Influence Of Dialysis Modality Research Articles

Does dialysis modality or duration influence outcomes in simultaneous pancreas-kidney transplant recipients? Single center experience and review of the literature.

The influence of dialysis modality and duration on outcomes following simultaneous pancreas-kidney transplantation (SPKT) remains uncertain. We performed a single-center retrospective review in 255 SPKT recipients according to dialysis modality (55 preemptive/no dialysis-ND, 70 peritoneal dialysis-PD, 130 hemodialysis-HD) and duration (55 none, 137<2 years, 41 2-4 years, 22>4 years). Mean follow-up was 9.4 years (median 9.2 years). Early (3-month) relaparotomy rate (20% ND vs. 36% PD/HD, p=.03) was lower in ND patients. There were no differences in early graft loss, patient survival, overall or death-censored kidney or pancreas graft survival rates (GSR) at 1 or 10 years follow-up. When analyzing dialysis duration, there were no differences in rates of pancreas thrombosis or early pancreas graft loss. Kidney delayed graft function (DGF) was lower in the ND/short dialysis groups combined (1.0%), compared to the intermediate/long dialysis groups combined (9.5%, p=.003). Early relaparotomy rates were higher with longer duration of dialysis (p=.045 between ND and >4 years of dialysis). Patient survival in the long dialysis group was 50% compared to 69.5% in the other three groups combined (p=.09). However, both overall and death-censored kidney and pancreas GSR were comparable. Preemptively transplanted patients had a lower incidence of kidney DGF and relaparotomy whereas patient survival was slightly lower with longer dialysis vintage prior to SPKT. Dialysis modality and duration did not influence either overall or death-censored pancreas or kidney GSR in patients with short waiting times, low KDPI donor organs, and dialysis duration up to 4 years.

Influence of Dialysis Modality on the Treatment of Anemia in Patients with End-Stage Kidney Disease

Abstract Anemia is a common complication among the patients with end-stage kidney disease. Management of anemia is influenced by several factors: iron deficiency, subtherapeutic dosage of erythropoietin, microinflammation, vitamin D deficiency, increased iPTH levels and inadequate hemodialysis. The aim of the study was to examine impact of dialysis modality on blood hemoglobin level as well as status of iron, status of vitamin D, hemodialysis adequacy and erythropoietin dose. The study included 120 patients which were divided into two groups: the group of patients treated with hemodiafiltration and the group of patients treated with standard hemo-dialysis. For statistical analysis Kolmogorov-Smirnov test, Student’s t-test and Mann-Whitney U-test were used. Blood hemoglobin level and parameters of hemodialysis adequacy (Kt/V index, spKt/V index, URR index), hematocrit ad protein catabolic rate (nPCR) were statisticaly significant lower in patients treated with regular hemodialysis compared to patients treated with regular hemodiafiltration. Serum ferritin level, C-reactive protein level and average monthly dose of intravenous iron were higher in the patients treated with regular hemodialysis compared to patients treated with hemodiafiltration. Patients treated with hemodiafiltration have lower grade of microinflammation, better iron status and better control of anemia compared to the patients treated with regular hemodialysis. Dialysis modality is an important factor that influences management of anemia in the patients with end-stage kidney disease.

Post-transplant Alternative Complement Pathway Activation Influences Kidney Allograft Function

The complement system is one of the crucial pathophysiological mechanisms that directly influence the function of a transplanted kidney. Since the complement pathways’ activation potential can be easily determined via their functional activity measurement, we focused on fluctuation in the cascade activity in the early post-transplant period. The aim of the study was to relate the kidney transplantation-induced complement system response to allograft outcome. Forty-two kidney recipients (aged: 53.5 [37–52], 17 females/25 males) and 24 healthy controls (aged: 40.5 [34–51], 13 females/11 males) were enrolled in the study. The functional activities of alternative, classical, and lectin pathways were determined before and in the first week after transplantation using Wielisa®-kit. We observed that the baseline functional activity of the alternative pathway (AP) was higher in chronic kidney disease patients awaiting transplantation compared to healthy controls and that its level depended on the type of dialysis. AP-functional activity was decreased following transplantation procedure and its post-transplant level was related to allograft function. The baseline and transplantation-induced functional activities of the classical and lectin pathways were not influenced by dialysis type and were not associated with transplant outcome. Moreover, our study showed that intraoperative graft surface cooling had a protective effect on AP activation. Our study confirms the influence of dialysis modality on persistent AP complement activation and supports the role of AP in an early phase after kidney transplantation and allograft outcome.

Cognitive function and advanced kidney disease: longitudinal trends and impact on decision-making.

Background: Cognitive impairment commonly affects renal patients. But little is known about the influence of dialysis modality on cognitive trends or the influence of cognitive impairment on decision-making in renal patients. This study evaluated cognitive trends amongst chronic kidney disease (CKD), haemodialysis (HD) and peritoneal dialysis (PD) patients. The relationship between cognitive impairment and decision-making capacity (DMC) was also assessed. Methods: Patients were recruited from three outpatient clinics. Cognitive function was assessed 4-monthly for up to 2 years, using the Montreal Cognitive Assessment (MoCA) tool. Cognitive trends were assessed using mixed model analysis. DMC was assessed using the Macarthur Competency Assessment tool (MacCAT-T). MacCAT-T scores were compared between patients with cognitive impairment (MoCA <26) and those without. Results: In total, 102 (41 HD, 25 PD and 36 CKD) patients were recruited into the prospective study. After multivariate analysis, the total MoCA scores declined faster in dialysis compared with CKD patients [coefficient = −0.03, 95% confidence interval (95% CI) = −0.056 to − 0.004; P = 0.025]. The MoCA executive scores declined faster in the HD compared with PD patients (coefficient = −0.12, 95% CI = −0.233 to − 0.007; P = 0.037). DMC was assessed in 10 patients. Those with cognitive impairment had lower MacCAT-T compared with those without [median (interquartile range) 19 (17.9–19.6) versus 17.4 (16.3–18.4); P = 0.049]. Conclusions: Cognition declines faster in dialysis patients compared with CKD patients and in HD patients compared with PD patients. Cognitive impairment affects DMC in patients with advanced kidney disease.

Influence of dialysis modalities on patients undergoing parathyroidectomy for renal hyperparathyroidism

Summary Background/Introduction Dialysis modalities may influence parathyroid hormone (PTH) levels and renal osteodystrophy patterns. To date, no study has compared the effects of dialysis modality on surgical patients with renal hyperparathyroidism. Purpose/Aim This study evaluated the influence of different dialysis modalities on perioperative features among patients undergoing parathyroidectomy. Methods Overall, 386 patients who underwent initial parathyroidectomy for renal hyperparathyroidism were recruited. Biochemical data and relevant symptoms were compared between hemodialysis and peritoneal dialysis patients. Results Compared with the hemodialysis patients, the 40 (10%) peritoneal dialysis patients were younger (p = 0.002) and had a shorter duration of dialysis (p Conclusion Patients on different dialysis modalities had similar decreases in intact PTH and alkaline phosphatase levels after surgery. However, the peritoneal dialysis patients had higher postoperative calcium–phosphorus product levels and more severe residual symptoms.

Health-related quality of life after kidney transplantation: who benefits the most?

The influence of dialysis modalities on HRQoL before and after kidney transplantation (KT) and the role of adherence to medication on HRQoL have not been fully studied. Sixty four dialysis patients who answered the 15D HRQoL survey during dialysis were surveyed again after KT. Adherence and employment were also investigated. The mean 15D score was highest among home hemodialysis patients (HHD) and lowest among in-center hemodialysis patients (icHD). After KT, the mean 15D score improved significantly in 78.6% of peritoneal dialysis patients (PD), 47.6% of HHD, and 53.8% of icHD. Then, mean 15D score remained unchanged in 28.6% of HHD and in 23.1% of icHD patients. A deterioration in the 15D score occurred in 14.3% of PD, 23.1% of icHD, and 23.8% of HHD patients, and this was influenced by the number of pills (P=0.04). Adherence to medication was the lowest in PD, timing being the most challenging task showing a connection to higher creatinine concentration (never forgot 1.41mg/dl vs. forgot 2.08mg/dl P=0.05). Employed patients had a higher mean 15D score. The icHD and PD patients benefited the most from KT and HHD the least. Low pill burden and employment were linked to a better HRQoL.

Study of Protein Oxidative Stress, Antioxidant Vitamins and Inflammation in Patients Undergoing either Hemodialysis or Peritoneal Dialysis.

The influence of dialysis modality on oxidative stress (OS) and inflammation is not yet clear. Elucidating this influence could provide novel therapy concepts for cardiovascular diseases. To compare protein OS, antioxidant vitamins and inflammation in patients undergoing either hemodialysis (HD) or peritoneal dialysis (PD). A cross-sectional study was performed with 19 PD and 21 HD patients treated for ≥ 6 months. The control group was composed of 17 healthy individuals. Advanced oxidation protein products (AOPP), advanced glycation end products (AGEs), vitamins C, A and E, C-reactive protein and interleukin 6 were measured in plasma samples. OS was higher in the dialysis group when compared with controls, but HD patients showed higher AOPP compared with PD (HD:141.9 ± 75.2 µmol/L; PD: 112.5 ± 69.3 µmol/L, P< 0.01) and AGEs (HD: 32.2 ± 10.6 AU x10³; PD: 26.6 ± 4.9 AUx10³, P< 0.05). There was no difference in inflammation and vitamin levels among dialysis patients. In HD patients, AGEs correlated moderately with serum vitamin C (r = 0.46; P< 0.05). The dialysis modality adopted influences protein OS, but it has no effect on antioxidant status or inflammation. Hemodialysis probably exacerbates OS due to the increased bioincompatibility of the dialysis procedure, and this scenario seems to be related to the intravenous supplementation of vitamin C. Peritoneal dialysis allows for a better oxidative balance, which may reduce cardiovascular risk.

HRQoL After Kidney Transplantation: Who Benefits the Most?

Aims. Health-Related Quality of Life (HRQoL) in chronic kidney patients is related to treatment modality, being better after kidney transplantation (KT) than during dialysis. We investigated the influence of dialysis modality on HRQoL before and after KT and the role of adherence on HRQoL. Material and methods. 64 dialysis patients who answered the 15D HRQoL survey during dialysis were surveyed again after KT and compared with the general population (GP). Adherence and employment were investigated. Results. The mean 15D score was highest among homehemodialysis patients (HHD) and lowest among in-centre hemodialysis patients (icHD) compared with the GP (P<0.001).Figure: No Caption available.Mean 15D improved in all groups after KT. 78.6% of peritoneal dialysis patients (PD) had a clinically significantly improved 15D score whereas only 47.6% of HHD improved their 15D score and 28.6% remained unchanged. For icHD 53.8% improved their 15D score and 23.1% remained unchanged. A deterioration in the 15D score occurred in 14.3% of PD, 23.1% of icHD and 23.8% of HHD patients and this was related to the number of pills (P=0.04).Figure: No Caption available.Adherence to medication was the lowest in PD. Timing was the most challenging task (not taking on time 25% HHD vs 62% PD patients P=0.03). Timing was related to a higher creatinine concentration (never forgot 125 μmol/L vs forgot 184 μmol/L P=0.05). Employed patients had a higher mean 15D score. Conclusions. HRQoL improved after KT but remained lower than the HRQoL of GP. icHD and PD patients benefited the most, whereas HHD patients had the best HRQoL during dialysis and only 47% experienced a clinically significant improvement after KT. Low pill burden and employment were associated with better HRQoL.

Influence of dialysis modality and membrane flux on insomnia severity in haemodialysis patients

Insomnia is an important problem in dialysis patients. A greater prevalence of insomnia in chronic kidney disease compared with non-renal patients suggests a role for uraemic toxins in contributing to insomnia. The aim of this study was to examine if dialysis modality and membrane permeability is associated with the frequency and severity of insomnia in haemodialysis patients. In our cross-sectional study, we evaluated 122 patients who were divided into three groups: on-line haemodiafiltration, high flux haemodialysis and low flux haemodialysis. The frequency and severity of insomnia was evaluated with the Insomnia Severity Index. Insomnia was present in 47.5% of all patients. The majority of patients who reported insomnia were receiving low flux haemodialysis (80%), followed by patients on high flux haemodialysis (43.6%) and haemodiafiltration (20.9%). Patients using low flux membranes, had a significantly higher Insomnia Severity Index (11.9 ± 6.6) compared with patients receiving high flux haemodialysis (6.8 ± 6.3) and haemodiafiltration (5.2 ± 7.0). The insomnia severity index did not differ between patients receiving high flux haemodialysis compared with on-line haemodiafiltration. This study indicates that different haemodialysis modalities are associated with insomnia and suggests a potential benefit of using high flux membranes.

Influence of Dialysis Modality and Membrane Flux on Quality of Life in Hemodialysis Patients

Background: The quality of life in patients undergoing hemodialysis is significantly disturbed. There are data that hemodiafiltration (HDF) may be more effective than conventional hemodialysis in the removal of uremic toxins and may reduce frequency and severity of intradialytic and postdialysis adverse symptoms in patients. Also, some researchers suggest advantages of using high-flux membranes compared with low-flux. Objective: The aim of this study was to examine whether hemodialysis modality and membrane flux, independent of membrane biocompatibility, make differences in quality of life in patients. Methods: In our cross-sectional study, we evaluated 124 patients who were divided, based on therapy, into three groups: online HDF, high-flux hemodialysis, and low-flux hemodialysis. Data were collected using the Short Form-36 questionnaire combined with special questionnaire, which included demographic and clinically related questions. Results: Health-related quality of life was better in patients on HDF compared with patients on hemodialysis, especially compared with low-flux hemodialysis patients in most of the scales and in both dimensions: physical component scale and mental component scale. There were no statistically significant differences in Short Form-36 domains between high-flux hemodialysis and low-flux hemodialysis. Conclusion: Our data suggest the potential advantages of HDF with regard to influence on quality of life, which is sufficient to justify further research in prospective and longitudinal study design.

Potential influence of dialysis modality on post-transplantation diabetes mellitus risk

Potential influence of dialysis modality on post-transplantation diabetes mellitus risk

Dialysis as a Bridge Therapy to Renal Transplantation: Comparison of Graft Outcomes According to Mode of Dialysis Treatment

Background Renal transplantation is the ideal renal replacement therapy in patients with end-stage renal disease. It was unclear whether a difference in dialysis modality influences outcomes after kidney transplantation. Therefore, we evaluated the influence of dialysis modality. Methods We compared various clinical and laboratory parameters of 70 peritoneal dialysis (PD) and 180 hemodialysis (HD) patients ( n = 250), including 91 females and an overall age 36.7 ± 9.7 years who underwent transplantation between 2000 and 2008 to evaluate factors affecting delayed graft function (DGF) and of transplant graft failure. Results Overall graft survival was 82% at 3 and 75% at 5 years. Among HD patients, 16% displayed DGF, versus 12% of PD patients. Multivariate analysis showed that factors affecting DGF were: mode of dialysis (relative risk [RR] = 1.39, 95% confidence interval (CI): 1.35–1.43; P < .01); parathyroid hormone (RR = 0.32, 95% CI: 0.30–0.34, P < .05), C-reative protein (RR = 1.03, 95% CI: 0.97–1.09; P < .05), hemoglobin levels (RR = .75, 95% CI: 0.72–0.79; P < .05). At 3 and 5 years follow-up, PD patients' showed fewer graft failures than HD patients (14% vs 20%; P < .05 and 17% vs 28%; P < .05). Conclusion Early graft function rates were better for PD than for HD patients. Inflammation and anemia should be carefully investigated and corrected to achieve better graft function.

An evaluation of illness, treatment perceptions, and depression in hospital- vs. home-based dialysis modalities

ObjectivesDepressive symptoms are common among patients with end-stage renal disease (ESRD). In order to better understand what factors influence these symptoms, we examined the impact of illness and treatment cognitions on emotional adjustment and the influence of dialysis modality (hospital- vs. home-based dialysis) on this relationship. MethodsA cross-sectional sample of 145 ESRD patients on four different dialysis modalities [hospital hemodialysis (HD), n=52; home HD, n=25; continuous ambulatory peritoneal dialysis (CAPD), n=45; automated PD (APD), n=23] completed the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, the Treatment Effects Questionnaire, and the Beck Depression Inventory. Measures of ESRD severity/comorbidity and biochemistry were also collected. ResultsPerceptions of treatment disruptiveness and attributions to poor medical care were significantly greater in CAPD. Home-based treatments were not found to confer an emotional adjustment advantage compared to hospital HD. There were marked differences across home-based modalities, with n=22 (44.4%) CAPD meeting the clinical cutoff of depression (≧16) vs. n=6 (26.1%) in APD and n=2 (8%) in home HD. After adjusting for case-mix differences, the mean levels of depressed mood remained significantly higher in CAPD patients compared to APD and home HD (P<.01). On multiple regression analysis, 42.5% of the variance in depression was explained by the End-Stage Renal Severity Index, dialysis modality, perceived treatment disruptiveness, and beliefs about illness consequences and the extent to which the illness could be controlled. ConclusionThe findings suggest that the benefits of self-care are not uniformly manifested across dialysis modalities and that patients' cognitions are important determinants of depressed mood with implications for future research and clinical practice.

Influence of dialysis modality on renal transplant complications and outcomes

The present study investigated the influence of the pretransplant dialysis modality, hemodialysis (HD) or peritoneal dialysis (PD), on renal transplant complications and outcomes. 402 cadaveric renal transplant patients maintained on HD (N = 303) or PD (N = 99) for more than 3 months prior to transplantation were studied retrospectively, and a total of 345 patients were followed up for 30.2 +/- 15.2 months. The impact of HD or PD on acute rejection, delayed graft function (DGF), infection, chronic rejection, and the survival rate of graft and patients were analyzed. There was no significant difference between the HD and PD groups with regard to the causes of end-stage renal disease, age, gender, blood pressure, hemoglobin, HLA match, hot and cold ischemia time, and hepatitis C virus infection. The incidence rates of DGF, acute rejection, chronic rejection and cytomegalovirus and other infections were also not significantly different between the HD and PD groups. However, compared to HD, patients with PD had longer dialysis duration (p < 0.05), but less hepatitis B infection (p < 0.05) and post-transplant infection (p < 0.05). In contrast, in those PD patients with hepatitis B infection, graft loss was significantly increased (19.23% vs. 8.86% , p = 0.021). The incidence of acute rejection episodes was higher in HD patients who had pretransplant dialysis for more than 12 months (p < 0.05). The overall patient and graft survival rates within 5 years between the HD and PD groups were not significantly different (p > 0.05). The influence of PD and HD on complications after renal transplant at 1 year and 5 years and graft survival rates was similar, and therefore, either HD or PD can be chosen as the pretransplant dialysis modality. However, patients in the PD group had a reduced incidence of hepatitis virus infection, suggesting that PD may have certain advantages over HD as a preoperative substitution therapy for renal transplantation.

Influence of Dialysis Modality on Complications and Patient and Graft Survival After Pancreas-Kidney Transplantation

Introduction We investigated whether hemodialysis or peritoneal dialysis prior to pancreas-kidney transplantation was a risk factor for the development of surgical complications, recipient mortality, or graft loss. Patients and methods From March 1995 to December 2006, 90 patients with type 1 diabetes underwent pancreas transplantation. Dialysis before transplantation was provides to 81 patients. We compared outcomes of recipients classified as two groups: (A) hemodialysis ( n = 49, 60.5%) versus (B) peritoneal dialysis ( n = 32, 39.5%) groups. Results Donor and recipient characteristics were similar in both groups. Enteric drainage was more frequently used in the hemodialysis group and bladder drainage in the peritoneal dialysis group ( P < .05). The rate of intra-abdominal infections was similar in both groups: 10 patients (20.4%) in the hemodialysis group and 9 patients (28.1%) in the peritoneal dialysis group ( P = NS). The incidence of enteric or bladder leakage was slightly higher in the peritoneal dialysis group (5 cases, 15.6% vs 4 cases, 8.2% in the hemodialysis group; P = NS). The rate of reoperations was also slightly higher in the peritoneal dialysis group B (15 cases, 46.9% vs 14 cases, 28.6% in the hemodialysis group; P = .07). Pancreas transplantectomy was significantly greater in the peritoneal dialysis (9 cases; 28.1%) than the hemodialysis group (5 cases; 10.2%; P < .05). The actuarial 3-year patient survival was 95.9% in the hemodialysis group and 93.4% in the peritoneal dialysis group ( P = NS); actuarial 3-year pancreas graft survival was 79.3% in the hemodialysis group and 68.3% in the peritoneal dialysis group ( P = NS). Conclusions We noted an insignificantly greater rate of reoperations but significantly higher incidence of pancreas transplantectomy in the peritoneal dialysis group; however, patient and pancreas graft survivals were similar in both study groups.

Health-related Quality of Life Taiwanese Dialysis Patients: Effects of Dialysis Modality

Taiwan has the highest incidence and prevalence of end-stage renal disease worldwide. However, not many studies have focused on the influence of dialysis modality on health-related quality of life (HRQoL) for dialysis patients in Taiwan. This study intended to compare the differences in HRQoL between peritoneal dialysis (PD) and hemodialysis (HD) and to evaluate the effects of dialysis modality on patient HRQoL. A cross-sectional survey using the Taiwan-version 36-item short-form health survey questionnaire (SF-36) was completed by 244 dialysis patients (58 PD and 186 HD patients) at two hospital-based dialysis units in southern Taiwan. Patient characteristics, diagnoses and laboratory data were individually extracted from the annual survey and matched with primary HRQoL data. Multiple linear regression analysis was performed to evaluate the effects of dialysis modality on HRQoL. Compared with HD patients, PD patients had higher scores in six of the eight SF-36 subscales, including physical functioning, role limitations due to physical and emotional problems, bodily pain, vitality, and mental health. However, only role limitations due to emotional problems and bodily pain reached significant difference levels (p < 0.05). After controlling for patient characteristics, comorbid conditions and laboratory values, the bodily pain score was 7.88 points higher for PD patients compared with HD patients, while the social functioning score was 9.00 points higher for HD patients compared with PD patients (p < 0.05). The present study provides cross-sectional confirmation for equivalent levels of HRQoL between PD and HD patients except for the subscales of bodily pain and social functioning. In addition to dialysis modality, HRQoL for dialysis patients may be more related to personal attributes, interactions with multiple diseases, social support and quality of care received. When informing patients about modality choices for dialysis, trade-offs should be discussed and individual preferences for specific aspects of HRQoL should be considered.

Influence of pretransplant dialysis modality on the change of lymphocyte subset populations and acute rejection rates after renal transplantation.

The influence of dialysis modality on the acute rejection (AR) rate after renal transplantation is controversial. We investigated whether the pretransplant dialysis modality correlated with the lymphocyte subset populations and the incidence of AR after renal transplantation. Thirty-eight first living renal transplant recipients, consisting of 22 patients on pretransplant hemodialysis (HD) and 16 patients on pretransplant peritoneal dialysis (PD), were studied. Peripheral blood samples were taken on days -1 through 28 after transplantation, and the lymphocyte fractions were exposed to the monoclonal antibodies anti-CD3, CD19, CD4, CD8 and CD28 for a flow cytometer analysis. Biopsy specimens were obtained at the time of presumed AR episodes and on day 28 after transplantation. The PD patients had a higher frequency of AR (37.5% in PD vs 9.1% in HD patients, P = 0.034). In contrast, two HD patients showed graft loss at 18 and 30 months after transplantation. The increases of CD3, CD19, CD4 and CD4+ CD28+ cells in the PD patients occurred earlier than in the HD patients and the numbers of these cells in the PD group were higher than those in the HD between days 3-28 after transplantation, most significantly on day 7. These findings suggest that the PD patients with similar clinical characteristics could potentially have a higher immunocompetence and immune responsiveness associated with a higher rate of AR in the early stage of renal transplantation when compared with the HD patients.

Initial survival advantage of peritoneal dialysis relative to haemodialysis

The influence of dialysis modality on prognosis is controversial. In the absence of randomized trials, epidemiological investigations present the best method for studying the problem. 4568 haemodialysis (HD) and 2443 peritoneal dialysis (PD) records in 4921 dialysis patients treated between 1990 and 1999 were retrieved from the Danish Terminal Uremia register in order to determine the influence of dialysis form on prognosis. The register is national, comprehensive, and incident. Factors reducing survival included age, cardiovascular disease, malignancy, lung disease, diabetes, alcoholism, haematological disease, but not sex or hypertension. Transplant non-candidacy was associated with an adjusted relative risk of 4.7 (CI 4.0-5.6). PD mortality relative to HD (after correction for comorbidity and transplant candidacy) was 0.65 (CI 0.59-0.72, P<0.001) on an "as treated" and "history" analysis and 0.86 (CI 0.78-0.95, P<0.01) on an intention-to-treat (ITT) analysis. The difference was confined to the first 2 years of dialysis. Change in dialysis modality was associated with increased mortality, and change from PD to HD with an accelerated mortality for the first 6 months. This was presumably due to the transfer of sick PD patients, but did not explain the difference. The relative advantage of PD was lower for diabetic patients, where it was not significant on ITT analysis. Dialysis prognosis improved by 14% during the period, with similar results for HD and PD patients. PD patients who were subsequently transplanted had a significantly shorter time to onset of graft function (3.5 vs 5.1 days, P<0.05). These results show a survival advantage for PD during the first 2 years of dialysis treatment. This may be due to unregistered differences in comorbidity at the start of treatment, or may be causal, possibly due to better preservation of residual renal function. The study lends credence to the "integrative care" approach to uraemia, where patients are started on PD and transferred to HD when PD related mortality increases.

Influence of dialysis modalities on serum AGE levels in end-stage renal disease patients.

The accumulation of advanced glycation end-products (AGEs) in end-stage renal disease (ESRD) influenced by dialysis modalities is of current interest. Highly permeable membranes in haemodialysis or haemofiltration should be able to eliminate circulating AGEs as well as their AGE precursors more efficiently. In our study, 10 non-diabetic and 10 diabetic ESRD patients were on haemodialysis with low-flux membranes (LF) followed by a cross-over haemodialysis with high-flux or super-flux polysulfone membranes (HF, SF) for 6 months each. We measured the protein-bound pentosidine and free pentosidine serum levels by high-performance liquid chromatography (HPLC) as well as the serum AGE peptide, AGE-beta(2)-microglobulin and beta(2)-microglobulin concentrations, using ELISA assays. All parameters investigated were significantly higher in dialysis patients than in healthy subjects. The reduction rates during a single dialysis session were found to be higher using the SF than those obtained with the HF (free pentosidine 82.4+/-7.3 vs 76.6+/- 8.7%; AGE peptides 79.7+/-7.7 vs 62.3+/-14.7%; AGE-beta(2)-microglobulin 64.0+/-16.5 vs 45.4+/-17.7%; beta(2)-microglobulin 70.5+/-5.6 vs 58.2+/-6.0%). The protein-bound pentosidine levels remained constant over the respective dialysis sessions. In the 6-month treatment period with the SF, decreased pre-dialysis serum levels of protein-bound pentosidine, free pentosidine and AGE peptides were observed in non-diabetics and diabetics as compared with values obtained with the LF. The respective pre-dialysis AGE-beta(2)-microglobulin concentrations decreased insignificantly, whereas those of beta(2)-microglobulin were significantly lower. Using the HF dialyser, only moderate changes of the parameters measured were noted. Treatment with the biocompatible polysulfone SF dialyser seems to be better suited to lower serum AGE levels and to eliminate their precursors.

Influence of dialysis modality on plasma and tissue concentrations of pentosidine in patients with end-stage renal disease

Plasma and tissue concentrations of pentose-derived glycation end-products (“pentosidine”) are elevated in diabetic patients with normal renal function and in both diabetic and nondiabetic patients with end-stage renal disease. To determine the influence of dialysis modality and other clinical variables on the accumulation of pentosidine, we used high-performance liquid chromatography to measure this advanced glycation end-product in plasma, skin, and peritoneal samples obtained from 65 hemodialysis and 45 peritoneal dialysis patients. Plasma pentosidine levels were significantly lower in peritoneal dialysis patients. Concentrations of pentosidine in skin were similar in the two groups. In contrast, peritoneal concentrations of pentosidine were significantly higher in the patients maintained on peritoneal dialysis. Our results demonstrate that dialysis modality influences the plasma and tissue distribution of pentosidine. Compared with hemodialysis, peritoneal dialysis is associated with lower levels of this glycation end-product in plasma, but with higher levels in the peritoneum. The mechanisms accounting for lower circulating levels of pentosidine in peritoneal dialysis patients remain to be determined. Higher levels in peritoneal tissues may reflect chronic exposure to the high concentrations of glucose in peritoneal dialysate.