Initiation Of Peritoneal Dialysis Research Articles

A predictive model based on serum bicarbonate for cardiovascular events after initiation of peritoneal dialysis

Background The risk of cardiovascular events (CVEs) in peritoneal dialysis (PD) patients is high, but varies widely among individuals. Metabolic acidosis is prevalent in PD patients and may be involved in the development of CVEs. The aim of the study was to evaluate serum bicarbonate as a risk factor and derive a model of new CVE. Methods A predictive model was established by performing an observational study in 187 PD patients obtained from the First Affiliated Hospital of Anhui Medical University. The variables were extracted using least absolute shrinkage and selection operator (LASSO) regression, and the modeling was developed using multivariable Cox regression. Results Left ventricular hypertrophy (HR = 1.965, 95%CI 1.086–3.557) and history of CVEs (HR = 2.435, 95%CI 1.342–4.49) were risk parameters for a new CVE. Serum albumin (HR = 0.924, 95%CI 0.864–0.989) and bicarbonate levels (HR = 0.817, 95%CI 0.689–0.969) were protective parameters, in which the risk of CVEs was reduced by 7.6% and 18.3% for each 1-unit increase in serum albumin (g/L) and bicarbonate (mmol/L) levels, respectively. A nomogram based on the above predictive indicators was proposed with a C-statistic of 0.806, indicating good discrimination. Moreover, it successfully stratified patients into low-, intermediate-, and high-risk groups. Conclusions: We performed a risk prediction model for the development of CVEs in patients with PD, which may help physicians to evaluate the risk of new CVEs and provide a scientific basis for further interventions. Further studies are needed to externally validate current risk models before clinical application.

Unveiling the Intricacies: Exploring Stepwise Initiation of Peritoneal Dialysis in a Single-Center Setting

Background and Objectives: Chronic kidney disease (CKD) poses a significant global health challenge, necessitating effective renal replacement therapies. Peritoneal dialysis (PD) offers a patient-friendly, home-based alternative to hemodialysis. The Stepwise Initiation of Peritoneal Dialysis (SIPD) method, used in the SPD group and involving a gradual introduction of PD, presents a potential advantage over traditional protocols, yet the scientific literature on its efficacy and safety is limited. Materials and Methods: We conducted a retrospective analysis of 39 end-stage renal disease patients undergoing SIPD and 78 patients receiving conventional PD (CPD) at a single center from 1 January 2010 to 31 December 2023. Patients were matched for age and sex. Surgical techniques, early and late complications, infection rates, and catheter survival were evaluated. Data were analyzed using statistical methods, including the chi-square test, t-test, and negative binomial regression. Results: The mean break-in period was significantly more extended for the SPD group (176.05 ± 154.39 days) compared to the CPD group (26.87 ± 58.45 days). Early complications were similar between groups, but late complications, including peritonitis, were significantly higher in the CPD group. The SPD group experienced fewer infection events (28 vs. 80, p = 0.043). Median catheter survival times were 1486 days for SPD and 1774 days for CPD, with no statistical difference. Age was a significant factor in peritonitis incidence, increasing with age in both groups. Conclusions: Our study suggests that SPD may reduce the incidence of catheter-related infections and peritonitis compared to CPD. The extended break-in period in SPD could enhance tissue healing and reduce biofilm formation, thereby contributing to fewer infectious complications. Despite these findings, no significant difference in overall catheter survival was observed. Further multi-center studies with larger sample sizes are recommended to confirm these results and explore the economic impact of SPD vs. CPD.

Impact of home-based exercise on residual kidney function in patients initiating peritoneal dialysis: A feasibility multicenter randomized controlled trial.

Although the impact of aerobic exercise (AE) and resistance training (RT) on peritoneal dialysis (PD) patients is well established, the impact of exercise programs on residual kidney function (RKF) has not been elucidated. Patients were randomly assigned to either the exercise (n = 25) or control groups (n = 30). Patients in the exercise group performed AE three times a week and RT twice a week at home for 24 weeks. The control group did not receive any specific intervention. The primary outcome was RKF, assessed by residual glomerular filtration rate (rGFR). Secondary outcomes included urinary protein levels, distance covered in the incremental shuttle walking test (ISWT), and glycated hemoglobin (HbA1c) percentages. Linear mixed-effects models showed no significant changes in mean rGFR between the exercise and control groups at 12 weeks (-0.40; 95% confidence interval (CI): -2.17, 1.36; p = 0.65) and at 24 weeks (0.65; 95% CI: -1.15, 2.45; p = 0.48). There was a trend toward improvement in mean urinary protein level and ISWT results, and a significant decrease in mean HbA1c percentage at 24 weeks in the exercise group (-1.07, 95% CI: -2.29, 0.15, p = 0.09; 37.7, 95% CI: -10.1, 85.5, p = 0.12; -0.57, 95% CI: -0.97, -0.18, p = 0.005, respectively) compared to the control group. The 24-week home-based exercise program did not demonstrate beneficial effects on RKF in incident PD patients. Nonetheless, it may have an impact on reducing urinary protein levels and HbA1c percentages.

The Time-Dependent Effect of Assistance on Peritoneal Dialysis Duration: An Analysis of Data from the French Language Peritoneal Dialysis Registry.

Key Points It is unknown whether the benefit of assisted peritoneal dialysis (PD) programs appears immediately after PD initiation or rather after some time spent on PD.The protective effect of assisted PD on the risk of transfer to hemodialysis was not constant over time; it started after the first 6 months on PD.Assisted PD programs should be sustainable for at least 6 months to observe their benefits. Background Peritoneal dialysis (PD) patient compliance is crucial for the prevention of complications. Assistance is associated with a lower risk of transfer to hemodialysis. As the risk of noncompliance increases over time, the protective effect of assistance on the risk of transfer to hemodialysis may not be immediate after PD initiation, but rather may appear after some time on PD. We aimed to analyze the time-varying effect of assistance on the risk of PD cessation. Methods This retrospective study was conducted using data from the French Language PD Registry of incident PD patients between 2002 and 2018. Because of nonproportional hazards, with a change in the effect of the assistance modality on the different outcomes appearing at 6 months after PD initiation, the associations between the assistance modality and the different outcomes were explored using time-dependent coefficient Cox regression. Results The study included 15,675 patients; 6717 deaths, 4973 transfers to hemodialysis, and 3065 kidney transplantations occurred. Both patients receiving nurse- and family-assisted PD had a lower risk of transfer to hemodialysis (mean cause-specific hazard ratio [cs-HR], 0.67; 95% confidence interval [CI], 0.62 to 0.72; and mean cs-HR, 0.75; 95% CI, 0.67 to 0.84). In the first 6 months after PD initiation, nurse-assisted PD patients had a greater risk of transfer to hemodialysis (<6 months cs-HR, 1.18; 95% CI, 1.03 to 1.36) but had a lower likelihood afterward (≥6 months cs-HR, 0.57; 95% CI, 0.53 to 0.62). Family-assisted PD was not associated with the risk of transfer to hemodialysis in the first 6 months after PD initiation, and those patients had a lower risk of transfer to hemodialysis afterward (≥6 months cs-HR, 0.72; 95% CI, 0.63 to 0.82). Conclusions When implementing a national nurse-assisted PD program, its positive impact on PD duration should not be expected immediately after PD initiation. Assisted PD programs should be sustainable for at least 6 months to observe their benefits. Podcast This article contains a podcast at https://www.asn-online.org/media/podcast/K360/2024_10_31_KID0000000577.mp3

Serum Soluble Suppression of Tumorigenicity-2 Levels Predict Cardiovascular Events in Patients Undergoing Incident Peritoneal Dialysis: A Prospective Cohort Study.

Biomarkers are urgently required to identify peritoneal dialysis (PD) patients at risk of cardiovascular (CV) events. This study aimed to investigate the predictive value of soluble suppression of tumorigenicity-2 (sST2) for CV events in patients undergoing incident PD. In this prospective cohort study, incident PD patients were enrolled. Blood samples to measure sST2 levels were obtained before PD catheter implantation. The patients underwent a standard peritoneal equilibration test (PET) after initiation of PD for 4-6 weeks. The sST2 levels in both serum and dialysate were determined using enzyme-linked immunosorbent assay. CV events were recorded during the follow-up period. A total of 137 patients were enrolled. During the follow-up period of 17.3 months, 49 (35.76%) patients experienced CV events. When patients were dichotomized based on the median values and the calculated cutoff values of sST2, the higher sST2 group had 2.980- and 3.048-fold increased risks of CV events, respectively, when compared with the lower sST2 group. Moreover, the prognostic value of sST2 remained significant as a continuous variable (per 1 standard deviation increase, hazard ratio [HR] = 1.037, 95% confidence interval [CI] 1.010-1.066, p = 0.008). N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were found to indicate a higher risk only when dichotomized based on the calculated cutoff values. Furthermore, serum sST2 and NT-proBNP levels simultaneously above the calculated cutoff values were associated with a higher risk of CV events (HR = 3.398, 95% CI 1.813-6.367, p < 0.001). Baseline serum sST2 level is an independent predictor of the risk of CV events in patients receiving incident PD, and in combination with NT-proBNP level, it can provide a more accurate predictive value.

Early Anuria in Incident Peritoneal Dialysis Patients: Incidence, Risk Factors, and Associated Clinical Outcomes

Rationale & ObjectiveThe development of anuria was linked to worse clinical outcomes in patients undergoing peritoneal dialysis (PD). Our objective was to investigate the incidence, risk factors, and associated clinical outcomes of anuria within the first year after PD. Study DesignRetrospective Cohort Study. Setting & ParticipantsPatients who started continuous ambulatory peritoneal dialysis (CAPD) at our center between 2006 and 2020 were included and followed up until January 31, 2023. ExposureAge, gender, diabetes, temporary hemodialysis, angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs), diuretics, baseline urine volume, serum albumin, daily glucose exposure, peritonitis, and incremental PD. OutcomesThe primary outcome was early anuria, defined as 24-hour urine volume ≤ 100mL within the first year of PD initiation. Secondary outcomes included all-cause mortality, cardiovascular disease (CVD) mortality, technique failure, and peritonitis. Analytical ApproachCox proportional hazards model. ResultsA total of 2592 CAPD patients aged 46.7 ± 14.9 years were recruited. Among them, 58.9% were male, 24.0 % had diabetes. Within the first year of PD therapy, 159 (6.13%) patients developed anuria, with a median duration of 7.53 (interquartile range [IQR] 3.93-10.0) months. Higher baseline urine volume (hazard ratio [HR] 0.93, 95% confidence interval [CI] 0.90-0.97), higher serum albumin (HR 0.92, 95% CI 0.88-0.95), with diabetes before PD (HR 0.57, 95% CI 0.35-0.92), and prescribed incremental PD (HR 0.27, 95% CI 0.14-0.51) were associated with a reduced risk for early anuria, while a higher level of daily glucose exposure (HR 1.01, 95% CI 1.00-1.01) was identified as a risk factor for early anuria. Subgroup analyses showed that using ACEI/ARBs was linked to a lower risk of early anuria (HR 0.25, 95% CI 0.09-0.69) in diabetic patients. Treating early anuria as a time-dependent covariate, early anuria was associated with a higher risk for all-cause mortality (HR 1.69, 95% CI 1.23-2.32) and technique failure (HR 1.43, 95% CI 1.00-2.04) after adjusting for confounding factors. LimitationsSingle-center and observational study. ConclusionsThe incidence of early anuria in our center was 6.13%. Higher baseline urine volume, higher serum albumin, a history of diabetes, incremental PD start, and lower daily glucose exposure were associated with lower risks of early anuria. In patients with diabetes mellitus, non-use of ACEI/ARBs was associated with early anuria. Early anuria was related to a higher risk for all-cause mortality and technique failure.

Retroperitoneal leakage as an important cause of acquired ultrafiltration decline in peritoneal dialysis: clinical characteristics and related risk factors.

Peritoneal dialysis (PD) is a widely-used renal replacement therapy while low ultrafiltration volume usually results in technique failure. Retroperitoneal leakage has been reported to be one of the causes of acquired decline in ultrafiltration. The present study investigated retroperitoneal leakage in PD patients and explored related risk factors. This study was designed as a prospective, observational study. A total of 420 PD patients regularly followed up at our center were enrolled from May 2011 to July 2021 and followed until December 2021. Retroperitoneal leakage was determined by magnetic resonance peritoneography and was used as the endpoint. Patients with retroperitoneal leakage were given intermittent PD or temporary hemodialysis (HD) as therapy. Cox regression models were used to identify risk factors for retroperitoneal leakage. The cohort was followed up for up to 125.0months (median: 46.4months; interquartile range: 16.6months). During the follow-up, 68 patients developed retroperitoneal leakage, with 31 (45.6%) cases occurring within the first year after PD initiation. A total of 62 (91.2%) patients recovered from retroperitoneal leakage and resumed their original PD regimen. Multivariate Cox regression analysis revealed that age and gender were independent predictors for retroperitoneal leakage. Younger males were more likely to develop retroperitoneal leakage. In females, waistline and body mass index (BMI) were found to be risk factors for retroperitoneal leakage. Retroperitoneal leakage was common in PD patients with ultrafiltration insufficiency and was usually reversible after appropriate treatment. Age and gender were independent risk factors for retroperitoneal leakage.

Pericatheter Leak Associated With Earlier Peritoneal Dialysis Initiation Does Not Influence Long-Term Outcomes

Internationally, peritoneal dialysis (PD) is increasingly being commenced within 2 weeks of catheter insertion. Studies are warranted to evaluate outcomes of this strategy. This study examines outcomes of early-start PD (ESPD) and conventional-start PD (CSPD), commencing at≤14 days and >14 days after catheter insertion, respectively. All adults with kidney failure within a large metropolitan PD unit initiating PD through a new catheter, inserted using laparoscopic or modified Seldinger technique, between August 2019 and August 2022, were included in this retrospective observational study. Demographic data and episodes of infectious and mechanical complications were collected using electronic medical records. Analysis was conducted using analysis of variance and Chi-square testing. A P-value< 0.05 was significant with Bonferroni correction performed where relevant. Kaplan-Meier and competing risks analyses were performed for time to PD-related peritonitis and transfer to hemodialysis. A total of 297 patients (70% male, mean age 58.7 years) were included, with 130 (43.8%) patients undertaking ESPD. Most patients had laparoscopically inserted catheters (65.3%) and 65 patients (22.0%) received prior hemodialysis. When compared to CSPD, ESPD was associated with a higher number of pericatheter leaks (6.9% vs. 0.6%, P= 0.003), with otherwise similar complication episodes and no significant difference with respect to time to PD-related peritonitis or transfer to hemodialysis. Catheter insertion technique or prior hemodialysis treatment did not significantly influence outcomes. ESPD is associated with increased pericatheter leaks when compared to CSPD, with an otherwise similar complication profile.

Nutritional Status of Patients Starting on Peritoneal Dialysis: A Comparison Between Planned and Unplanned Dialysis Initiation

A suboptimal dialysis initiation with insufficient or no planning before urgent start of dialysis remains a common problem associated with increased morbimortality. Whether nutritional markers differ between patients starting peritoneal dialysis (PD) in unplanned and planned modes has not yet been explored. Therefore, we aimed to evaluate whether the nutritional status at the start of dialysis differed between patients with unplanned and planned PD initiation. In this observational study comprising 47 adult patients starting PD (age 58±15 years, 51% female), 29 patients had unplanned (starting dialysis up to 72 hours after peritoneal catheter implantation) and 18 planned (follow-up pre-dialysis >90 days) dialysis initiation. Within 30 days of PD initiation, nutritional status was evaluated using anthropometric measurements, multifrequency bioelectrical impedance analysis, appetite assessment, handgrip strength, laboratory markers, and the malnutrition-inflammation score (MIS). Physical activity and performance were also evaluated. Patients with an unplanned PD initiation had a higher frequency of diabetes, higher blood glucose, urea, and glycated hemoglobin levels, and lower hemoglobin and albumin levels. Furthermore, they had a lower calf circumference, slower gait speed, higher protein intake, and greater MIS, while their physical activity level and appetite did not differ. Patients with an unplanned PD had unfavorable clinical and nutritional markers compared with those with planned PD. These findings indicate that a lack of follow-up prior to dialysis initiation can influence the clinical and nutritional statuses of patients, reinforcing the importance of conservative treatment prior to dialysis initiation.

Plasma angiotensin-converting enzyme 2 (ACE2) is a marker for renal outcome of diabetic kidney disease (DKD) (U-CARE study 3)

IntroductionACE cleaves angiotensin I (Ang I) to angiotensin II (Ang II) inducing vasoconstriction via Ang II type 1 (AT1) receptor, while ACE2 cleaves Ang II to Ang (1–7) causing vasodilatation...

#546 Decline of kidney function before and after start of peritoneal dialysis (PD)

Abstract Background and Aims Residual kidney function (RKF) is a key component for PD adequacy and associated with improved volume status, nutrition and quality of life as well as with increased survival. The aim of the present study was to compare decline of kidney function before and after start of PD. Method We studied patients starting PD (during 2000-2019) in an ongoing prospective study of patients starting dialysis. Study inclusion in almost all PD patients coincided with PD catheter insertion. Patients were included in the present analysis if they had at least one urinary collection before, and one after PD initiation (a), PD initiation less than six months after study inclusion (b) and &amp;gt; 6 months PD treatment (c). P-creatinine to calculate eGFR was retrospectively collected for 12 months before start of PD. During a large part of the study period, it was a clinical routine to collect 24-hour urine collections regularly in CKD5 patients, and these data were retrieved when available. After start of PD, regular 24-hour urine collections were part of the clinical routine to follow up and were retrieved for up to 12 months after PD start. eGFR was measured using the CKD-epi 2021 equation and GFR was calculated as the average of urinary creatinine and urea clearance corrected for BSA. The decline of eGFR before start of PD, the decline of GFR from 24-hour urine collections and the decline of GFR after start of PD were compared to each other. Results We studied 138 patients starting PD. The mean age was 55 ± SD13 years, and there were 80 males and 58 females. The mean blood pressure was 153 ± SD21/89 ± SD11 mmHg and BMI was 25 ± SD4 kg/m2. The etiologies of end stage kidney disease were nephrosclerosis 17%, diabetic nephropathy 22%, glomerulonephritis 25%, polycystic kidney disease 14% and other 22%. The GFR at PD start was 8.5 ± SD 2.3 mL/min/1,73 m² and eGFR was 5.8 ± SD 1.9 mL/min/1,73 m². The results show a significantly slower kidney function decline rate after start of PD, with an average of −0.59 mL/min/1,73 m²/month before PD initiation compared to −0.34 mL/min/1,73 m²/month after. Conclusion Decline of GFR was slower after start of PD suggesting that earlier initiation of dialysis may be beneficial for the preservation of RKF. Notably, there was a marked attenuation after 3 months of dialysis. Furthermore, the decline rate of GFR before PD start was similar using eGFR or GFR from 24-h urine collection, though for eGFR at somewhat lower levels. However, there were pronounced differences between those two methods in individual patients demonstrating that eGFR is unreliable with very low GFR. Further study will be performed to analyze what factors that are associated with better preservation of RKF.

#1439 Risk factors and significance of a reduction of serum albumin after start of PD

Abstract Background and Aims A reduction in the serum level of albumin following the initiation of peritoneal dialysis (PD) has been reported to associate with impaired survival. Our aim was to identify pre-PD risk factors of drop of serum albumin, and to estimate how a decrease in albumin level affects PD patients’ survival prognosis. Method We included all adult patients who had been on PD for at least half a year in the Helsinki area in Finland during the years 2004 to 2019. Patients who had a dialysis history longer than 1 year before transferal to PD were excluded. We analysed the serum albumin level at start of PD and the last available albumin level before 6 months after start of PD. A 20% reduction of serum albumin was considered significant. Logistic regression was used to assess the association between risk factors (age, sex, primary kidney disease, comorbidities, laboratory variables) and a 20% drop of serum albumin. Cox regression was employed to study the effect of albumin drop on survival with adjustment for confounders. Results Of 379 patients, 80 (21%) showed a reduction of serum albumin of at least 20% after start of PD. High age, high albumin level at start of PD, high level of HDL cholesterol and low level of ionized calcium all associated independently with the risk of an albumin drop in the logistic regression analysis. The albumin level at start (hazard ratio 0.94 per one g/l increment, 95% CI 0.89-0.98) and a 20% or larger drop of albumin level (HR 2.3, 95% CI 1.4-3.9) were connected to impaired survival irrespective of each other. Other independent predictors of worse survival were high age, peripheral vascular disease, a history of stroke, and diabetes. Conclusion A drop of serum albumin after start of PD is frequent and associates with impaired survival. Drop of albumin is more common among elderly patients and those with high values HDL cholesterol or low levels of ionized calcium.

Comparison of Unplanned/Urgent-Start Versus Conventional-Start Peritoneal Dialysis: A Systematic Review and Meta-Analysis.

The timing of peritoneal dialysis (PD) initiation, whether conventional-start (planned) or urgent-start (unplanned), may impact the outcomes of PD and the rate of associated complications in individuals with chronic kidney disease (CKD). The goal of this study was to evaluate the effects of unplanned/urgent-start PD versus conventional-start PD in this cohort of patients. Electronic search of MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases was done from inception until July 2023 for studies reporting outcomes of unplanned/urgent-start and conventional-start PD in CKD patients. Outcomes of interest included mechanical complications, post-procedure infections, mortality, and transfer to hemodialysis. Heterogeneity, publication bias, and the influence of individual studies on the pooled odds ratio (OR) with 95% confidence interval (CI) were evaluated. Twenty-seven studies were finally included in the review. The overall risk of post-procedure infectious was comparable for both PD initiation methods (OR: 1.05; 95% CI: 0.83-1.34). Similarly, the risks for peritonitis and exit site infections did not differ significantly. However, urgent-start PD correlated with a significantly higher risk of overall mechanical complications (OR: 1.70; 95% CI: 1.23-2.34). Specifically, the risk for leaks was notably higher (OR: 2.47; 95% CI: 1.67-3.65) in the urgent-start group compared to the conventional-start PD group. Urgent-start PD correlated with significantly increased mortality rates (OR: 1.83; 95% CI: 1.39-2.41). There was no difference in the likelihood of technique survival and transfer to hemodialysis. Both urgent-start and conventional-start PD correlated with similar risks of overall infectious complications. Urgent-start PD resulted in significantly increased risks of mechanical complications and mortality. Our findings emphasize the need for meticulous planning and consideration when opting for PD initiation.

Utilization of peritoneal dialysis for ventilated COVID-19 patients with acute kidney injury

BackgroundPeritoneal dialysis for acute kidney injury is not typically a first-line option for mechanically ventilated patients in the intensive care unit. This series investigates the technical feasibility and clinical implications of bedside peritoneal dialysis catheter placement and utilization for mechanically ventilated COVID-19 patients. MethodsPatient data was retrospectively collected on patient characteristics, hospital course, fluid balance, ventilatory mechanics and associated morbidity and mortality of qualifying patients at a single center from March to April of 2020. Peritoneal dialysis catheters were inserted at bedside in the ICU for use as the primary modality of renal replacement therapy. Ventilatory mechanics were obtained prior to catheter insertion and after the first dwell. Statistics were calculated using GraphPad Prism and Excel. ResultsSeven male ventilated patients ages 52–83 were included. They were primarily Hispanic (71.43%). Comorbidities included chronic kidney disease (14.29%), hypertension (57.14%), hyperlipidemia (42.86%), and diabetes (28.57%). There were no mortalities associated the procedure. All-cause mortality at the time of data collection was 42.8%. Two patients had delayed initiation of peritoneal dialysis due to bleeding. Ventilatory mechanics before and after the first dwell did not demonstrate a significant difference in required FiO2, PEEP, tidal volumes or PaO2 to FiO2 ratios (p = 0.9172, p = 0.7398, p = 0.0924, p = 0.7227). DiscussionBedside placement of catheters was performed quickly and safely. Peritoneal dialysis was utilized for the treatment of acute kidney injury in mechanically ventilated patients with COVID-19 without significantly impacting respiratory mechanics. Peritoneal dialysis should be considered for similar ICU patients needing renal replacement therapy.

Immediate-start peritoneal dialysis without break-in-period: an 18-year retrospective cohort study on patient survival.

Immediate-start peritoneal dialysis (ISPD) is an effective renal replacement therapy that can prevent central venous catheterization due to its immediate initiation of peritoneal dialysis (PD) after catheter insertion without a break-in period. This study aimed to investigate the effect of ISPD on long-term patient survival. In this retrospective single-center cohort study, 178 consecutive patients who started PD from August 2005 to March 2023 were enrolled, from whom 144 patients with ISPD were analyzed. PD was initiated without a break-in period within 24 hours of catheter insertion using percutaneous needle-guidewire technique. The primary outcome was patient survival, estimated using the Kaplan-Meier method. A Cox proportional hazard regression model was used to identify factors independently associated with patient survival. The median follow-up period was 4.00 years (interquartile range, 1.23‒5.75 years). The mean age of patients was 61.6 ± 13.6 years; 58 patients (40.3%) were male and 93 patients (64.6%) were diabetic. Overall patient survival rates at 1, 3, 5, and 10 years were 98.5%, 93.5%, 92.1%, and 65.6%, respectively. The technique survival rates at 1, 3, 5, and 10 years were 88.1%, 74.9%, 63.2%, and 40.2%, respectively. The peritonitis-free survival rates at 1, 3, 5, and 10 years were 92.3%, 76.0%, 59.4%, and 28.0%, respectively. In the multivariate analysis, diabetes was the only factor associated with patient survival and technique survival. Our study demonstrated that patient survival and technique survival rates were relatively high in ISPD patients who were catheterized using percutaneous needle-guidewire technique.

Exploring Preconceptions as Barriers to Peritoneal Dialysis Eligibility: A Global Scenario-Based Survey of Kidney Care Physicians

IntroductionDespite growing number of patients requiring kidney replacement therapy peritoneal dialysis (PD) is underutilized globally. A contributory factor may be clinician myths around its use. The aim of this study was to explore perceptions around PD initiation by clinicians according to various physical, social and clinical characteristics of patients. MethodsAn online global survey (English, Thai) was administered to ascertain nephrologists’ and nephrology trainees’ decisions on recommending PD as a treatment modality. Results645 participants (522 nephrologists; 123 trainees; 56% male) from 54 countries (66% high income countries (HICs), 22% upper middle income, 12% low middle income countries and 1% from lower income countries) completed the survey. 81% of respondents identified as attending physicians/consultants with 19% trainees or other. PD was recommended for most scenarios including repeated exposures to heavy lifting, swimming (especially in a private pool and ocean), among patients with cirrhosis or cognitive impairment with available support, and those living with a pet if a physical separation can be achieved during PD. Certain abdominal surgeries were more acceptable to proceed with peritoneal dialysis (hysterectomy 90%) compared to others (hemicolectomy 45%). Similar variation was noted for different types of stomas (nephrostomies 74%; suprapubic catheters 53%; ileostomies 27%). ConclusionsThe probability of recommending PD in various scenarios was greater among clinicians from HICs, larger units and consultants with more clinical experience. There is a disparity in recommending PD across various clinical scenarios driven by experience, unit-level characteristics and region of practice. Globally, evidence-informed education is warranted to rectify misconceptions to enable greater PD uptake.

Predicting solute transfer rate in patients initiating peritoneal dialysis

BackgroundWhile assessment of membrane characteristics is fundamental to peritoneal dialysis (PD) prescription in patients initiating therapy, peritoneal equilibration test has theoretical and practical drawbacks. We wished to determine whether an equation using simple clinical variables could predict fast (above population mean) peritoneal solute transfer rate without dialysate sampling.MethodsWe measured peritoneal solute transfer rate, as determined by peritoneal equilibration test using the 4-h dialysate to plasma creatinine ratio, in consecutive PD outpatients attending a single tertiary hospital for their first clinical follow-up within 3 months of dialysis initiation. An equation estimating peritoneal solute transfer rate based on readily available clinical variables was generated in a randomly selected modeling group and tested in a distinct validation group.ResultsWe included 712 patients, with 562 in the modeling group and 150 in the validation group. Mean age was 58.4 ± 15.9 with 431 (60.5%) men. Mean peritoneal solute transfer rate value was 0.73 ± 0.13. An equation based on gender, race, serum sodium and albumin yielded a receiving operator characteristics (ROC) area under the curve (AUC) to detect fast peritoneal solute transfer rate (> 0.73) of 0.74 (0.67–0.82). Estimated peritoneal solute transfer rate values based on percentiles 15th (> 0.66), 20th (> 0.68), 25th (> 0.69) and 30th (> 0.70) could rule out fast peritoneal solute transfer rate with negative predictive values of 100%, 93.5%, 84.2% and 80.0%, respectively.ConclusionsAn equation based on simple clinical variables allows ruling out fast transport in a significant proportion of patients initiating PD with a high degree of confidence without requiring dialysate sampling. This could prove useful in guiding dialysis prescription of PD patients in daily clinical practice, particularly in low-resource settings.Graphical abstract

Apparent Treatment-Resistant Hypertension in the First Year Associated With Cardiovascular Mortality in Peritoneal Dialysis Patients.

Few reports have focused on the association between apparent treatment-resistant hypertension (aTRH) and cardiovascular (CV) mortality in peritoneal dialysis (PD) population, thus we conducted this retrospective cohort to explore it. This was a retrospective cohort study conducted from January 2011 to January 2020 with PD patients in 4 Chinese dialysis centers. aTRH was defined according to the American College of Cardiology and American Heart Association guidelines. aTRH duration was calculated as the total number of months when patients met the diagnostic criteria in the first PD year. The primary outcome was CV mortality, and the secondary outcomes were CV events, all-cause mortality, combined endpoint (all-cause mortality and transferred to hemodialysis [HD]), and PD withdrawal (all-cause mortality, transferred to HD, and kidney transplantation). Cox proportional hazards models were used to assess the association. A total of 1,422 patients were finally included in the analysis. During a median follow-up period of 26 months, 83 (5.8%) PD patients incurred CV mortality. The prevalence of aTRH was 24.1%, 19.9%, and 24.6% at 0, 3, and 12 months after PD initiation, respectively. Overall, aTRH duration in the first PD year positively associated with CV mortality (per 3 months increment, adjusted hazards ratio [HR], 1.29; 95% confidence interval 1.10, 1.53; P = 0.002). After categorized, those with aTRH duration more than 6 months presented the highest adjusted HR of 2.92. Similar results were found for secondary outcomes, except for the CV event. Longer aTRH duration in the first PD year is associated with higher CV mortality and worse long-term clinical outcomes. Larger studies are warranted to confirm these findings. There is no clinical trial registration for this retrospective study.

A comparison of urgent-start of hemodialysis vs urgent initiation of peritoneal dialysis: a meta-analysis study.

To investigate the effects of urgent-start HD(USHD) and urgent-start PD(USPD) on dialysis patients and provide references for relevant clinical practice. A literature search was conducted in Chinese and English databases (PubMed, Web of Science, Cochrane Library, CNKI, Wanfang, VIP) and the cutoff date for which was July 30, 2023. Studies comparing USHD and USPD were included and I2 statistics and Q tests were used to determine heterogeneity among them. Risk ratios (RR) with 95% confidence intervals (CI) were computed for count data. Nine studies met the inclusion criteria. The all-cause mortality rate was 0.173 (0.070, 0.277) for USPD versus 0.214 (0.142, 0.286) for USHD, indicating that USPD had a protective effect against all-cause mortality compared to USHD (RR = 0.76, 95% CI 0.63-0.91). Patients receiving USPD had lower risks of infection-related mortality (RR = 0.19; 95% CI 0.05-0.76), bacteremia (RR = 0.38; 95% CI 0.18-0.80), and composite complications (RR = 0.54; 95% CI 0.41-0.71). However, no significant differences were found between USHD and USPD for cardiovascular mortality (RR = 0.68; 95% CI 0.28-1.68) or cancer mortality (RR = 0.44; 95% CI 0.15-1.29). Compared to USHD, USPD has better protective effects against all-cause mortality, infection-related mortality, bacteremia, and composite complications. However, more high-quality research is still needed to further investigate the impacts of the two dialysis modalities on patients.

Predictors of early peritoneal dialysis initiation in newborns and young infants following cardiac surgery.

This single-centre, retrospective cohort study was conducted to investigate the predictors of early peritoneal dialysis initiation in newborns and young infants undergoing cardiac surgery. There were fifty-seven newborns and young infants. All subjects received peritoneal dialysis catheter after completion of the cardiopulmonary bypass. Worsening post-operative (post-op) positive fluid balance and oliguria (<1 ml/kg/hour) despite furosemide were the clinical indications to start early peritoneal dialysis (peritoneal dialysis +). Demographic, clinical, and laboratory data were collected from the pre-operative, intra-operative, and immediately post-operative periods. Baseline demographic data were indifferent except that peritoneal dialysis + group had more newborns. Pre-operative serum creatinine was higher for peritoneal dialysis + group (p = 0.025). Peritoneal dialysis + group had longer cardiopulmonary bypass time (p = 0.044), longer aorta cross-clamp time (p = 0.044), and less urine output during post-op 24 hours (p = 0.008). In the univariate logistic regression model, pre-op serum creatinine was significantly associated with higher odds of being in peritoneal dialysis + (p = 0.021) and post-op systolic blood pressure (p = 0.018) and post-op mean arterial pressure (p=0.001) were significantly associated with reduced odds of being in peritoneal dialysis + (p = 0.018 and p = 0.001, respectively). Post-op mean arterial pressure showed a statistically significant association adjusted odds ratio = 0.89, 95% confidence interval [0.81, 0.96], p = 0.004) with peritoneal dialysis + in multivariate analysis after adjusting for age at surgery. In our single-centre cohort, pre-op serum creatinine, post-op systolic blood pressure, and mean arterial pressure demonstrated statistically significant association with peritoneal dialysis +. This finding may help to better risk stratify newborns and young infants for early peritoneal dialysis start following cardiac surgery.