Maintenance Peritoneal Dialysis Patients Research Articles

The relationship between changes in peritoneal membrane solute transfer characteristics and cardiac remodeling in patients with peritoneal dialysis.

We aimed to determine the relationship between the dilatation of the heart chambers and the change in peritoneal membrane solute transfer characteristics (PMTC) in long-term peritoneal dialysis (PD) patients. This is a retrospective, single-center study including the follow-up of maintenance PD patients. According to the changes in PMTC from baseline to the last visit, patients were divided into three groups; stable (n = 11), increased (n = 41), and decreased transporters (n = 35). Left atrium (LA) and Right ventricle (RV) dilatation were more prominent in the PMTC-decreased group compared to PMTC-increased and stable groups (p < 0.001 and p = 0.07, respectively). The Cox regression analysis showed that only decreased PMTC was associated with LA dilatation (HR 2.89 [CI 95%1.54, 5.45] p < 0.01) and RV dilatation (HR 3.01 [CI 95%1.40, 6.21] p < 0.01). PD can be associated with unfavorable dynamic changes in cardiac structure and functions even at the subclinical level.

Random forest can accurately predict the technique failure of peritoneal dialysis associated peritonitis patients.

Peritoneal dialysis associated peritonitis (PDAP) is a major cause of technique failure in peritoneal dialysis (PD) patients. The purpose of this study is to construct risk prediction models by multiple machine learning (ML) algorithms and select the best one to predict technique failure in PDAP patients accurately. This retrospective cohort study included maintenance PD patients in our center from January 1, 2010 to December 31, 2021. The risk prediction models for technique failure were constructed based on five ML algorithms: random forest (RF), the least absolute shrinkage and selection operator (LASSO), decision tree, k nearest neighbor (KNN), and logistic regression (LR). The internal validation was conducted in the test cohort. Five hundred and eight episodes of peritonitis were included in this study. The technique failure accounted for 26.38%, and the mortality rate was 4.53%. There were resignificant statistical differences between technique failure group and technique survival group in multiple baseline characteristics. The RF prediction model is the best able to predict the technique failure in PDAP patients, with the accuracy of 93.70% and area under curve (AUC) of 0.916. The sensitivity and specificity of this model was 96.67 and 86.49%, respectively. RF prediction model could accurately predict the technique failure of PDAP patients, which demonstrated excellent predictive performance and may assist in clinical decision making.

The risk factors and predictive model for cardiac valve calcification in patients on maintenance peritoneal dialysis: a single-center retrospective study

Background Cardiovascular calcification includes cardiac valve calcification (CVC) and vascular calcification. We aimed to analyze risk factors for CVC, and construct a predictive model in maintenance peritoneal dialysis (MPD) patients. Methods We retrospectively analyzed MPD patients who began peritoneal dialysis between January 2014 and September 2021. Patients were randomly assigned to the derivation cohort and validation cohort in a 7:3 ratio. The patients in the derivation cohort were divided into the CVC group and non-CVC group. Logistic regression was used to analyze risk factors, then the rms package in R language was used to construct a nomogram model to predict CVC. Results 1,035 MPD patients were included, with the age of 50.0 ± 14.2 years and 632 males (61.1%). Their median follow-up time was 25 (12, 46) months. The new-onset CVC occurred in 128 patients (12.4%). In the derivation cohort, multivariate logistic regression indicated old age, female, high systolic blood pressure (SBP), high calcium-phosphorus product (Ca × P), high Charlson comorbidity index (CCI) and long dialysis time were independent risk factors for CVC (p < 0.05). We constructed a nomogram model for predicting CVC in the derivation cohort, with a C index of 0.845 (95% CI 0.803–0.886). This model was validated with a C index of 0.845 (95%CI 0.781–0.909) in the validation cohort. Conclusion We constructed a nomogram model for CVC in MPD patients, using independent risk factors including age, sex, SBP, Ca × P, CCI and dialysis time. This model achieved high efficiency in CVC prediction.

Factors Associated with Self-Management of Peritoneal Dialysis Patients in Urumqi of Xinjiang of China: A Cross-Sectional Survey.

To explore the factors associated with self-management of Peritoneal Dialysis (PD) patients and methods of acquiring PD knowledge. Cross-sectional survey design. Urumqi, Xinjiang, China. 131 Chinese maintenance Peritoneal Dialysis (PD) patients. This cross-sectional study was conducted from October 2019 to March 2020 in the First Affiliated Hospital of Xinjiang Medical University of China. 131 PD patients were recruited. Data were collected, including demographic characteristics, clinical dialysis data, self-management ability scale, and methods to obtain PD knowledge. A self-management questionnaire was used for the evaluation of self-management ability. The score of the self-management ability of PD patients in Xinjiang, China, was (57.6±13.7) points, which was at the middle level in China. There was no statistically significant difference in the self-management ability scores of patients with different ages, sex, ethnicity, marital status, pre-dialysis status, PD time, PD procedures, self-care ability, PD satisfaction, and 24-hour average urine output (P>0.05). There were significant differences in the self-management ability scores of patients with different education levels, occupations, and medical insurance forms (P<0.05). The self-management ability of PD patients was positively correlated with the disease course of uremia and attending lectures on PD knowledge (P<0.05). The main factor affecting self-management ability was education level. There 73.28% of patients considered that it was necessary to establish a WeChat group for PD patients, and 65.7% believed that establishing a WeChat group for PD patients could facilitate communication between patients and enhance treatment confidence. The study surveyed PD patients who have certain self-management ability. For patients with different education levels, different health education methods should be adopted to promote the improvement of patients' self-management ability. Furthermore, WeChat is essential for Chinese PD patients to obtain disease-related information.

Impact of COVID-19 on maintenance peritoneal dialysis patients and providers: A review.

The COVID-19 pandemic exerted complex pressures on the nephrology community. Despite multiple prior reviews on acute peritoneal dialysis during the pandemic, the effects of COVID-19 on maintenance peritoneal dialysis patients remain underexamined. This review synthesizes and reports findings from 29 total cases of chronic peritoneal dialysis patients with COVID-19, encompassing 3 case reports, 13 case series, and 13 cohort studies. When available, data for patients with COVID-19 on maintenance hemodialysis are also discussed. Finally, we present a chronological timeline of evidence regarding the presence of SARS-CoV-2 in spent peritoneal dialysate and explore trends in telehealth as they relate to peritoneal dialysis patients during the pandemic. We conclude that the COVID-19 pandemic has underscored the efficacy, flexibility, and utility of peritoneal dialysis.

Proton pump inhibitor usage associates with higher risk of first episodes of pneumonia and peritonitis in peritoneal dialysis patients

Background A large number of studies have shown that proton pump inhibitors (PPIs) are associated with infection events. Therefore, we retrospectively evaluated the association of PPI therapy with the occurrence of first pneumonia and peritoneal dialysis(PD)-related peritonitis events in the maintenance PD patients. Methods We collected PD patients in two large hospitals from January 1, 2012 to December 31, 2016, and divided them into the PPI group and the non-PPI group. Multivariate Cox proportional hazards models were applied to evaluate the cumulative incidence and hazard ratios (HRs). Inverse probability of treatment weight (IPTW) method was used to adjust for covariate imbalance between the two groups and further confirm our findings. Results Finally, 656 PD patients were included for data analysis, and the results showed that PPI usage was associated with an increased risk of pneumonia [HR 1.71; 95% CI 1.06-2.76; p = 0.027] and peritonitis [HR 1.73; 95% CI 1.24-2.40; p = 0.001]. IPTW-adjusted HRs for the association of PPIs with pneumonia and peritonitis were 1.58 (95% CI:1.18-2.12; p = 0.002) and 2.33 (95% CI:1.91-2.85; p < 0.001), respectively. Moreover, the competitive risk model proved that under the conditions of competition for other events(including transfer to hemodialysis therapy, kidney transplant, transfer from our research center, loss to follow-up, and death), the differences in endpoints events between the two groups were still statistically significant (p = 0.009, p < 0.001, respectively). Conclusions PPIs was associated with an increased risk of first pneumonia and PD-related peritonitis events in PD patients, which reminds clinicians to be cautious when prescribing acid-suppressing drugs for PD patients.

POS-671 Relationship of serum phosphorus and peritonitis risk in maintenance peritoneal dialysis patients

Previous studies have showed a link between phosphorus and inflammation. Whether serum phosphorus is associated with peritonitis risk in peritoneal dialysis (PD) patients remains unknown.We aimed to investigate the relationship of serum phosphorus with peritonitis risk in maintenance PD patients.

Aberrant serum parathyroid hormone, calcium, and phosphorus as risk factors for peritonitis in peritoneal dialysis patients

Identifying modifiable risk factors of peritoneal dialysis (PD)-related peritonitis is of clinical importance in patient care. Mineral bone disease (MBD) has been associated with mortality and morbidity in end-stage kidney disease (ESKD) patients. However, its influence on PD related peritonitis due to altered host immunity remains elusive. This study investigated whether abnormal biomarkers of MBD are associated with the development of peritonitis in patients undergoing maintenance PD. We conducted a retrospective observational cohort study, analysing data derived from a nationwide dialysis registry database in Taiwan, from 2005 to 2012. A total of 5750 ESKD patients commencing PD therapy during this period were enrolled and followed up to 60 months or by the end of the study period. The patients were stratified based on their baseline serum parathyroid hormone (PTH) levels, calcium (Ca) levels or phosphorus (P) levels, respectively or in combinations. The primary outcome was the occurrence of first episode of peritonitis, and patient outcomes such as deaths, transfer to haemodialysis or receiving renal transplantation were censored. Peritonitis-free survival and the influence of PTH, Ca, P (individual or in combination) on the peritonitis occurrence were analysed. A total of 5750 PD patients was enrolled. Of them, 1611 patients experienced their first episode of peritonitis during the study period. Patients with low PTH, high Ca or low P levels, respectively or in combination, had the lowest peritonitis-free survival. After adjusting for age, sex and serum albumin levels, we found that the combinations of low PTH levels with either high Ca levels or low/normal P levels were significant risk factors of developing peritonitis. Abnormal mineral bone metabolism in maintenance PD patients with low serum PTH levels, in combination with either high Ca levels or low/normal P levels, could be novel risk factors of PD-related peritonitis.

COVID-19–Associated Acute Kidney Injury and Quantified Protein Catabolic Rate: A Likely Effect of Cytokine Storm on Muscle Protein Breakdown

Rationale & ObjectivesPreviously we reported a cohort of patients with coronavirus disease 2019 (COVID-19)–associated acute kidney injury (AKI) with striking biochemical evidence of tissue breakdown in the absence of apparent rhabdomyolysis. We sought to quantify the extent of tissue catabolism in similar patients.Study DesignDuring acute peritoneal dialysis (PD) in patients with COVID-19–associated AKI, we measured urea Kt/V adequacy and calculated the daily urea nitrogen generation rate while quantifying daily protein intake.Setting & PopulationWe did calculations in 8 patients with COVID-9–associated AKI undergoing acute PD at Mount Sinai Hospital in New York City. As a comparator, we obtained urea kinetic parameters from our database of ambulatory patients receiving maintenance PD.Exposure or Predictors8 patients with COVID-19–associated AKI undergoing acute PD.OutcomesUrea nitrogen generation rate in relation to daily protein intake.Analytical ApproachUrea nitrogen generation rate from urea kinetics was related to measured daily dietary protein intake in these patients and we compared it with this relationship in ambulatory maintenance PD patients for whom both parameters were calculated from urea kinetics.ResultsUrea nitrogen generation rate in patients with AKI was 10.2 ± 5 g/d, which is more than 2-fold higher than for stable outpatients receiving maintenance PD (4.7 ± 3 g/d) despite similar dietary protein intake (74.8 ± 11 vs 67.2 ± 29 g/d, respectively). This strongly suggests endogenous protein breakdown, probably from muscle. Urea nitrogen generation rate in these patients with AKI corresponds to 315 g/d of ongoing muscle breakdown and cumulative 2.5 kg of muscle breakdown during the early course of AKI.LimitationsSmall number of participants and assumptions in comparing urea nitrogen generation rate with protein intake.ConclusionsIn highly catabolic patients, an endogenous source of urea generation such as muscle protein breakdown seems to be the most likely explainable cause for our findings. This is the first study that we are aware of to quantify the degree of endogenous protein breakdown induced by COVID-19–related cytokine storm.

Catheter Type, Placement, and Insertion Techniques for Preventing Catheter-Related Infections in Maintenance Peritoneal Dialysis Patients: Summary of a Cochrane Review

Catheter Type, Placement, and Insertion Techniques for Preventing Catheter-Related Infections in Maintenance Peritoneal Dialysis Patients: Summary of a Cochrane Review

SUN-084 HEMOGLOBIN VIARIABILITY AND MORTALITY OF PERITONEAL DIALYSIS PATIENTS

The study investigated the independent association between hemoglobin variability and mortality in a retrospective cohort of 3161 peritoneal dialysis patients. The retrospective cohort analysis used data in Zhejiang Province Dialysis Control Center database. In the cohort, a total of 3161 maintenance peritoneal dialysis patients were recruited. Hemoglobin variability (Hb-var) was defined as the difference between maximum and minimum of hemoglobin values during follow-up period (time＞12 months from 2008 to 2017) in each patient. 3161 patients were divided into 6 groups: 10 g/L≤Hb-var＜20 g/L、20 g/L≤Hb-var＜30 g/L、30 g/L≤Hb-var＜40 g/L、40 g/L≤Hb-var＜50 g/L、50 g/L≤Hb-var＜60 g/L、Hb-var≥60g/L. The baseline demographic characteristics and laboratory measures in the cohort, Hb-var group, survival and death group was shown in Table 1, Table 2 and Table 3, respectively. The difference of age, follow-up time, albumin, BMI, calcium, creatine, fasting blood glucose, hemoglobin levels, potassium, sodium, phosphorus, PTH, cardiovascular disease, cerebrovascular disease, diabetes mellitus and reason of peritoneal dialysis between survival and death group displayed statistically significant. As shown in Figure 1, we found that the AUC of hemoglobin and mortality ROC curve was 0.638, therefore we determined that the optimal entry point of hemoglobin level was 123g/L. Next, Kaplan-Meier curve showed that hemoglobin levels continuously lower than 123g/L can increase the risk of death in peritoneal dialysis patients. The Hb-var showed no association with all cause death using Kaplan-Meier curve (Figure 2) instead. We concluded that hemoglobin levels continuously lower than 123g/L can increase the risk of death in peritoneal dialysis patients. Hb-var was not associated with all cause death.

Study on the Prevalence of Vascular Calcification in Different Types of Arteries and Influencing Factors in Maintenance Peritoneal Dialysis Patients

Objective: To investigate the occurrence of vascular calcification (VC) in different types of arteries in patients with maintenance peritoneal dialysis (PD) patients and its influencing factors. Methods: This study enrolled PD patients with stable status who has received PD treatment for more than 6 months in Peking University People’s Hospital. We used plain X-ray films of abdomen, pelvis, and hands to quantitatively evaluate VC of large artery (abdominal aorta, iliac artery), medium artery (femoral artery, radial artery), and small artery (finger arteries). Two radiologists read and scored radiographs blindly. Demographic data, clinical characteristics, Charlson comorbidity index (CCI), baseline and time-average laboratory indices including parameters of calcium phosphorus metabolism, serum albumin, PD adequacy were collected. A logistic regression model was used to estimate the influencing factors of different sites of VC. Results: (1) 154 PD patients were enrolled in this study: seventy-eight males, mean age was 60.4 ± 13.9 years, and median PD duration was 24 (16.39) months. The major primary disease was diabetic nephropathy (39%). (2) Among the 154 PD patients, the proportion of calcification of large artery was the highest (found in 100 patients, accounting for 64.9%); then the medium artery (66, 42.9%); and 15 of small artery, accounting for 9.7%. (3) Logistic regression showed that older age, longer dialysis duration, lower baseline serum intact parathyroid hormone (iPTH), and higher CCI scores were independent risk factors of large artery calcification (p < 0.05), and higher CCI scores, higher baseline serum triglycerides (TG), lower baseline serum iPTH, and time-average iPTH were independent risk factors of medium and small arteries. Conclusions: In PD patients, the occurrence of large artery calcification was higher than others. Among different sites of VC, the abdominal aortic calcification was most likely to occur, and the proportion of small artery calcification was low. Calcification of medium and small arteries can exist alone without calcification of large artery. Large artery calcification was more likely to occur in patients with older age, longer dialysis duration, lower baseline serum iPTH levels and higher CCI scores. Patients with higher CCI scores, higher baseline TG and lower baseline iPTH, and time-average iPTH were more likely to develop small and medium artery calcification.

Studies on the relationship of vitamin D receptor gene distribution and bone mineral density in patients with maintenance peritoneal dialysis

Objective To explore frequency distribution of vitamin D receptor (VDR) genotype and the correlations between polymorphism of VDR gene BsmⅠsites and bone mineral density in the patients undergoing maintenance peritoneal dialysis. Methods A case-control study was conducted based on 82 patients with maintenance peritoneal dialysis and 80 healthy people. The frequency distribution of VDR genotype in two groups was detected and analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Serum biochemistry and bone mineral density of the patients undergoing maintenance peritoneal dialysis were detected by dual energy X-ray absorption (DEXA) and automatic biochemical analyzer, respectively. All data was analyzed with SPSS 19.0 software. Results The frequency distribution of VDR genotype between case group and control group had no significant difference (P>0.05). The serum biochemical index such as Ca, P, alkaline phosphatase (ALP) and parathyroid hormone (PTH)] of patients with maintenance peritoneal dialysis had no significant difference among three VDR genotypes(P>0.05). Compared to VDR bb genotype, the serum Ca was significantly higher in VDR BB genotype (P<0.05). The bone mineral density (BMD) and T-Score of patients with VDR BB genotype were the lowest, the BB genotype was the highest, and the difference was statistically significant among three genotypes (P<0.05). Conclusions The frequency distribution of VDR genotype between case group and control group had no significant difference. However, there is a correlation between VDR gene BsmⅠsites and bone mineral density of maintenance peritoneal dialysis patients. Key words: Peritoneal dialysis; Receptors, calcitriol/GE; Bone density

Correlation study on the quality of life in patients with maintenance peritoneal dialysis and their primary caregivers

Objective To investigate the quality of life and its related factors in maintenance peritoneal dialysis (MPD) patients and their primary caregivers; to analyze the correlation of the quality of life MPD patients and their primary caregivers. Methods A total of 92 MPD patients and their primary caregivers were chosen for the study. The patients were performed peritoneal dialysis catheterization in our hospital nephrology from June 2008 to June 2012 and had regularly peritoneal dialysis. General clinical data and questionnaire survey of all patients and primary caregivers were analyzed retrospectively. Results The total score of SF-36 was (86.75±20.76) in MPD patients. There was no significant difference in the scores of SF-36 liking gender or marital status(P>0.05), while there were significant differences in the score of SF-36 such as age, dialysis time, medicare reimbursement and work status(P<0.05). Multiple linear regression analysis showed that age was related factor for the quality of life of MPD patients. The total score of SF-36 was (121.46±18.57) in primary caregivers. There were significant differences in the score of SF-36 in primary caregivers with different gender, age, length of day care, care duration and family/social relations(P<0.05). Multiple linear regression analysis showed that gender, age and time of day care were related factors for the quality of life in primary caregivers. Correlation analysis showed that the score of SF-36, PCS and MCS in MPD patients were positively correlated with the score of SF-36 and MCS in primary caregivers respectively. Conclusions The quality of life in MPD patients is poor, and age is the main related factor. The quality of life is lower in primary caregivers than in normal people, and gender, age and time of day care are the related factors. The quality of life in MPD patients is positively correlated with the quality of life in primary caregivers. To improve the quality of life in patients, the quality of life in primary caregivers should be improved by varieties of ways. Key words: Maintenance peritoneal dialysis; Primary caregivers; Quality of life; Correlation

Risk factors for pulmonary hypertension in patients receiving maintenance peritoneal dialysis.

We investigated the risk factors for pulmonary hypertension (PH) in patients receiving maintenance peritoneal dialysis (MPD). A group of 180 end-stage renal disease patients (124 men and 56 women; mean age: 56.43±8.36) were enrolled in our study, which was conducted between January 2009 and June 2014. All of the patients received MPD treatment in the Dialysis Center of the Second Affiliated Hospital of Soochow University. Clinical data, laboratory indices, and echocardiographic data from these patients were collected, and follow-ups were scheduled bi-monthly. The incidence and relevant risk factors of PH were analyzed. The differences in measurement data were compared by t-test and enumeration data were compared with the χ2 test. Among the 180 patients receiving MPD, 60 were diagnosed with PH. The remaining 120 were regarded as the non-PH group. Significant differences were observed in the clinical data, laboratory indices, and echocardiographic data between the PH and non-PH patients (all P<0.05). Furthermore, hypertensive nephropathy patients on MPD showed a significantly higher incidence of PH compared with non-hypertensive nephropathy patients (P<0.05). Logistic regression analysis showed that the proportion of internal arteriovenous fistula, C-reactive protein levels, and ejection fraction were the highest risk factors for PH in patients receiving MPD. Our study shows that there is a high incidence of PH in patients receiving MPD and hypertensive nephropathy patients have an increased susceptibility to PH.

Pulse Wave Velocity: A Valuable Predictor for Cardio-Cerebrovascular Disease and Death in PD Patients

Aims: To evaluate the value of pulse wave velocity (PWV) to predict cardio-cerebrovascular (CVD) and death in peritoneal dialysis (PD) patients. Methods: In all, 59 maintenance PD patients from January 2012 to December 2012 were enrolled. Patients were classified as group A (>9 m/s) and group B (≤9 m/s), based on the results of carotid-femoral PWV (CF-PWV). Results: CF-PWV was positively correlated with age (r = 0.71, p < 0.01), left atrial diameter (r = 0.58, p < 0.01), left ventricular mass index (r = 0.59, p < 0.01) and 24H average systolic blood pressure (SBP) (r = 0.57, p < 0.01). Age (relative risk (RR) 1.086, 95% confidence interval (CI) 1.024-1.153, p < 0.01) and 24H average SBP (RR 1.047, 95% CI 1.013-1.082, p < 0.01) were risk factors of higher CF-PWV. The cumulative and new CVD free survival rates of group A significantly decreased. Elder (RR 1.114, 95% CI 1.013-1.224, p = 0.026) and higher PWV (RR 1.482, 95% CI 1.01-2.176, p = 0.044) were risk factors of CVD in PD patients. Conclusion: PWV is a valuable predictor of CVD and death in PD patients.

Effect of problem-based learning health educational model on life quality of maintenance peritoneal dialysis patients

Objective To explore the effect of problem-based learning （PBL） health educational model on life quality of maintenance peritoneal dialysis patients .Methods Forty-six maintenance peritoneal dialysis patients in our hospital were chosen and divided into the control group （ n =22 ） and the experimental group （n=24）.The control group received the routine health education , and the experimental group received the PBL health educational model .The treatment compliance and life quality of patients were assessed by the treatment compliance evaluation scale and KDQOL-SF questionnaire survey between two groups 6 months after the intervention.Results The treatment compliance 6 months after the intervention was （3.88 ±0.78） in the experimental group, and was （2.91 ±0.73） in the control group, and the difference was statistically significant （t=4.344,P〈0.05）.The scores of KDTA and SF-36 were respectively （51.40 ±9.24） and （49.39 ±6.17） in the experimental group after intervention , and were higher than those of the control group , and the differences were statistically significant （t=2.614,3.928, respectively;P〈0.05）.Conclusions PBL health educational model is in accord with the characteristics of health education among maintenance peritoneal dialysis patients , and can improve their life quality, and is worthy of clinical promotion . Key words: Peritoneal dialysis; PBL; Health education; Life quality

Effective Achievement of Hemoglobin Stability with Once-Monthly C.E.R.A. in Peritoneal Dialysis Patients: A Prospective Study

BackgroundCorrection of low hemoglobin (Hb) levels is associated with improved survival and greater quality of life in dialysis patients, but frequent administration of erythropoiesis stimulating agent (ESA) therapy is unsatisfactory for peritoneal dialysis patients.ObjectiveThe objective of this study was to assess Hb stability in an unselected population of maintenance peritoneal dialysis patients receiving once-monthly treatment with C.E.R.A., a continuous erythropoietin receptor activator.MethodsIn a prospective, non-interventional, single-arm study at 33 Germany dialysis centers, peritoneal dialysis patients with or without ESA treatment prior to study entry received once-monthly treatment with C.E.R.A. Hb stability was assessed by the proportion of patients for whom all measured Hb values during months 6–8 (the evaluation phase) were within the range 11–12, 11–13, 10–12 or 11–12.5 g/dL.Results220 patients received at least one dose of C.E.R.A. During the evaluation phase, 185 patients provided ≥1 Hb measurement (efficacy population) and 162 patients provided ≥2 Hb measurements (the modified efficacy population). The mean (SD) time between C.E.R.A. doses was 28.2 (7.2) days and mean (SD) C.E.R.A. dose was 109 (57) μg per application. Mean (SD) Hb level was 11.1 (1.4) g/dL at baseline and 11.5 (1.3) g/dL at the end of the study (modified efficacy population). The primary efficacy variable, all measured Hb values in the range 11–12 g/dL, was 18.4 % (34/185) and 14.8 % (24/162) in the efficacy and modified efficacy populations, respectively. The mean (SD) maximum intra-individual fluctuation in Hb level was 0.56 (0.50) g/dL in the efficacy population and 0.58 (0.49) g/dL in the modified efficacy population, with maximum intra-individual fluctuation ≤1 g/dL in 85.4 % (158/185) and 83.3 % (135/162) of patients, respectively. No adverse drug reactions were reported during the study.ConclusionIn this large population of maintenance peritoneal dialysis patients, once-monthly administration of C.E.R.A. achieved a high degree of Hb stability and was well-tolerated.

Risk Factor Analysis of Calcification in Aortic and Mitral Valves in Maintenance Peritoneal Dialysis Patients

Background/Aims: This study aimed to investigate potential risk factors for calcification in aortic and mitral valves in maintenance peritoneal dialysis (MPD) patients. Methods: We enrolled MPD patients who had undergone over 18 months of dialysis in our dialysis center, examined their cardiac valve calcification status by echocardiography, and recorded their biochemical data and dialysis-related indicators. These results were compared by logistic regression analyses to identify the risk factors associated with calcification in aortic and mitral valves. Results: Among the 117 enrolled MPD patients, 41 exhibited calcification in aortic or mitral valves, including 38 with aortic valve calcification (AVC) and 17 with mitral valve calcification (MVC); 14 of them had calcification in both aortic and mitral valves. Multivariate logistic regression analysis revealed that age (OR=1.965, p=0.01), diabetes history (OR=4.693, p=0.029), calcium-phosphorus product (OR=2.373, p=0.001) and prealbumin (OR=0.908, p=0.012) were independently related to AVC, whereas age (OR=3.179, p=0.023), calcium-phosphorus product (OR=6.512, p=0.001), prealbumin (OR=0.885, p=0.033), high-density lipoprotein (OR=19.540, p=0.011) and diabetes history (OR=6.948, p=0.038) were independently related to MVC. Conclusions The incidence of cardiac valve calcification in MPD patients is high, and the incidence of AVC is higher than MVC. Age, diabetes history, calcium-phosphorus product and hypo-prealbuminemia are independent risk factors for AVC, whereas age, calcium-phosphorus product and hypo-prealbuminemia are independent risk factors for MVC.

Audit Of The Prevalence Of Malnutrition Using The Modified Subjective Global Assessment Tool In Maintenance Peritoneal Dialysis Patients In The Top End Renal Service Of The Nortehrn Territory Australia

Introduction The objective of the audit is to determine the prevalence of malnutrition in maintenance peritoneal dialysis (MPD) patients in the Top End of the Northern Territory, using the modified Subjective Global Assessment (SGA) tool. Methods: The audit was conducted in an outpatients setting. Approximately 75% of PD patients in the Top End Renal service are represented by Aboriginal and Torres Strait Island people. The study population was MPD patients in the Top End Renal Service (TERS) of the Northern Territory, from January 1st 2010 to December 31st 2010. Results were compared to malnutrition rates found in the 2008/09 the audit of MPD patients in the TERS. The SGA’s were performed by the renal Dietitian as part of the standard dietetic support of MPD patients. SGA scores were collected from patient medical charts. Results: Patients were classified into one of three categories, based on their SGA score (A) Well-nourished; (B) Mild- Moderate Malnutrition, (C) Severe malnutrition. Malnutrition (B or C) was detected in 10% of PD patients, compared to the 2008/09 audit where 76% of MPD patients had some degree of malnutrition. Summary: These results were much lower than malnutrition rates (76%) in the MPD patients audited in 2008/09. A number of factors affecting the PD service after the 2008/09 audit could explain the decrease in malnutrition rates including the implementation of free oral nutrition supplements to MPD patients, development of service wide culturally appropriate education resources used in the pre-dialysis and dialysis stage. Future research into the correlation between improved peritonitis rates and decreased malnutrition rates in the population are warranted.