Impact Of Dialysis Modality Research Articles

#1157 Body mass and fluid balance in dialysis: global profiles in Apollo Dial DB

Abstract Background and Aims Fluid management is a fundamental component of dialysis care. Achieving euvolemia and avoiding fluid overload can be challenging in dialysis. Apollo Dial DB, an anonymised dialysis database from a global kidney care network, was used to gain deeper insights in patterns of patient body mass and fluid balance during dialysis treatments worldwide. Method Apollo Dial DB, a global anonymised dialysis database, contains real-world data from patients in 40 countries beginning January 2018 throughout March 2021. Parameters include demographics, diagnoses, laboratories, medications, treatments, quality of life, and outcomes. This analysis assessed body mass and fluid status parameters on patients in Asia-Pacific (AP), Europe, Middle East, and Africa (EMEA), Latin America (LA), Northern America (NA). In addition, bioimpedance for body compositions of patients was assessed as it was available in AP, EMEA, and LA. Results The first version of the Apollo Dial DB includes data on 543, 169 patients, with 4.6% from AP, 13.9% from EMEA, 7.0% from LA, and 74.5% from NA countries. EMEA and NA have a higher proportion of patients in the bigger height categories versus the AP and LA regions (Table 1). There is a difference in mean body weight post dialysis of more than 10 kg between regions; the highest weights were observed in EMEA and NA in contrast to the AP and LA regions. Average albumin levels were consistent in all global regions. Intradialytic weight gain is lowest in EMEA at 1.8 kg and highest in NA at 2.2 kg between treatments. While ultrafiltration volume ranged from 2.0 L to 2.4 L, being the highest in AP and NA. Bioimpedance measures defining body compositions were available for the majority of patients in AP (59.3%), EMEA (86.9%), and LA (90.7%). Patient averages in EMEA are slightly higher for ATM, FTM, LTM, TBW than for LA and AP; this is somewhat explained by the differences in body weight between the cohorts (Fig. 1). Conclusion A descriptive analysis of the body mass and fluid status across minor and major regions bring to light key profiles and differences in the characteristics of dialysis patients across the world and fluid management practices in dialysis care. Differences in intradialytic weight gain may deserve further analysis considering the impact of dialysis modality on fluid balance, such as potential influences of convective therapies. These findings act as benchmarks for the nephrology community. Apollo Dial DB offers opportunities for investigators to conduct global analytics and advance kidney disease research.

Mortality of dialysis patients in Qatar: A retrospective epidemiologic study

Background: End-stage kidney disease (ESKD) patients on maintenance renal replacement therapy (RRT) have far lower life spans than those of the general population. No previous studies have been performed to assess the mortality of dialysis patients in the State of Qatar. We designed this study to assess the mortality of dialysis patients in Qatar and the impact of dialysis modality. Methods: All chronic ambulatory dialysis patients (both on hemodialysis (HD) and peritoneal dialysis (PD) between 2014 and 2016) were included in the study, whereas patients undergoing dialysis for less than 3 months were excluded. We reviewed patients’ demographics, comorbidities, and general laboratory investigations through our electronic record system and collected and analyzed them. We identified patients who died during that period and compared them to those who survived. We performed a subanalysis for HD versus PD patients who died. Results: The total number of deceased dialysis patients was 164, with an overall crude mortality rate of 6.4%. They were significantly older than those who survived (p = 0.0001). The mortality rate was significantly higher in female than in male patients (51.2% and 38.9%, respectively) (p = 0.004) but significantly lower in PD than HD patients (1.36%, PD; 5.0%, HD; p = 0.007). It was also significantly higher in natives than in the expats (60.3% and 39.6%, respectively) (p = 0.0008); however, no significant differences were noted between deceased natives and expats in most demographic and laboratory characteristics. The most common cause of patient death was CVD (62 patients, 37.8%), followed by sepsis (44 patients, 26.8%). Diabetes, cerebrovascular accident, and dyslipidemia were more common in HD deceased patients than in PD patients (80.6%, 47%, and 59%, respectively, in HD patients vs 68.5%, 42%, and 31%, respectively, in PD patients). Albumin and potassium levels in deceased PD patients were significantly lower than in HD patients (p = 0.001). Conclusion: Our study found that the high-risk population had a significant mortality, which was higher in HD than PD patients. This is the first study to look at these outcomes in Qatar. We identified multiple mortality associated factors, such as comorbid conditions and old age. We believe that improving treatment and close monitoring for comorbid conditions in the dialysis population might improve survival.

The Impact of Dialysis Modality on Left Ventricular Function in Patient with End Stage Kidney Disease

Introduction: Cardiovascular disease is frequent in end-stage kidney disease patients, and is a major cause of morbidity and mortality. This study was carried out to assess the comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis on left ventricular function.Methods: A prospective observational study was carried out in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis at least for 6 months. The duration of the study was from June 2019 to May 2020. CAPD consists of 3 to 4 exchanges/day and haemodialysis 2-3 times/week for 4 hours. Baseline characteristics age, gender, dialysis duration, hypertension, diabetes and hyperlipidaemia were collected. The same cardiologist performed all echocardiography at the end of hemodialysis session in hemodialysis patients and after the drain of dialysate in peritoneal dialysis patients.Results: Sixty patients (40 hemodialyses, 20 peritoneal dialyses) were enrolled. The mean age of the patient was 53.71±13.00 years (range 25-76). There was a slightly higher number of male in the hemodialysis group (p= 0.065). Systolic and diastolic blood pressure were significantly higher in hemodialysis groups (p<0.001). Regarding left ventricular parameters, hemodialysis patients had a higher prevalence of left ventricular diastolic dysfunction, left ventricular hypertrophy, left ventricular mass compared to peritoneal dialysis patients. Pericardial effusion and thickening were present higher in hemodialysis patients and was statistically significant (p<0.05).Conclusion: The modality of dialysis influence left ventricular function. Left ventricle dysfunction is prevalent among hemodialysis patients compared to peritoneal dialysis. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.

Impact of dialysis modality on major adverse cardiovascular events and all-cause mortality: a national population-based study.

Only few studies with inconsistent results comparing the relative risk of cardiac mortality between peritoneal dialysis (PD) and hemodialysis (HD). Switches between renal replacement therapy (RRT) modalities render objective assessment of survival benefits a greater challenge. Data were retrieved from Taiwan's National Health Insurance Database from 1 January 2006 to 31 December 2015. We included 13 662 and 41 047 long-term dialysis patients in a propensity score matching study design and a time-varying study design, respectively, to compare major adverse cardiovascular events (MACEs) between patients receiving PD and HD. We also included 109 256 dialysis patients to compare the all-cause mortality among different RRT modalities. For MACE, the hazard ratio (HR) for PD patients compared to HD patients was 0.95 [95% confidence interval (CI) 0.89-1.02] in the propensity score study design and 1.06 (95% CI 1.01-1.12) in the time-varying study design. For all-cause mortality, the HR for PD patients compared to HD patients was 1.09 (95% CI 1.05-1.13) in the propensity score study design and 1.13 (95% CI 1.09-1.17) in the time-varying study design. The HR for death was higher at a level of statistical significance for females (1.21, 95% CI 1.15-1.28), patients ≥65 years old (1.30, 95% CI 1.24-1.36) and diabetes mellitus (DM; 1.28, 95% CI 1.22-1.34). The HR for MACE is significantly higher among PD patients in time-varying design analysis. In addition, all-cause mortality was higher in PD patients compared to patients with HD, especially in those who were aged ≥65 years, female or DM.

Impact of dialysis modality on long-term outcomes in kidney transplantation recipients: a propensity-matched cohort study

Impact of dialysis modality on long-term outcomes in kidney transplantation recipients: a propensity-matched cohort study

Hospitalization for Patients on Combination Therapy With Peritoneal Dialysis and Hemodialysis Compared With Hemodialysis

IntroductionCombination therapy with peritoneal dialysis and hemodialysis (PD+HD) is widely used for PD patients with decreased residual kidney function in Japan; however, hospitalization for this combined dialysis has not been investigated so far. We compared the risk of hospitalization for PD+HD with that for HD.MethodsA multicenter, prospective observational study was conducted on 42 PD+HD and 42 HD patients matched for age and diabetic nephropathy. The main outcome measure was the cumulative incidence of hospitalization for any cause assessed with the Kaplan-Meier method. Hospitalization rates (the number of admissions per 100 patient-years) associated with dialysis modality were also calculated. The impact of dialysis modality on time to hospitalization was analyzed using the Cox proportional hazard model.ResultsThere was no significant difference between groups in terms of age, sex, dialysis vintage, diabetic nephropathy, and comorbidities. The cumulative incidence of hospitalization did not significantly differ between the groups (log-rank test, P = 0.36). Although total hospitalization rates were 66.0 in PD+HD and 59.2 in HD, hospitalization rates for the sum of PD-related infections (a composite of catheter-related infection and peritonitis) and vascular access troubles were 21.7 in PD+HD and 7.2 in HD. On univariate Cox proportional hazard analysis, dialysis modality had no significant impact on time to hospitalization.ConclusionThe risk of hospitalization was not significantly different between PD+HD and HD, although PD+HD patients had a higher risk of dialysis access–related complications than HD patients.

A Comparison of Patient-Reported Outcome Measures of Quality of Life By Dialysis Modality in the Treatment of Kidney Failure: A Systematic Review.

Background:There is an increasing demand to incorporate patient-reported outcome measures (PROMs) such as quality of life (QOL) in decision-making when selecting a chronic dialysis modality.Objective:To compare the change in QOL over time among similar patients on different dialysis modalities to provide unique and novel insights on the impact of dialysis modality on PROMs.Design:Systematic reviews, randomized controlled trials, and nonrandomized controlled trials were examined via a comprehensive search strategy incorporating multiple bibliographic databases.Setting:Data were extracted from relevant studies from January 1, 2000 to December 31, 2019 without limitations on country of study conduction.Patients:Eligible studies included adults (≥18 years) with end-stage kidney disease of any cause who were prescribed dialysis treatment (either as lifetime treatment or bridge to transplant).Measurements:The 5 comparisons were peritoneal dialysis (PD) vs in-center hemodialysis (ICHD), home hemodialysis (HHD) vs ICHD, HHD modalities compared with one another, HHD vs PD, and self-care ICHD vs traditional nurse-based ICHD.Methods:Included studies compared adults on different dialysis modalities with repeat measures within individuals to determine changes in QOL between dialysis modalities (in-center or home dialysis). Methodological quality was assessed by the Scottish Intercollegiate Guidelines Network (SIGN 50) checklist. A narrative synthesis was conducted, synthesizing the direction and size of any observed effects across studies.Results:Two randomized controlled trials and 9 prospective cohort studies involving a combined total of 3711 participants were included. Comparing PD and ICHD, 5 out of 9 studies found significant differences (P < .05) favoring PD in the change of multiple QOL domains, including “physical component score,” “role of social component score,” “cognitive status,” “role limitation due to emotional function,” “role limitation due to physical function,” “bodily pain,” “burden of kidney disease,” “effects of kidney disease on daily life,” “symptoms/problems,” “sexual function,” “finance,” and “patient satisfaction.” Conversely, 3 of these studies demonstrated statistically significant differences (P < .05) favoring ICHD in the domains of “role limitation due to physical function,” “general health,” “support from staff,” “sleep quality,” “social support,” “health status,” “social interaction,” “body image,” and “overall health.” Comparing HHD and ICHD, significant differences (P < .05) favoring HHD for the QOL domains of “general health,” “burden of kidney disease,” and the visual analogue scale were reported.Limitations:Our study is constrained by the small sample sizes of included studies, as well as heterogeneity among both study populations and validated QOL scales, limiting inter-study comparison.Conclusions:We identified differences in specific QOL domains between dialysis modalities that may aid in patient decision-making based on individual priorities.Trial registration:PROSPERO Registration Number: CRD42016046980.Primary funding source:The original research for this study was derived from the Canadian Agency for Drugs and Technologies in Health (CADTH) 2017 optimal use report, titled “Dialysis Modalities for the Treatment of End-Stage Kidney Disease: A Health Technology Assessment.” The CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.

Frequency of HbsAg and Anti-HCV among Hemodialysis Patients in three Genral Hospitals of Azad Jammu and Kashmir State

Background: The impact of dialysis modality on the rates and types of infectious complications has not been well studied. The aim of the present investigation was to evaluate the rates of hepatitis C virus and hepatitis B virus infections in hemodialysis patients in three general hospitals of Azad Kashmir. In dialysis patient, if left unaddressed these may lead to very fatal consequences at the individual and national level. Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent significant public health issues globally. These infections are important causes of morbidity and mortality in hemodialysis patients. Patients with HBV/HCV co-infection have a higher risk of progression to cirrhosis and decompensated liver disease and have an increased risk of hepatocellular cancer (HCC). Because the two hepatotropic viruses share same modes of transmission, co-infection with the two viruses is not uncommon, especially in areas with a high prevalence of HCV infection and among people at high-risk for parenteral infection.&#x0D; Objective: The present work was aimed to determine the frequency of hepatitis B and C among dialysis patients in Azad Kashmir dialysis centers.&#x0D; Design: Cross-sectional descriptive study.&#x0D; Settings: Pathology laboratory of Abbas Institute of Medical Sciences, Muzaffarabad, Azad Jammu &amp; Kashmir.&#x0D; Participants: A representative sample of 110 patients of dialysis from all Azad Kashmir dialysis centers including both males and females was studied between August and December 2016. BMI was calculated after measuring weight and height followed by measurement of hepatitis B and C in dialysis patients.&#x0D; Results: In this study, out of 110 patients: 52.72% dialysis patients were hepatitis C positive and 13.63% dialysis patients were hepatitis B positive.&#x0D; Conclusion: Our findings revealed ongoing HCV incidence and high HCV/HBV prevalence among HD patients in Azad Kashmir. But incidence and prevalence appear to be declining year by year. About one-fifth of HD patients are chronic carriers of HCV infection, in need of HCV treatment, and potentially can transmit the infection to other HD patients. In context of rapidly growing HD patient population, these findings highlight the need to improve standards of infection control during dialysis in Azad Kashmir.

Design and methodology of the impact of HemoDiaFIlTration on physical activity and self-reported outcomes: a randomized controlled trial (HDFIT trial) in Brazil

BackgroundEnd stage renal disease (ESRD) patients require a renal replacement therapy (RRT) to filter accumulated toxins and remove excess water, which are associated with impaired physical function. Hemodialysis (HD) removes middle-molecular weight (MMW) toxins less efficiently compared to hemodiafiltration (HDF); we hypothesized HDF may improve physical function. We detailed the design and methodology of the HDFIT protocol that is testing whether changing from HD to HDF effects physical activity levels and various outcomes.MethodsHDFIT is a prospective, multi-center, unblinded, randomized control trial (RCT) investigating the impact of dialysis modality (HDF verses HD) on objectively measured physical activity levels, self-reported quality of life, and clinical/non-clinical outcomes. Clinically stable patients with HD vintage of 3 to 24 months without any severe limitation ambulation were recruited from sites throughout southern Brazil. Eligible patients were randomized in a 1:1 ratio to either: 1) be treated with high volume online HDF for 6 months, or 2) continue being treated with high-flux HD. This study includes run-in and randomization visits (baseline), 3- and 6-month study visits during the interventional period, and a 12-month observational follow up. The primary outcome is the difference in the change in steps per 24 h on dialysis days from baseline to the 6-month follow up in patients treated with HDF versus HD. Physical activity is being measured over one week at study visits with the ActiGraph (www.actigraphcorp.com). For assessment of peridialytic differences during the dialysis recovery period, we will analyze granular physical activity levels based on the initiation time of HD on dialysis days, or concurrent times on non-dialysis days and the long interdialytic day.DiscussionIn this manuscript, we provide detailed information about the HDFIT study design and methodology. This trial will provide novel insights into peridialytic profiles of physical activity and various self-reported, clinical and laboratory outcomes in ESRD patients treated by high volume online HDF versus high-flux HD. Ultimately, this investigation will elucidate whether HDF is associated with patients having better vitality and quality of life, and less negative outcomes as compared to HD.Trial registrationRegistered on ClinicalTrials.gov on 20 April 2016 (NCT02787161).

Peritoneal Dialysis Is an Independent Factor Associated to Lower Intima Media Thickness in Dialysis Patients Free From Previous Cardiovascular Disease.

Carotid intima media thickness (cIMT) displays prognostic value as a marker of cardiovascular risk in dialysis patients. However, few data are available regarding the impact of dialysis modality on cIMT. The aim of this study is to determine whether the modality of dialysis influences cIMT values. We compared 237 peritoneal dialysis (PD) and 451 hemodialysis (HD) patients without previous cardiovascular disease included in NEFRONA, a prospective, observational and multicenter study. This cross sectional study included the determination of cIMT in 6 carotid territories by arterial ultrasound. cIMT was determined in territories without atheroma plaque and averaged. A second analysis was performed using all territories, giving a truncated cIMT value of 1,5 mm to territories presenting with atheroma plaque. Age and plaque presence at baseline were the clinical variables more closely associated to cIMT in dialysis patients. The evaluation of the impact of the modality of dialysis on cIMT showed that PD patients had lower cIMT than HD patients, both in territories with no plaques and when using truncated cIMT values. No differences were found between right and left sides, neither in cIMT or truncated cIMT values. Lineal multivariate analysis adjusted by several clinical variables showed a statistically significant association of PD with a lower cIMT (slope -0.036; SD 0.010). These results were also confirmed when truncated cIMT values were used. We conclude that the modality of dialysis has an impact on cITM. HD patients have greater global cIMT than PD patients, and PD is and independent factor associated with a lower cIMT.

Mortality and Low Serum Bicarbonate Level in Patients on Hemodiafiltration versus Peritoneal Dialysis.

Mortality is substantially elevated in patients on chronic kidney disease in comparison to general population. In this study, we observed the mortality rate in relation to risk factors including low serum bicarbonate level, coronary artery disease (CAD), and dialysis modality in patients on dialysis during a median follow-up time of 60 months. We studied 96 dialysis patients, 62 males and 34 females, on mean age 62.1 ± 14.27 years old. The treatment modalities which were applied were predilution hemodiafiltration (HDF, n = 76), and peritoneal dialysis (PD, n = 20). We performed Kaplan–Meier curves and a Cox-regression analysis to investigate significant risk factors for mortality including hypertension, diabetes mellitus, smoking, bone disease defined by intact-parathormone, serum albumin, serum bicarbonate levels < or >22 mEq/L, dialysis modality, and the existence of CAD. Cox-regression analysis revealed a significant impact of serum bicarbonate levels <22 mEq/L on mortality in combination to dialysis modality and CAD. The prevalence of CAD on mortality was found significant (log-rank = 5.507, P = 0.02). Furthermore, the impact of dialysis modality on mortality was shown significant (log rank = 22.4, P = 0.001), noting that during the first 28–30 months from the treatment initiation, the survival was better for PD; but then, the mortality was significantly increased comparatively to HDF. Uncorrected metabolic acidosis and CAD were shown as independent significant predictors for mortality in patients on renal replacement therapy. PD may provide worse survival after 2–2.5 years of treatment initiation than HDF.

P6481Incidence and impact of dialysis modality on acute coronary syndrome and death in end stage renal failure patients

P6481Incidence and impact of dialysis modality on acute coronary syndrome and death in end stage renal failure patients

The impact of dialysis modality and membrane characteristics on intradialytic hypotension.

The risk of intradialytic hypotension (IDH) is determined by various factors, among them dialysis modality and dialyzer membrane. We conducted a literature search in PubMed on November 1, 2016 and selected relevant randomized controlled and cross-over trials, and prospective and retrospective cohort studies published in English that investigated the association between IDH and dialysis modality and membrane, respectively. This literature search revealed 669 publications on dialysis modality, 64 on dialysis membrane, and 24 on acetate/bicarbonate dialysate. After omission of duplicate papers and publications outside the scope of this review, we selected 34 papers for inclusion, 19 on dialysis modality, 8 on dialyzer membrane, and 7 on acetate/bicarbonate dialysate. Several strands of evidence indicate that hemodiafiltration (HDF) is associated with lower IDH rates compared to hemodialysis (HD). Data do not show an unequivocal benefit of synthetic vs nonsynthetic dialyzer membranes with respect to IDH occurrence. Acetate-based vs bicarbonate-based dialysate appears to be associated with an increased IDH rate.

Impact of dialysis modality on the survival of patients with end-stage renal disease and prior stroke.

Of patients with end-stage renal disease (ESRD), 8-16 % had a history of stroke at dialysis initiation. We used the National Health Insurance Research Database of Taiwan to evaluate whether peritoneal dialysis (PD) or hemodialysis (HD) confers a survival advantage for patients with incident ESRD and prior stroke. We identified 975 patients undergoing PD and 975 propensity score-matched patients with newly diagnosed ESRD and prior stroke undergoing HD between 2000 and 2010. Both cohorts were followed up until the end of 2011. Comparisons of the risks of mortality between PD and HD were analyzed using the Cox proportional hazards regression model. In the propensity score-matched cohorts, there was a 2.4 per 100 person-years greater mortality in patients with PD (20.4 vs. 18.0 per 100 person-years) with an adjusted hazard ratio (HR) of 1.20 (95 % CI 1.06-1.36). For patients with diabetes, ESRD and prior stroke, patients undergoing PD had inferior survival compared with those undergoing HD (adjusted HR 1.22, 95 % CI 1.05-1.43), particularly among female patients (adjusted HR 1.55, 95 % CI 1.25-1.91). For patients with ESRD and prior stroke but without diabetes, there was no significant difference in mortality between PD and HD (adjusted HR 1.20, 95 % CI 0.96-1.50). PD was associated with overall poorer survival among patients with diabetes, ESRD and prior stroke and with similar overall survival among patients with ESRD and prior stroke, but without diabetes, compared with HD.

Cognitive Dysfunction in Chronic Renal Disease: Impact of Dialysis Modality

Cognitive Dysfunction in Chronic Renal Disease: Impact of Dialysis Modality

Social functioning and socioeconomic changes after introduction of regular dialysis treatment and impact of dialysis modality: a multi-centre survey of Japanese patients.

Patient socialization and preservation of socioeconomic status are important patient-centred outcomes for those who start dialysis, and retention of employment is a key enabler. This study examined the influence of dialysis inception and modality upon these outcomes in a contemporary Japanese cohort. We conducted a survey of prevalent chronic dialysis patients from 5 dialysis centres in Japan. All patients who had been on peritoneal dialysis (PD) since dialysis inception were recruited, and matched with a sample of those on in-centre haemodialysis (ICHD). We assessed patients' current social functioning (Short Form 36 Health Survey), and evaluated changes to patient employment status, annual income, and general health condition from the pre-dialysis period to the current time. A total of 179 patients were studied (102 PD and 77 ICHD). There were no differences in social functioning by modality. Among them, 113 were employed in the pre-dialysis period with no difference by modality. Of these, 22% became unemployed after dialysis inception, with a corresponding decline in average working hours and annual income. The odds of unemployment after dialysis inception were 5.02 fold higher in those on ICHD compared to those on PD, after adjustment for covariates. There were no changes for those who were already unemployed in the pre-dialysis period. Employment status is significantly hampered by dialysis inception, although PD was associated with superior retention of employment and greater income compared to ICHD. This supports a positive role for PD in preservation of socioeconomic status and potentially other patient-centred outcomes.

Impact of Dialysis Modality on Kidney Transplantation Outcomes

Survival benefits of renal transplantation over dialysis therapy are well established for patients with end-stage renal disease (ESRD). Transition from one treatment modality to another is common. Understanding the differences in outcomes with the various renal replacement therapies will help nephrologists to provide best advice for dialysis patients. The influence of pretransplant dialysis modality on post-transplant outcomes is not clear. An overview of the various issues related to dialysis modality on kidney transplantation outcomes is discussed in this topic review. These include allograft and recipient survival, the impact of dialysis vintage and choice of dialysis modality on transplant outcomes.

Medication burden in CKD-5D: impact of dialysis modality and setting.

BackgroundMedication adherence is thought to be around 50% in the general and dialysis population. Reducing the pill burden (PB) reduces regime complexity and can improve adherence. Increased adherence should lead to improvement in treatment outcomes and patient quality of life. There is currently little published data on PB in CKD-5D across dialysis modalities.MethodsThis is a retrospective, single renal network study. All in-centre HD (MHD), peritoneal dialysis (PD) and home HD (HHD) patients were identified in the Greater Manchester East sector renal network. Information collected included age, sex, comorbidities, daily PB, dialysis vintage and adequacy. Data were retrieved from a customized renal database, clinic and discharge letters with cross validation from the general practitioner when needed.ResultsTwo hundred and thirty-six prevalent dialysis patients were studied. HHD patients had a significantly lower PB (11 ± 7 pills/day) compared with PD and MHD (16 ± 7 pills/day). The HHD patients required fewer BP medications to meet the recommended target. HD setting was the only significant factor for reducing PB. For home therapies (HHD versus PD), weekly Kt/v and serum phosphate were significant factors influencing PB. When comparing all modalities, OR of PB ≥ 15/day for MHD versus HHD was 3.9 and PD versus HHD was 4.9. The influence of HHD is dominant above factors such as comorbidities or clinical variables in reducing PB for MHD. Higher clearances achieved by HHD could explain differences in PB with PD.ConclusionThis is the first comparative study of PB across all dialysis modalities and factors that influence it. The PB advantage in HHD may result in greater adherence and might contribute to the outcome benefit often seen with this modality. Higher clearances achieved by HHD could explain differences in PB with PD but the precise reasons for lower PB remain speculative and deserve further research in larger settings.

The Impact of Dialysis Modality on Novel Markers of Stress Reaction, Matrix Remodeling and Endothelial Damage in Children on Chronic Dialysis

Background/Aims: Dialysis triggers stress reaction, matrix remodeling and endothelial damage, but little is known about the changes it induces on selected heat shock proteins (Hsp90α), adhesion molecules (E-cadherin, sE-selectin), metalloproteinases (MMP-8) and their extracellular inducer (EMMPRIN). The aim of this study was to assess serum concentrations of the above-mentioned parameters in children on chronic dialysis. Methods: 19 patients on hemodialysis (HD), 22 children on peritoneal dialysis (PD) and 30 age-matched controls were examined. Serum concentrations of parameters were assessed by ELISA. Results: Hsp90α, MMP-8, EMMPRIN and E-cadherin concentrations were significantly increased in children on dialysis vs. controls and higher levels were in HD than PD patients. There was no difference in the level of sE-selectin between HD and PD modalities. A single HD session diminished Hsp90α, MMP-8, EMMPRIN and E-cadherin values, but had no impact on sE-selectin levels. Conclusions: Hemodialysis evokes stress reaction, matrix and endothelium destruction, to a greater extent than peritoneal dialysis. Single hemodialysis influences circulating cells rather than endothelial cells.

Impact of dialysis modality on left ventricular geometry assessed by echocardiography in patients with end stage renal disease

Purpose: Left ventricular hypertrophy (LVH) is an independent risk factor for morbidity and mortality in patients with end stage renal disease. This study aimed to evaluate pattern of LV remodeling according to dialysis modality in patients with end stage renal disease. Methods: We retrospectively evaluated change in LV mass index (LVMI), relative wall thickness (RWT) and LV geometry, assessed by 2D transthoracic echocardiography, in patients starting dialysis while hospitalized from 2000 to 2012. Patients were classified into hemodialysis (HD) group and peritoneal dialysis (PD) group. Follow-up duration of performing echocardiogram was 11.6±4.5 months. LV geometry was divided into 4 groups as normal LV geometry, concentric remodeling, concentric LVH and eccentric LVH according to LVMI and RWT using cutoff values of 131 (men) or 100 (women) g/m2 for LVMI and 0.45 for RWT, both men and women. The multivariate analysis was performed to evaluate the independent predictors of change in LV geometry among the patients who showed the change of LV geometry. Results: 74 patients with HD (age 54.9±13.0 years, 50.0% male) and 34 patients with PD (age 48±15.1 years, 58.8% male) were enrolled. Before initiation of dialysis, there were no significant difference of ejection fraction, LVMI, RWT (56.1±14.0% vs. 55.8±14.2%, p=0.898; 169.0±47.9g/m2 vs. 168.5±57.3g/m2, p=0.964; 0.46±0.1 vs. 0.46±0.1, p=0.937, respectively). There was no difference of geometry distribution between two groups (4.1% vs. 5.9% concentric remodeling, 51.4% vs. 50.0% concentric LVH, 37.8% vs. 32.4% eccentric LVH, respectively). Follow-up echocardiogram revealed that LVMI and RWT in both groups were not significantly different (166.4±44.4g/m2 vs. 154.5±49.0g/m2, p=0.221; 0.47±0.10 vs. 0.48±0.12, p=0.287). LVMI and RWT showed no significant difference over time in both groups (p=0.63 vs. p=0.22; p=0.31 vs. 0.93, respectively). However, the geometric change of LV was significantly different between two groups. Change to eccentric LVH from the other LV geometries was significantly higher in PD group (37.8% vs. 87.5%, p=0.001, Odds ratio [OR] 11.5, 95% Confidence interval [CI] 2.3-58.3). Change to concentric LVH from the other geometries was not significantly different. PD was associated with increase of LVMI (OR 2.88 95% CI 0.86-9.96). HD was associated with reduction of LVMI (OR 1.89 95% CI 0.94-3.97). Conclusion: Otherwise there was no difference in prevalence of LV geometry pattern at the time of initiating dialysis, PD was an independent predictor for LVMI increment and HD was an independent predictor for LVMI reduction.