Initiation Of Peritoneal Dialysis Research Articles

Excessive salt intake increases peritoneal solute transport rate via local tonicity-responsive enhancer binding protein in subtotal nephrectomized mice.

High peritoneal transport is associated with high mortality and technical failure in peritoneal dialysis (PD). Baseline peritoneal solute transport rate (PSTR) as measured by the peritoneal equilibration test (PET) within 6 months after PD initiation varies between patients. Sodium is reported to be stored in the skin or muscle of dialysis patients. This study investigated whether excessive salt intake in uremic mice caused peritoneal alterations without exposure to PD fluid. Sham-operated (Sham) and subtotal nephrectomized (Nx) mice were randomly given tap water or 1% sodium chloride (NaCl)-containing water for 8 weeks. PET was then performed to evaluate peritoneal function. Human mesothelial cell line Met-5A was used for in vitro studies. We observed higher PSTR in Nx mice with 1% NaCl-containing drinking water (Nx + salt) compared with those with tap water (Nx + water), along with enhanced angiogenesis and inflammation in the peritoneum. Blockade of interleukin (IL)-6 signaling rescued peritoneal transport function in Nx + salt mice. In cultured Met-5A, additional NaCl in the medium upregulated IL-6 as well as vascular endothelial growth factor-A, associated with increased expression and nuclear translocation of tonicity-responsive enhancer binding protein (TonEBP). Knockdown of TonEBP lowered the induction caused by high tonicity. Peritoneal TonEBP expression was higher in Nx + salt mice, while removal of high-salt diet lowered TonEBP level and improved peritoneal transport function. Excessive dietary salt intake caused peritoneal membrane functional and structural changes under uremic status. TonEBP regulated hypertonicity-related inflammatory changes and might play a crucial role in high baseline peritoneal transport.

Association of B-Type Natriuretic Peptide Level With Residual Kidney Function in Incident Peritoneal Dialysis Patients.

Residual kidney function (RKF) is an important factor influencing both technique and patient survival in peritoneal dialysis (PD) patients. B-type natriuretic peptide (BNP) is considered a marker of cardio-renal syndrome. The relationship between BNP and RKF in PD patients remains unclear. We conducted a prospective study of 89 patients who had started and continued PD for 6 months or more in Kyushu University Hospital between June 2006 and September 2015. Participants were divided into low BNP (≤ 102.1 ng/L) and high BNP (> 102.1 ng/L) groups according to median plasma BNP level at PD initiation. The primary outcome was RKF loss, defined as 24-hour urine volume less than 100 mL. We estimated the association between BNP and RKF loss using a Kaplan-Meier method and Cox proportional hazards model and compared the rate of RKF decline between the 2 groups. To evaluate the consistency of the association, we performed subgroup analysis stratified by baseline characteristics. During the median follow-up of 30 months, 30 patients lost RKF. Participants in the high BNP group had a 5.87-fold increased risk for RKF loss compared with the low BNP group after adjustment for clinical and cardiac parameters. A high plasma BNP level was more clearly associated with RKF loss in younger participants compared with older participants in subgroup analysis. B-type natriuretic peptide may be a useful risk marker for RKF loss in PD patients. The clinical importance of plasma BNP level as a marker of RKF loss might be affected by age.

Successful Initiation of Dialysis with a 20-Year-Old Buried Peritoneal Dialysis Catheter: Case Report and Literature Review

Buried peritoneal dialysis (PD) catheters are typically inserted several weeks or months before the anticipated need for dialysis. Occasionally, renal function unexpectedly stabilizes after the surgery, and a patient may go years before the catheter is needed. We report a case of successful initiation of PD with a twenty-year-old buried catheter. We outline the steps needed to optimize the catheter function and review the benefits of the buried PD catheter.

Direct and indirect costs of end-stage renal disease patients in the first and second years after initiation of nocturnal home haemodialysis, hospital haemodialysis and peritoneal dialysis.

To estimate the direct and indirect costs of end-stage renal disease (ESRD) patients in the first and second years of initiating peritoneal dialysis (PD), hospital-based haemodialysis (HD) and nocturnal home HD. A cost analysis was performed to estimate the annual costs of PD, hospital-based HD and nocturnal home HD for ESRD patients from both the health service provider's and societal perspectives. Empirical data on healthcare resource use, patients' out-of-pocket costs, time spent on transportation and dialysis by ESRD patients and time spent by caregivers were analysed. All costs were expressed in Hong Kong year 2017 dollars. Analysis was based on 402 ESRD patients on maintenance dialysis (PD: 189; hospital-based HD: 170; and nocturnal home HD: 43). From the perspective of the healthcare provider, hospital-based HD had the highest total annual direct medical costs in the initial year (mean ± SD) (hospital-based HD = $400 057 ± 62 822; PD = $118 467 ± 15 559; nocturnal home HD = $223 358 ± 18 055; P < 0.001) and second year (hospital-based HD = $360 924 ± 63 014; PD = $80 796 ± 15 820; nocturnal home HD = $87 028 ± 9059; P < 0.001). From the societal perspective, hospital-based HD had the highest total annual costs in the initial year (hospital-based HD = $452 151 ± 73 327; PD = $189 191 ± 61 735; nocturnal home HD = $242 038 ± 28 281; P < 0.001) and second year (hospital-based HD = $413 017 ± 73 501; PD = $151 520 ± 60 353; nocturnal home HD = $105 708 ± 23 853; P < 0.001). This study quantified the economic burden of ESRD patients, and assessed the annual healthcare and societal costs in the initial and second years of PD, hospital-based HD and nocturnal home HD in Hong Kong. From both perspectives, PD is cost-saving relative to hospital-based HD and nocturnal home HD, except that nocturnal home HD has the lowest cost in the second year of treatment from the societal perspective. Results from this cost analysis facilitate economic evaluation in Hong Kong for health services and management targeted at ESRD patients.

Peritoneal Dialysis in Pediatric Postoperative Cardiac Surgical Patients.

ABSTRACTBackgroundWe determined the prevalence of acute kidney injury requiring peritoneal dialysis (PD), the factors associated with early PD initiation, prolonged PD and mortality among pediatric postoperative cardiac surgical patients.Materials and MethodsThe hospital records of 23 children, aged 12 years or younger, who had undergone cardiac surgery and required PD subsequently, during a 1-year period were reviewed. Demographic data, intraoperative variables, and postoperative complications were compared between survivors and nonsurvivors of PD, between the short and long duration PD groups, and between the early and late PD initiation groups.ResultsSix hundred and eight pediatric patients who underwent open heart surgery were enrolled in this study. 23 (3.78%) of them required PD. When compared with survivors (n = 11), non survivors (n =12) were more likely to have a higher serum procalcitonin (p = 0.01), higher serum potassium on day 2 (p = 0.001), day 3 (p = 0.04), day of termination of PD (p = 0.001) and a lower urine output on day 3 of PD (p = 0.03). Prolonged PD was associated with time of PD initiation (p = 0.01), a higher postoperative serum creatinine on day 3 (p = 0.01) of PD initiation as well on the day of PD termination (p = 0.01) and the final outcome in terms of survival (p = 0.02). Factors significantly associated with an early PD initiation were CPB time (p = 0.04), sepsis (p = 0.02) and shorter PD duration (p = 0.003).ConclusionPD is very useful mode of renal replacement therapy among pediatric postoperative cardiac surgical patients. The intraoperative and postoperative variables have important association with the time of PD initiation, PD duration and patient survival.How to cite this articleSahu MK, Bipin C, Arora Y, Singh SP, Devagouru V, Rajshekar P, et al. Peritoneal Dialysis in Pediatric Postoperative Cardiac Surgical Patients. Indian J Crit Care Med 2019;23(8):371–375.

Increase of Eosinophil in Dialysate During Induction of Peritoneal Dialysis.

As a rare complication in patients on peritoneal dialysis (PD), increase of eosinophil (peritoneal dialysate fluid [PDF] eosinophilia), including eosinophilic peritonitis, was observed in PDF. The majority of eosinophilic peritonitis cases are detected during the early phase of PD induction. However, the frequency of and mechanisms underlying PDF eosinophilia remain unclear. We therefore investigated the frequency of PDF eosinophilia and what mechanisms, specifically complement activation, might contribute to its occurrence. In 48 patients, eosinophil counts and concentrations of complement activation products, such as C3a, C5a, and sC5b-9, interleukin (IL)-5, and IL-6 in PDF were evaluated on days 1, 2, and 4 after starting PD therapy. We focused on the relationships between patient background characteristics and eosinophil counts and levels of C3a, C5a, and sC5b-9 as complement activation products in PDF. In 33.3% of PD patients, increased PDF eosinophils were observed on day 1. Eosinophil counts correlated with PDF levels of C3a on days 1 and 2, IL-5 on days 1, 2, and 4, and IL-6 on day 1. In terms of background characteristics, only the duration the PD catheter was left in place differed significantly between PDF eosinophilia and non-PDF eosinophilia. Notably, PDF levels of C3a differed significantly between patients with and without eosinophilia, suggesting that C3a might be a candidate for induction of increased eosinophil.PDF eosinophilia was frequently observed during PD initiation. Our results suggest that PD catheter insertion and complement activation might be related to increases in eosinophils in PDF during PD initiation.

Long-term clinical outcomes of peritoneal dialysis patients: 10-year experience of a single unit from Tunisia.

Published data on the outcome of maintenance peritoneal dialysis (PD) since the initiation of PD in Tunisia is poor. The purpose of this study is to report long-term clinical outcomes of PD patients through a 10-year experience at a single unit. This is a retrospective review of the medical records of 182 PD patients who were followed up from January 2006 to June 2016. All patients were followed till death, renal transplant, switch over to hemodialysis (HD) or the end of the study in June 2016. The mean age of the incident patients was 43.93 ± 16.95 years. Nineteen (10.4%) were aged >65 years and 59.3% were male. The average duration of follow-up was 27.75 ± 26.18 months. The mean duration of PD treatment was 27.75 ± 26.18 months. There were 186 episodes of peritonitis that occurred over the total study period (54 episodes during the 1st year). The overall incidence of peritonitis during the 10-year study period was 1 per 27.25 patient months. Mechanical complications were noted in 31.2% of cases. Thirty- two (17.6%) patients had catheter displacement. Only 26 cases of hemoperitoneum (14.3%) were recorded. Death occurred in 23.1% of cases. Twenty-two patients (27.5%) were transplanted; 56 patients (70%) were transferred to HD, one patient had renal recovery and one case had voluntarily interrupted PD. In Kaplan-Meier curves of residual renal function (RRF) loss, there was a significant difference between peritonitis group and peritonitis-free group (P = 0.01). Technique and patient survival were associated with diabetes with a significant difference. The main cause of technique failure was peritonitis (61.4%). Moreover, the main repertoried causes of death were cardiovascular and septic causes. The mortality of diabetic and elderly PD patients was higher than mortality in nondiabetic and nonelderly groups, respectively, in our study. Peritonitis was associated with loss of RRF and technique failure.

Triglyceride Glucose Index Predicting Cardiovascular Mortality in Chinese Initiating Peritoneal Dialysis: A Cohort Study

Background: Insulin resistance (IR) is increased among people with end-stage renal disease (ESRD). The Triglyceride glucose (TyG) index is a marker of IR and is also associated with the prognosis of cardiovascular disease among patients initiating peritoneal dialysis (PD). This study was aimed at examining the associations between TyG index and cardiovascular deaths in patients initiating PD. Methods and Results: Three thousand fifty-four patients initiating PD between 2007 and 2014 were included in a prospective cohort derived from Henan PD Registry, TyG index alongside other baseline characteristics were measured when ESRD patients initiated PD. Logistic regression adjusting for age, gender, and major cardiovascular risk factors estimated the association between TyG index and subsequent cardiovascular mortality within 2 years since the initiation of PD. Results: TyG index was positively associated with cardiovascular mortality: adjusted incidence rates ratio (95% CI) comparing the highest vs. lowest TyG index quartile was 2.32 (2.12–2.55) in all, 2.22 (2.01–2.46) in those with body mass index (BMI) <25 kg/m², and 2.82 (2.24–3.54) in those with BMI ≥25 kg/m², respectively. Linear dose-response relationships were revealed in all and by BMI. Conclusions: TyG index might be a prognostic factor in predicting cardiovascular mortality among patients initiating PD.

Polyneuritis and Rare Sequelae of Leptospirosis Contracted While on an Urban Clean-Up Mission in Detroit : A Case Report of Weil’s Disease and Literature Review

Leptospirosis is a common zoonosis, an infectious disease that infects both humans and animals, which is caused by spirochete bacteria from genus Leptospira . Approximately 30% of children in urban Detroit and 16% of adults in Baltimore demonstrated serologic evidence of previous leptospirosis infections. The Detroit study showed correlation between degree of rat infestation and seropositivity rates. This finding suggests rats are major vectors for human leptospirosis in mainland United States. The leptospires from infected animals survive best in fresh water, damp alkaline soil, vegetation, and mud with temperatures higher than 22 °C. Although leptospirosis is a well documented clinical condition, the sequelae of polyneuritis has not yet been reported to our knowledge. The following case is an example of such an occurrence. A 49-year-old Caucasian female presented to the emergency department with flu-like symptoms after volunteering in an urban Detroit neighborhood clean-up project. She admitted to picking up wood from stagnant water without wearing personal protective equipment. The primary differential diagnosis being Weil’s disease from leptospirosis and was proven positive with serologic testing via the Center for Disease Control. A computed tomography (CT) abdomen and pelvis demonstrated lymphadenopathy throughout the abdomen and near the spinal column. She was treated with ceftriaxone and doxycycline for 12 days but developed chronic neuralgia and polyneuritis. Leptospires are known to cause vasculitis. This patient developed polyneuritis either from direct invasion of the nerves from leptospires or compromised blood supply to the nerves. In addition to antibiotics, patients with severe cases of leptospirosis also require supportive therapy and careful management of renal, hepatic, hematologic, and central nervous system complications. If renal failure ensues, early initiation of hemodialysis or peritoneal dialysis may reduce mortality. Rapid identification of symptoms and a high clinical suspicion are paramount because early intervention can save their life. J Med Cases. 2019;10(6):183-187 doi: https://doi.org/10.14740/jmc3320

Atherogenic ratios and serum lipid levels in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis

Background: Patients with end-stage renal disease (ESRD) on continuous ambulatory peritoneal dialysis (CAPD) often have an atherogenic lipid profile. Lipid disturbances that have been observed in patients with ESRD on CAPD include hypercholesterolemia, hypertriglyceridemia, and decreased high-density lipoprotein cholesterol (HDL-c). Aim and Objectives: To study the atherogenic ratios and serum lipid levels in patients with ESRD on CAPD and compare with healthy controls. Materials and Methods: This study included 30 patients with ESRD before and after the initiation of continuous ambulatory peritoneal dialysis and 30 healthy controls. Thirty patients with ESRD after the start of peritoneal dialysis were regularly followed up for 3rd, 6th, 9th, 12th, and 15th months. The biochemical parameters were measured in baseline and follow-up samples. Results: The concentrations of (TC), serum triglycerides (TGs), very low-density lipoprotein cholesterol (VLDL-c), and atherogenic ratios were increased and levels of serum TC, low-density lipoprotein cholesterol (LDL-c), and HDL-c were decreased significantly during 3rd and 6th months. However, after 1 year of CAPD, the serum TGs, VLDL-c, TC, and LDL-c levels were significantly higher than the baseline values and HDL-c was significantly lower than the baseline values. Conclusion: The present study findings conclude that the continuous peritoneal absorption of glucose during CAPD contributes to alteration in serum lipids. However, the changes are fluctuating as an adaptation to the peritoneal absorption of glucose.

Peritoneal Dialysis in an Extremely Low Birth Weight Neonate with Ileostomy.

ABSTRACTBackgroundAcute kidney injury (AKI) is a common complication in sick, extremely low birth weight (ELBW) neonates. Peritoneal dialysis (PD) is the treatment modality but is seldom attempted in this patient population. We present a 40-day-old ELBW neonate previously operated for necrotizing enterocolitis with ileostomy who developed AKI. Peritoneal dialysis was started by a modifying intercostal drain.ResultsDoing a simple procedure and using a few modifications helped the baby to come out of acute kidney injury.ConclusionPeritoneal dialysis can be technically quite challenging in ELBW neonates but is possible with certain innovative modifications.Key messageChallenging technical problems in potentially fatal conditions sometimes respond to simple innovation. Initiation of early peritoneal dialysis in a sick ELBW with ileostomy and AKI helped saved her life.How to cite this articleKaul A, Jadhav K, Shah S. Peritoneal Dialysis in an Extremely Low Birth Weight Neonate with Ileostomy. Indian J Crit Care Med 2019;23(5):232–233.

Baseline serum leptin predicts peritoneal dialysis adequacy: a single-center prospective, longitudinal study

Hyperleptinemia is often observed in peritoneal dialysis (PD) patients. But, there are few studies on the relationship between blood leptin level and PD survival, and, some of them contradict each other. The present study aimed to investigate the impact of PD initiation on the serum leptin concentrations and its association with PD adequacy. Method. A total of 23 patients with end-stage renal disease (ESRD), who started the treatment with continuous ambulatory peritoneal dialysis (CAPD), were included in this prospective single-center observational longitudinal study. Among the patients, there were 15 men and 8 women; the average age of the patient population was 52.4 ± 12.3 years. The treatment with CAPD was performed using Dianeal PD 4 with glucose concentration of 1.36% and 2.27%. The patients were screened before PD initiation and after 3- and 12- month PD treatment. Leptin levels were determined in all patients using ELISA-method. Results. The median serum leptin concentration at study entry was 10.6 [5.6-21.9] ng/mL. Leptin level and its dynamics during the year after PD treatment initiation were dependent on body mass index (BMI). The overweight or obese patients had ever-increasing leptin levels after 3- and 12- month PD treatment. Whereas in the PD patients with normal weight, we observed a significant decrease of leptin levels after 12-month PD treatment. Serum leptin concentration in the women was significantly higher compared with the men (46.4 [1.1-95] vs 9.8 [3.2-14.5] ng/mL; p = 0.02). Blood cholesterol levels had a positive correlation with serum leptin concentrations after 3- and 12- month PD treatment: r = 0.53, p = 0.01 and r = 0.56, p = 0.008, respectively. However, we did not find a statistically significant association of leptin with PD adequacy parameters after 3- and 12- month PD treatment of the patients. In the Cox proportional hazard model adjusted for gender, serum leptin level demonstrated itself as the effective factor in PD adequacy survival: HR 5.3 (95% CI 1.7; 16.3). PD adequacy survival was better in the patients with leptin concentrations above the median (≥10.6 ng/mL) compared with the patients who had serum leptin levels below the median (log rank test, χ2 = 8.2; p = 0.0042). Conclusions. Our study have demonstrated markedly elevated serum leptin level in the overweight PD patients and its strong decrease during 12 months in the patients with normal weight. Low serum leptin level before PD initiation is associated with inadequate PD.

Association between timing of peritoneal dialysis initiation and mortality in end-stage renal disease

Despite the widespread use of chronic dialysis for end-stage renal disease (ESRD), there is no consensus on the optimal timing of initiating renal replacement therapy. Over the past decade, a worldwide trend toward increasing glomerular filtration rate at the initiation of dialysis has been noted. However, available data indicate that early dialysis has no survival benefit or is harmful. Peritoneal dialysis (PD) is one alternative for ESRD and has potential survival factors different from those of hemodialysis. The association between the timing of PD initiation and survival is unclear. This review examines the effect of the timing of dialysis on clinical outcomes in PD patients.

Parameters associated with therapeutic response using peritoneal dialysis for therapy refractory heart failure and congestive right ventricular dysfunction.

BackgroundIn patients with refractory heart failure (HF) peritoneal dialysis (PD) is associated with improved functional status and decrease in hospitalization. However, previous studies did not focus on right ventricular dysfunction as an important pathophysiologic component of cardiorenal syndrome.MethodsIn a prospective cohort study PD was started in 40 patients with refractory right HF (with/without left HF). Refractoriness to conservative therapy was defined as persistent right heart congestion/ascites with intensified diuretic treatment and/or ≥2 hospitalizations within 6 months because of cardiac decompensation despite optimal medical treatment, and/or acute renal failure during intensified conservative treatment of cardiac decompensations.ResultsPatient survival was 55.0% at 1 year, 35.0% at 2 years and 27.5% at 3 years. The number of hospitalization days declined after initiation of PD for both cardiac [13 (IQR 1–53) days before vs. 1 (IQR 0–12) days after start of PD, p<0.001] and unplanned reasons [12 (IQR 3–44) days before vs. 1 (IQR 0–33) days after start of PD, p = 0.007]. Using a combined endpoint including survival time of ≥1 year and either improvement in quality of life or decline in hospitalizations we found that patients with extended ascites, higher systolic pulmonary artery pressure, more marked impairment of right ventricular function and tricuspid valve insufficiency, higher residual renal function as well as those who could perform PD without assistance have benefited most from this therapy.ConclusionsPatients with more pronounced backward failure, less marked residual renal functional impairment and those not depending on assistance for therapy are likely to profit most from PD.

Icodextrin is Associated with a Lower Risk of Stroke in Peritoneal Dialysis Patients

Background/Aims: This study investigated whether peritoneal dialysis (PD) patients using icodextrin were at a reduced risk of stroke. Methods: From Taiwan National Health Insurance data, it was found that there were 6,796 new end-stage renal disease patients undergoing dialysis between 2005 and 2011. We compared the risk of stroke between PD patients with or without icodextrin treatment. The follow-up period began from the date of PD initiation to the end of 2011. The time-dependent Cox proportional hazards regression models were used to analyze the risk of stroke. Results: Among PD patients, the icodextrin users had both a lower incidence and risk of stroke than icodextrin non-users (incidence: 22.4 vs. 25.2/1,000 person-years) with an adjusted hazard ratio of 0.76 (95% CI 0.63–0.93). The results were similar in models considering death a competing risk (overall: adjusted subhazard ratio [SHR] 0.78, 95% CI 0.63–0.94). Icodextrin users also had a lower risk of ischemic stroke with or without considering death a competing risk (adjusted SHR 0.71, 95% CI 0.57–0.89 and adjusted HR 0.74, 95% CI 0.59–0.93, respectively), compared to non-users. Conclusion: The use of icodextrin is associated with a lower incidence and risk of stroke in PD patients.

Viridans streptococcus peritonitis in peritoneal dialysis: clinical characteristics and comparison with concurrent polymicrobial infection

BackgroundThe clinical course of Viridans streptococci (VS) peritonitis in patients undergoing peritoneal dialysis (PD) is rarely reported. This study examined the association of clinical factors with VS peritonitis.MethodsWe retrospectively reviewed clinical data from patients with VS peritonitis from March 1990 to February 2016 in a PD center in Taiwan and evaluated clinical profiles and treatment outcomes.ResultsA total of 109 episodes of VS peritonitis in 71 patients identified. Among these patients, 57 had mono-VS peritonitis and 14 had concurrent polymicrobial infections. The median time interval from PD initiation to the first VS peritonitis episode was 18 months (range, 0.6–144 months). Among clinical outcomes, most VS peritonitis episodes were completely cured regardless of a history of peritonitis. All episodes with catheter removal occurred in those without a history of recent antibiotic use.ConclusionVS peritonitis in patients undergoing PD typically has favorable treatment outcomes. Antibiotic therapy should be started promptly.

Fluid Management With Peritoneal Dialysis After Pediatric Cardiac Surgery.

Children who undergo cardiac surgery with cardiopulmonary bypass are a unique population at high risk for postoperative acute kidney injury (AKI) and fluid overload. Fluid management is important in the postoperative care of these children as fluid overload is associated with increased morbidity and mortality. Peritoneal dialysis catheters are an important tool in the armamentarium of a cardiac intensivist and are used for passive drainage for fluid removal or dialysis for electrolyte and uremia control in AKI. Prophylactic placement of a peritoneal catheter is a safe method of fluid removal that is associated with few major complications. Early initiation of peritoneal dialysis has been associated with improved clinical markers and outcomes such as early achievement of a negative fluid balance, lower vasoactive medication needs, shorter duration of mechanical ventilation, and decreased mortality. In this review, we discuss the safety and potential benefits of peritoneal catheters for dialysis or passive drainage in children following cardiopulmonary bypass.

Sustained Increase in Peritoneal Dialysis Prevalence through a Structured PD Initiation Service

A structured peritoneal dialysis (PD) initiation service provided by a dedicated team of nephrologists, interventionists, and PD nurses, taking patients through the stages of predialysis education and monitoring, dialysis catheter insertion, dialysis initiation, and follow-up in the immediate post-dialysis initiation period, can go a long way in expanding PD prevalence. The authors noticed a rapid expansion of their PD program following the introduction of such a service, and they share their experience in this article. A multidisciplinary team providing 1-stop coordinated care may help in alleviating the differences in patient selection criteria, minimize delays in PD catheter insertions, ensure timely initiation of dialysis, reduce the need to start dialysis urgently, actively identify and sort any teething issues, enhance patients' confidence, and reduce technique failures.

Subcutaneous Cuff Migrates After Initiation of Peritoneal Dialysis.

The aim of this study was to determine whether subcutaneous cuffs migrate toward the exit site after initiation of peritoneal dialysis (PD) and to clarify the factors affecting such migration. Subcutaneous cuff migration was defined as extension of the length of the external catheter. In this single-center, retrospective study, the external catheter lengths at initiation and 1 year later were compared in 33 PD patients (median age 62 years; 64% men; 49% with diabetes mellitus). The correlations between patient background characteristics at initiation and extension of catheter length were also examined. The external catheter length was significantly extended at 1 year later (13.5 vs 15.0 cm, p < 0.001). There was no relationship between a history of exit-site infection and extension of catheter length (p = 0.250). Hemoglobin (r = -0.447, p = 0.009), serum albumin (r = -0.377, p = 0.031), and external catheter length at initiation (r = -0.350, p = 0.046) showed negative correlations with extension. In conclusion, subcutaneous cuff migration was observed in just 1 year and may be associated with malnutrition, anemia, and short external catheter length at initiation of PD.

Early initiation of peritoneal dialysis improves postoperative recovery in children with right ventricular outflow tract obstructive lesions at high risk of fluid overload: a propensity score-matched analysis.

Postoperative fluid overload is common in children after cardiac surgery, especially for those with right ventricular outflow tract obstruction, which is associated with poor outcomes. This study was conducted to investigate whether early peritoneal dialysis (PD) was associated with improved outcomes in these children at high risk of fluid overload. Between January 2010 and January 2015, a total of 2555 consecutive patients with right ventricular outflow tract obstruction underwent anatomical repair. Using empirical risk evaluation, 219 patients at high risk of fluid overload were identified. A propensity score matching was performed to correct the selection bias and identify the comparable patient groups: the early PD group, in whom PD was initiated within 6 h of admission in paediatric ICU, and the control group, without early PD. The mechanical ventilation time, vasoactive-inotropic score and time to negative fluid balance were compared in 45 matched patient pairs (totally 90). After propensity matching, there were no statistically significant differences between the 2 groups in terms of demographics and preoperative characteristics. The early PD group had shorter mechanical ventilation time [median 49 h, interquartile range (IQR) 31-97 h vs median 76 h, IQR 55-166 h; P < 0.01]; lower vasoactive-inotropic score (median 17, IQR 16-21 vs median 22, IQR 18-26; P < 0.01); shorter duration of inotrope requirement (median 7 days, IQR 6-9 days vs median 8 days, IQR 7-13 days; P < 0.01); shorter time to negative fluid balance (median 20 h, IQR 13-34 h, vs median 48 h, IQR 40-74 h; P < 0.01) and a higher rate of negative fluid balance at 24 h (69% vs 29%, P < 0.01). When compared with the control group, the early PD group showed shorter mechanical ventilation time, less inotropic requirement and lower time to attain negative fluid balance. On the basis of our empirical risk-evaluation practice, early PD could improve immediate postoperative recovery in children with right ventricular outflow tract obstruction.