RIPK3 activation promotes peritoneal dialysis-related peritoneal fibrosis via NLRP3/Caspase-1/IL-1β pathway.

Introduction:Understanding the inflammatory processes that are associated with the risk of mortality in patients undergoing peritoneal dialysis (PD) may help guide clinical decision-making and risk and mortality stratification in this population.Objective:To evaluate the association of hematological indices derived from complete blood count with unfavorable outcomes in patients undergoing PD.Methods:Prospective cohort with 43 patients undergoing PD follow up for 18 months. Complete blood count data were collected from medical records and the hematological indices were calculated for all participants in the four follow-up waves. Associations between these indices and classic inflammatory markers were investigated by correlation analyses. Patient survival was estimated by the Kaplan Meier method (K-M) after dividing the patients into two groups based on the median as the cut-off point for each hematological index. The Cox model with competitive-risk framework was used to evaluate the influence of indices on survival.Results:The AISI and SIRI indices had a significant positive correlation with global leukocytes (r = 0.74 and r = 0.71, respectively, p < 0.001). Only AISI and SII showed K-M significant estimates indicating greater survival for AISI ≤149.61 and SII ≤722.80. In the Cox regression model, patients who presented AISI above 149.6 and SII above 722.80 had 9.38 and 4.0 times, respectively, higher risk of death or transfer to HD than other patients.Conclusion:AISI and SII were independently associated with the risk of unfavorable outcomes in PD patients.

Erythrocytes or red blood cells (RBCs) are the most abundant cells in the bloodstream. RBCs undergo a programmed cell death known as eryptosis, which is comparable to apoptosis. Enhanced eryptosis contributes to the pathophysiology of several clinical disorders ( e.g. , anemia, metabolic syndrome, diabetes, uremia, sepsis, fever, and dehydration), specifically their development and progression, in both chronic and acute cases. In this review, we focused on eryptosis in patients with chronic kidney disease (CKD) and end-stage kidney disease who were treated with peritoneal dialysis (PD) or hemodialysis (HD). We also focused on eryptosis in patients with acute kidney injury (AKI) and sepsis.

Introduction:The medical residency (MR) curriculum underwent a reformulation, and in 2021, the competency matrix for MR in nephrology was published. This study aimed to evaluate nephrologists' perceptions of the competencies acquired during residency and their relevance in clinical practice.Method:This was a cross-sectional study conducted using a self-administered electronic questionnaire, which included demographic data, information on professional practice, and an assessment of both the learning and the usefulness of the skills acquired during the MR program in nephrology. Participants responded to questions on a five-point Likert scale. Only nephrologists who had graduated from programs accredited by the Brazilian Ministry of Education were included.Results:A total of 163 nephrologists from different states in Brazil were included. Most considered the clinical skills acquired to be useful for practice, except for palliative care, in which 54% felt capable, although 93.2% considered it essential. Procedures for which usefulness exceeded self-reported competence included fundoscopy, insertion of permanent hemodialysis catheters, insertion of peritoneal dialysis catheters, and ultrasonography. Furthermore, less than 40% of participants reported feeling prepared to engage in management, clinical research, and teaching activities, despite perceiving their relevance.Conclusion:The study highlights nephrologists' perceptions of competencies acquired during MR and underscores the need for improvements in nephrology training, particulary in management, teaching, and research.

The medical residency (MR) curriculum underwent a reformulation, and in 2021, the competency matrix for MR in nephrology was published. This study aimed to evaluate nephrologists&apos; perceptions of the competencies acquired during residency and their relevance in clinical practice. This was a cross-sectional study conducted using a self-administered electronic questionnaire, which included demographic data, information on professional practice, and an assessment of both the learning and the usefulness of the skills acquired during the MR program in nephrology. Participants responded to questions on a five-point Likert scale. Only nephrologists who had graduated from programs accredited by the Brazilian Ministry of Education were included. A total of 163 nephrologists from different states in Brazil were included. Most considered the clinical skills acquired to be useful for practice, except for palliative care, in which 54% felt capable, although 93.2% considered it essential. Procedures for which usefulness exceeded self-reported competence included fundoscopy, insertion of permanent hemodialysis catheters, insertion of peritoneal dialysis catheters, and ultrasonography. Furthermore, less than 40% of participants reported feeling prepared to engage in management, clinical research, and teaching activities, despite perceiving their relevance. The study highlights nephrologists&apos; perceptions of competencies acquired during MR and underscores the need for improvements in nephrology training, particulary in management, teaching, and research.

Adherence to home dialysis is the focus of renal nurse support. Remote patient monitoring (RPM) promises improved adherence and clinical tools. Remote monitoring has been available for more than a decade. Limited findings of how nurses use and perceive RPM are available in published literature. To understand renal nurses' experience of RPM when supporting patients undergoing ambulatory peritoneal dialysis at home. Qualitative description of renal nurses' accounts of their experiences of using RPM across three centres delivering support for home dialysis. Focus group and interview data were audio-recorded, transcribed verbatim and interpreted with the aid of NVivo software. Participants reported that RPM is valued for the programming of machines remotely. Patient health benefits were described as complex with no direct link to reduced hospitalisations. RPM is a tool that helps maintain relationships with patients. Routine checking of remote monitoring reports was only common when first introduced, and in smaller centres. Costs and data privacy can complicate the uptake. Results were similar across three different centres. Renal nurses supporting home dialysis patients monitor adherence to treatment, using RPM as a tool that is most beneficial for the remote adjust of dialysis machine programs, but which also serves as a tool for building on their relationship with patients which in turn supports adherence, thus justifying overcoming barriers to use such as costs or availability of technology.

Resumo Introdução: Compreender os processos inflamatórios associados ao risco de mortalidade em pacientes em diálise peritoneal (DP) pode ajudar a orientar a tomada de decisões clínicas e a estratificação de risco e mortalidade nessa população. Objetivo: Avaliar a associação entre índices hematológicos derivados de hemograma completo e desfechos desfavoráveis em pacientes sob DP. Métodos: Coorte prospectiva com 43 pacientes em DP acompanhados por 18 meses. Dados do hemograma completo foram coletados dos prontuários médicos e índices hematológicos foram calculados para todos os participantes nas quatro etapas do acompanhamento. Associações entre esses índices e marcadores inflamatórios clássicos foram investigadas por meio de análises de correlação. A sobrevida dos pacientes foi estimada pelo método de Kaplan Meier (K-M) após divisão dos pacientes em dois grupos, com base na mediana como ponto de corte para cada índice hematológico. Utilizou-se o modelo de Cox com estrutura de risco competitivo para avaliar a influência dos índices na sobrevida. Resultados: Os índices AISI e SIRI apresentaram correlação positiva significativa com a contagem total de leucócitos (r = 0,74 e r = 0,71, respectivamente, p &lt; 0,001). Apenas AISI e SII apresentaram estimativas significativas de K-M, indicando maior sobrevida para AISI ≤149,61 e SII ≤722,80. No modelo de regressão de Cox, os pacientes com AISI superior a 149,6 e SII acima de 722,80 apresentaram risco 9,38 e 4,0 vezes maior, respectivamente, de óbito ou transferência para HD em comparação aos demais pacientes. Conclusão: AISI e SII foram independentemente associados ao risco de desfechos desfavoráveis em pacientes em DP.

Macrophage extracellular traps promote peritoneal fibrosis through the ROS/TGF-β/Smad pathway under high-glucose dialysis conditions.

Background: Fungal peritonitis (FP) treatments are successful in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). There were few studies that reported the success and outcome of reinitiated CAPD. Objective: To characterize the clinical characteristics and outcomes of patients who developed FP after reinitiating CAPD. Materials and Methods: A retrospective study was undertaken in the peritoneal dialysis center at Uttaradit Hospital in Uttaradit, Thailand. Between November 2008 and November 2018, all FP-related CAPD patients had their medical records examined. Results: Five hundred eighteen CAPD patients were enrolled. Twenty-eight bouts of FP occurred in 28 patients, with nine caused by Candida species and 19 caused by filamentous fungi. FP was responsible for 6.5% of all peritonitis occurrences. Sixteen of the 28 patients successfully resumed peritoneal dialysis, while 12 did not. Three patients died, one dropped out, two experienced technical failure, and six were switched to hemodialysis. All patients who resumed peritoneal dialysis had a 94 percent 1-year technical survival rate. Conclusion: In regions where CAPD patients have trouble obtaining hemodialysis maintenance, more than half (57%) of FP patients can resume peritoneal dialysis under carefully selected social and physical conditions.

BackgroundLong-term peritoneal dialysis (PD) induces persistent inflammation and fibrosis of the peritoneal membrane (PM), altering the peritoneal solute transport rate (PSTR). We previously found elevated miR-503-5p levels in exosomes from PD effluent (PDE) in patients with high PSTR. As PSTR is strongly influenced by intraperitoneal inflammation, this study aimed to explore the relationship between miR-503-5p, inflammation, and peritoneal fibrosis and the underlying mechanisms.MethodsBioinformatics analyses were initially performed to identify the miR-503-5p target genes and determine the research subject. Real-time polymerase chain reaction (RT-PCR), miRNA RT-PCR, and western blotting were used to detect the expression levels of miR-503-5p and its targets in human MeT-5A mesothelial cells. A cell counting kit-8 assay was used to ascertain the impact of miR-503-5p on cellular proliferation, and cell cycle was evaluated using a FACScan flow cytometer. The miR-503-5p target genes were identified using mimic/inhibitor transfection and dual-luciferase reporter assays. The PDE exosomes (PDE-exos) labeled with PKH67 were used to observe their interactions with MeT-5A cells.ResultsPatients with PD who exhibited an increasing PSTR had notably elevated dialysate interleukin (IL)-6 concentrations, which demonstrated a positive correlation with the PSTR. The induction of lipopolysaccharides remarkably enhanced the expression of miR-503-5p and IL-6 in peritoneal mesothelial cells (PMCs). Overexpression of miR-503-5p induced cell cycle arrest in the G1/S phase and notably upregulated the expression of fibrotic indicators (alpha-smooth muscle actin and type I collagen) in PMCs. Cyclin D1 was a direct target of miR-503-5p and expressed in PMCs. Additionally, PKH67-labeled PDE-exos were internalized by PMCs.ConclusionsPatients with PD who had a high PSTR exhibited an elevated inflammatory state, and the presence of inflammatory factors stimulated the upregulation of miR-503-5p expression, which led to cell cycle arrest in PMCs and promoted peritoneal fibrosis development.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12882-025-04587-1.

Peritoneal dialysis-associated peritonitis caused by Listeria monocytogenes (LM) is a rare occurrence among peritoneal dialysis patients. It can be induced by an contaminated diet and lacks characteristic clinical manifestations. We present a case of recurrent peritonitis caused by LM. The patient an aged male, had a history of four years of peritoneal dialysis with diabetic kidney disease, high blood pressure, heart failure, chronic hepatitis B, and syphilis. The patient ingested food contaminated with monocyte listeria and had repeated symptoms of peritoneal cloudy, diarrhoea, abdominal pain, chills and fever. The efficacy of Cefazolin sodium combined with Ceftazidime is poor. Finally, its successful treatment included a combination of Vancomycin, Amikacin, and Piperacillin Tazobactam. Keywords: Listeria monocytogenes; Peritoneal dialysis; Peritonitis; Recrudescence.

The relationship between social support, psychological distress, and patient activation in peritoneal dialysis patients: a cross-sectional study

BackgroundThailand implemented a peritoneal dialysis (PD)-first policy under its universal health coverage (UHC) from 2008 to 2022. This study aims to describe patient survival during dialysis and after kidney transplantation (KT), and to identify factors associated with survival in these periods among UHC-covered patients undergoing PD, hemodialysis (HD), or transitioning between dialysis modalities.MethodsThis retrospective study analyzed data from patients receiving PD, HD, or KT, recorded by the National Health Security Office (NHSO) between January 2013 and December 2021. Patients were categorized into four groups: PD, HD, PD-to-HD transition, and HD-to- PD transition. Survival factors were analyzed using Cox proportional hazards models.ResultsAmong 81,572 patients receiving kidney replacement therapy, 38.9% were on PD, 35.3% were on HD, 10.2% transitioned from PD to HD, and 15.6% transitioned from HD to PD. Patients transitioning from PD to HD had superior 3- and 5-year survival rates compared to the other three groups. Survival outcomes were significantly influenced by age at dialysis initiation, diabetes, and comorbidities. Overall, 1,517 patients (1.9%) received KT: 70.4% had PD, 19.8% HD, and 9.8% had transitioned. Median follow-up time before KT was 94.5 months. Post-KT survival rates were comparable across dialysis groups. Factors associated with post-KT survival were age, cardiac disease, antibody-mediated rejection, and delayed graft function.ConclusionsUnder Thailand’s PD-first policy, starting with PD and later switching to HD was linked to better survival than staying on a single modality or switching from HD to PD. A higher proportion of PD patients underwent KT compared to HD patients. Post-KT survival rates remained similar across all dialysis modalities. These findings underscore the importance of individualized dialysis modality selection and proactive transition planning to optimize patient outcomes.

Curvularia lunata Peritonitis in Continuous Ambulatory Peritoneal Dialysis: An Occupational Exposure at Play

Chronic inflammation (CIn) is common among peritoneal dialysis (PD) patients and contributes to adverse outcomes. However, the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) and fibrinogen-to-albumin ratio (FAR) in PD remains uncertain. In this prospective cohort study, 65 PD patients were followed for 18 months. Baseline demographic, clinical and laboratory data were collected and inflammatory indices were calculated. The composite outcome was all-cause mortality or transfer to hemodialysis (HD). Logistic regression analyses were used to identify independent predictors of outcomes. Over the 18-month follow-up, 23 patients (35.4%) died and 13 (20.0%) transferred to HD. Patients with adverse outcomes had higher baseline FAR, C-reactive protein (CRP) and serum glucose (Glc) levels and lower triglycerides (TG). In multivariate analysis, higher FAR (OR 5.28, 95% CI 1.16-24.12), CRP (OR 1.28, 95% CI 1.02-1.62) and PTH (OR 1.01, 95% CI 1.00-1.01) were independently associated with adverse outcomes, while NLR showed marginal significance. In the mortality-only model, FAR (OR 3.99, 95% CI 1.17-13.61) and PTH remained significant predictors. FAR demonstrated a significant prognostic association with mortality and composite adverse outcomes in PD patients, whereas NLR had limited predictive value. Albumin-based inflammatory indices such as FAR may complement established markers for risk stratification. Larger multicenter studies are warranted to validate these findings.

PurposeThis study aimed to explore factors affecting the quality of life in peritoneal dialysis (PD) patients. Furthermore, based on the Individual and Family Self-management Theory, this study constructed a path analysis to explore the relationship between psychological distress, social support, patient activation, and quality of life.Participants and MethodsThis study was a cross-sectional study. It included 211 PD patients from a peritoneal dialysis center in China. The questionnaire survey employed convenience sampling, with data collection conducted between March and June 2025. The survey tools included a general information questionnaire, the perceived social support scale, the Kessler psychological distress scale, the patient activation measure-13 item and the short-form 12-item health survey. Correlation analysis and linear regression were used to explore the factors affecting the quality of life of PD patients. Path analysis was performed using structural equation modelling, and the bootstrap program was employed to further test the mediating effect.ResultsIn this study, quality of life was assessed in two dimensions, physical component summary (PCS) and mental component summary (MCS). MCS was positively correlated with social support (r = 0.55, P < 0.01) and patient activation (r = 0.51, P < 0.01), and negatively correlated with psychological distress (r = −0.65, P < 0.01). PCS was also positively related with social support (r = 0.23, P < 0.01) and patient activation (r = 0.21, P < 0.01), and negatively related with psychological distress (r = −0.25, P < 0.01). Complications, psychological distress, social support, and patient activation explained 48% of MCS. Age, monthly household income, psychological distress, social support, and patient activation explained 12% of PCS. The structural equation modelling exhibited a good fit (CMIN/df = 1.380, P = 0.252, GFI = 0.995, AGFI = 0.961, NFI = 0.993, IFI = 0.998, TLI = 0.990, CFI = 0.998, RMSEA=0.043). Path analysis revealed that social support (β = 0.17, P < 0.05), psychological distress (β = −0.47, P < 0.001), and patient activation (β = 0.18, P < 0.01) directly influenced MCS; only psychological distress (β = −0.29, P < 0.01) directly influenced PCS. Furthermore, patient activation mediated the relationship between social support and MCS (β = 0.10, 95% confidence interval [CI]: 0.02–0.18, P < 0.01), and also mediated the relationship between psychological distress and MCS (β = −0.04, 95% CI: −0.09 - −0.01, P < 0.01).ConclusionThe results indicated that psychological distress, social support, patient activation, and quality of life were closely related in PD patients. These findings emphasize the importance of implementing comprehensive care strategies for PD patients that address their physical, psychological, and social needs. Interventions should be implemented to alleviate psychological distress and strengthen social support. Concurrently, educational programs should be implemented to actively guide PD patients in participating in their own dialysis care, thereby enhancing engagement and improving their overall quality of life.

Increasingly, nephrologists struggle with providing care to patients with complex diseases who are heading towards the end of life. In this vignette, we illustrate how to recognize and acknowledge disease progression, tailor treatments to frailty status, and extend high-quality kidney care through to the time of death. Questions answered include how to discuss prognosis while retaining feelings of hope, and tips on how to recognize that the end-of-life may be approaching are included as part of the case discussion. We advocate for modest changes to nephrology care guidelines that promote integration of both high clinical standards and holistic and practical kidney care.

ABSTRACTIntroductionIn patients with incident end-stage kidney disease (ESKD), hyperkalemia (HyperK) is a common indication for initiating kidney replacement therapy (KRT). Hemodialysis (HD) and peritoneal dialysis (PD) both effectively reduce serum potassium, but HD is often considered superior due to its perceived faster efficiency. However, evidence supporting this perception remains limited. We hypothesized that HD and PD would be equally effective for the management of severe HyperK during hospitalization.MethodsWe conducted a prospective cohort study at the Nephrology Department of Hospital Civil de Guadalajara. Consecutive, dialysis-naïve patients hospitalized with ESKD and severe HyperK (serum potassium >6.5 mEq/L at admission) between 2022 and 2024 were included. The modality of KRT (HD vs PD) was determined by the treating nephrology team. The primary outcome was the trajectory of serum potassium reduction between groups. Secondary outcomes included daily potassium trajectory, catheter dysfunction, length of stay and mortality.ResultsEighty-two patients were included: 34 initiated PD, 37 HD and 11 received conservative management. Baseline demographic and clinical characteristics were similar across groups (P > .05). Median age was 65 years [interquartile range (IQR) 53–74], with diabetes in 33% and hypertension in 53%. Median admission potassium was 6.99 mEq/L (6.7–7.6), serum creatinine 15.9 mg/dL (11.5–23.1) and estimated glomerular filtration rate 2.91 mL/min/1.73 m² (1.80–4.09). The PD group underwent a mean of 45 (±15) exchanges during hospitalization, and the HD group received 4.6 (±1) sessions. Serum potassium decreased similarly in both groups (P > .05), with substantial reductions on Day 1 (PD 6.03 mEq/L; HD 5.90 mEq/L) and stabilization by Day 5 through Day 15. Catheter dysfunction occurred in 11% of patients, with similar rates between groups, hospitalization median was 5 days (IQR 3–8) and 12-month mortality was 26.8%, without differences between modalities.ConclusionsIn this prospective cohort of ESKD patients with severe HyperK, both PD and HD achieved comparable potassium reduction and clinical outcomes, supporting PD as an effective alternative for urgent-start KRT.

Given the lack of cost-effectiveness information, continuous ambulatory peritoneal dialysis (CAPD) with icodextrin (CAPD+ICO) has not yet been included in the Universal Health Coverage (UHC) scheme. This study aimed to evaluate the cost-utility of dialysis treatments for end-stage renal disease (ESRD) patients with fluid and sodium overload, comparing CAPD+ICO and automated peritoneal dialysis (APD) against glucose-based CAPD. A Markov model was applied to evaluate lifetime costs and health outcomes from a societal perspective. Data, including transitional probabilities, direct medical and non-medical costs, and utilities, were collected from randomized controlled trials conducted across 16 hospitals in various regions of Thailand. Compared to glucose-based CAPD, the incremental cost-effectiveness ratio (ICER) for CAPD+ICO was 908,440 THB (26,082 USD) per quality-adjusted life year (QALY) gained, while APD was dominated, incurring higher costs and yielding fewer QALYs. The results indicated that glucose-based CAPD had a 90% probability of being the most cost-effective option from a societal perspective, based on Thailand's willingness-to-pay (WTP)threshold of 160,000 THB (4,603 USD) per QALY gained. Therefore, CAPD+ICO is not considered a good value for money, requiring an additional annual budget of approximately 58 million THB (2 million USD). These findings provide important economic evaluation evidence to support policy decision-making alongside clinical effectiveness and equity considerations in guiding future UHC benefit package decisions for dialysis modalities among ESRD patients with fluid and sodium overload in Thailand.

Given the lack of cost-effectiveness information, continuous ambulatory peritoneal dialysis (CAPD) with icodextrin (CAPD+ICO) has not yet been included in the Universal Health Coverage (UHC) scheme. This study aimed to evaluate the cost-utility of dialysis treatments for end-stage renal disease (ESRD) patients with fluid and sodium overload, comparing CAPD+ICO and automated peritoneal dialysis (APD) against glucose-based CAPD. A Markov model was applied to evaluate lifetime costs and health outcomes from a societal perspective. Data, including transitional probabilities, direct medical and non-medical costs, and utilities, were collected from randomized controlled trials conducted across 16 hospitals in various regions of Thailand. Compared to glucose-based CAPD, the incremental cost-effectiveness ratio (ICER) for CAPD+ICO was 908,440 THB (26,082 USD) per quality-adjusted life year (QALY) gained, while APD was dominated, incurring higher costs and yielding fewer QALYs. The results indicated that glucose-based CAPD had a 90% probability of being the most cost-effective option from a societal perspective, based on Thailand’s willingness-to-pay (WTP) threshold of 160,000 THB (4,603 USD) per QALY gained. Therefore, CAPD+ICO is not considered a good value for money, requiring an additional annual budget of approximately 58 million THB (2 million USD). These findings provide important economic evaluation evidence to support policy decision-making alongside clinical effectiveness and equity considerations in guiding future UHC benefit package decisions for dialysis modalities among ESRD patients with fluid and sodium overload in Thailand.