-up time of 2098 days. Among PD patients, a higher TyG index, TyG–BMI, and TG/HDL-C ratio were identified as independent risk factors for all-cause mortality according to Cox proportional hazards analyses (hazard ratio (HR) 1.588, 95% confidence interval (CI) 1.261–2.000; HR 1.428, 95% CI 1.067–1.910; HR 1.431, 95% CI 1.105–1.853, respectively). In a model integrating the three IR indices, the TyG index showed the highest predictive stability. According to the forest plot for the TyG index, no significant interactions were observed among the subgroups.ConclusionSignificant associations were found between the TyG index, TyG–BMI, and TG/HDL-C ratio and the incidence of all-cause mortality among PD patients. The TyG index may be the most stable of the three surrogate IR markers. Finally, a correlation was identified between IR and the risk of all-cause mortality in patients undergoing PD.

Tidal Versus Intermittent Peritoneal Dialysis in Chronic Peritoneal Dialysis Patients: Randomized, Open-Label, Prospective Control Study.

Tidal peritoneal dialysis (TPD) provides better fluid flow mechanics and is more comfortable for the patient, owing to fewer alarms and less pain during inflow and outflow. The long-term characteristics of patients with TPD were not evident. In this randomized controlled follow-up study, we aimed to explore the characteristics of patients with TPD, compared to IPD. A total of 85 patients were randomized to either IPD or 70% TPD between January 2019 and December 2020, and all patients were followed up on December 2021. The characteristics of patients between the two groups were analyzed using a t-test or chi-square as appropriate. The overall survival and technical survival were analyzed using Kaplan-Meier analysis. Forty-two patients were assigned to IPD, and 43 patients were assigned to TPD. The basal characteristics of patients were not different between the two groups. In an average of 16 months of follow-up, 19 patients died, and 25 patients dropped out of peritoneal dialysis. The two groups had no difference in overall survival and technical survival. TPD was associated with high urine volume (p = 0.001), lower blood urea nitrogen (p = 0.002), lower phosphorus (p = 0.004), and fewer cycler alarms (p < 0.001). The chance of patients reporting abdominal fullness was higher in patients with TPD (p = 0.001). In the randomized, controlled, follow-up study, TPD may preserve residual renal function and is associated with lower urea nitrogen and phosphorus in chronic peritoneal dialysis patients. TPD is associated with fewer cycler alarms but may increase the chance of patients reporting abdominal distension.

Opioid Prescriptions for US Patients Undergoing Long-Term Dialysis or with Kidney Transplant from 2011 to 2020.

Pain is important for patients with kidney failure, but opioid medication prescriptions are associated with morbidity and mortality. The Centers for Disease Control and Prevention issued opioid prescription guidelines in 2016 and 2022, associated with dramatically decreased prescription rates in the United States. It is critical to know if nationwide opioid prescription rates for patients with kidney failure have decreased. We analyzed the USRDS database from 2011 to 2020 to describe trends in the proportion of ESKD patients who received one or more, or long-term opioid prescriptions, examined factors associated with long-term opioid prescriptions, and evaluated associations of all-cause death with short-term or long-term opioid prescriptions. From 2011-2022, the percentage of patients with kidney failure (dialysis and kidney transplant) who received at least one or more, or who had received long-term opioid medication prescriptions decreased steadily, from 60% to 42%, and from 23% to 13%, respectively (both P for trend <0.001). The largest reductions in prescription rates were for hydrocodone and oxycodone. Similar trends existed for dialysis and kidney transplant patients. Women, the poor and those in rural settings were more likely to receive long-term opioid prescriptions. Prescription rates were highest in White patients and those 45 to 64 years old. Short-term and long-term opioid medication prescriptions were associated with higher mortality in both dialysis and kidney transplant patients. ESKD patients' opioid prescription rates decreased between 2011 and 2020. Higher mortality risk was associated with both short-term and long-term opioid prescriptions. Mortality risk was monotonically associated with morphine milligram equivalents in patients with kidney failure who received long-term opioid prescriptions.