Peritoneal Dialysis Survival Research Articles

Impact of Time-interval and Frequency of Hospitalization Due to Fluid Overload on Survival in Peritoneal Dialysis: Thailand Experience.

Fluid overload (FO) is common and linked to high mortality in patients undergoing peritoneal dialysis (PD). This study evaluates the impact of the time interval and frequency of FO-related hospitalizations on mortality and patient survival rates in PD patients. Data from PD patients voluntarily registered in the Database of Peritoneal Dialysis in EXcel (DPEX) was reviewed. We included patients who started PD between January 2008 and December 2018, had a history of FO-related hospitalizations after starting PD, and were followed until December 2020 or death. We analyzed the time interval to the first FO-related hospitalization after starting PD, the number of such hospitalizations, and the cumulative FO-free time. Mortality and patient survival rates were calculated, and multiple Cox regression identified factors associated with mortality. Among 1,858 patients hospitalized due to FO, those hospitalized within 12 months of starting PD or with less than 12 months of cumulative FO-free time had high mortality rates of 38.8 and 40.3 per 100 patient-years, respectively. One-year survival rates were 70.1% for those with a time to first FO-related hospitalization within 12 months of starting PD and 68.7% for those with less than 12 months of cumulative FO-free time. Adjusted hazard ratios were 2.92 (2.31-3.69) for a cumulative FO-free time of less than 12 months, 1.53 (1.18-1.99) for a time to first FO-related hospitalization within 12 months, and 1.05 (1.03-1.07) per FO-related hospitalization. The time interval to the development of FO significantly impacts mortality in patients undergoing peritoneal dialysis.

Nephrologists’ perspectives on communication and decision-making regarding technique survival in peritoneal dialysis: an international qualitative interview study

ObjectivesPeritoneal dialysis (PD) allows patients increased autonomy and flexibility; however, both infectious and non-infectious complications may lead to technique failure, which shortens treatment longevity. Maintaining patients on PD remains a...

The Importance of Blood Pressure Control in the Survival of Peritoneal Dialysis Patients Using a Multistate Model

Since less attention has been paid to the effect of passing blood pressure states on the survival of peritoneal dialysis (PD) patients, this study aimed to inves­tigate the survival of PD patients with and without hypertension, estimate the probability of hypertension and determine the influential factors. In this retro­spective cohort study, the data of 700 patients visiting dialysis centers from all provinces of Iran from 1997-2009 were analyzed. For data analysis, the multistate survival model was used. The median survival time (months) and five-year survival were 75% and 56%, respectively. Males had a higher probability of hypertension (63%) than females (52%). The risk of death in normotensive patients increased with age and fast blood sugar (FBS) (age: HR = 1.02, p-va­lue <0.001; FBS: HR = 1.03, p-value = 0.034) and decreased with increasing albumin (HR = 0.60, p-value = 0.015). When experiencing hypertension, the death risk increased with age (age: HR = 1.03, p-value<0.001); also, higher serum albumin and blood urea nitrogen (BUN) had a protective effect against mortality (albumin: HR = 0.66, p-value = 0.038; BUN: HR = 0.99, p-value = 0.014). Paying attention to age, obesity, and blood sugar in PD patients seems necessary.

Association between sarcopenic obesity and mortality in patients on peritoneal dialysis: a prospective cohort study.

Whether sarcopenic obesity had unfavorable effect on survival of peritoneal dialysis (PD) patients is unknown. We aimed to investigate the association between sarcopenic obesity and survival in PD patients. This was a prospective observational study. Eligible PD patients from November 2016 to December 2017 were enrolled and followed until August 31, 2023. Sarcopenia was defined following the recommendations of the Asian Working Group for Sarcopenia (AWGS) as low appendicular skeletal muscle mass index (ASMI) and handgrip strength (HGS). Obesity was defined using the percentage of body fat (PBF). Survival analysis was conducted using the Kaplan-Meier and log-rank test. The Cox regression and the cumulative incidence competing risk (CICR) analyzes were used to investigate the association between sarcopenic obesity and all-cause mortality. A total of 223 patients were enrolled with 133 (59.6%) males, a median age of 57.5 (44.6, 65.7) years, a median dialysis vintage of 20.3 (6.4, 57.7) months and 48 (21.5%) who had comorbid diabetes mellitus. Among them, 46 (20.6%) patients were sarcopenic, and 25 (11.2%) patients were diagnosed with sarcopenic obesity. After followed up for 51.6 (25.6, 73.9) months, the Kaplan-Meier curve showed the sarcopenic obesity (log-rank = 13.527, p < 0.001) group had significant lower survival rate compared to the nonsarcopenic non-obesity group. For multivariate analysis, the CICR method showed patients with sarcopenic obesity had significantly higher mortality rate (HR: 2.190, 95% CI: 1.011-4.743, p = 0.047) compared to those with nonsarcopenic non-obesity. Sarcopenia is not uncommon in PD patients, with a considerable proportion having sarcopenic obesity. There is a significant association between sarcopenic obesity and an increased risk of mortality in PD patients.

Longitudinal association between dietary protein intake and survival in peritoneal dialysis patients

Background Decreased dietary protein intake (DPI) may lead to protein-energy malnutrition and may be associated with increased mortality risk. We hypothesized that longitudinal changes in dietary protein intake have independent associations with survival in peritoneal dialysis (PD) patients. Methods 668 stable PD patients were selected in the study from January 2006 to January 2018 and were followed up until December 2019. Their three-day dietary records were collected at the baseline (the sixth month after PD) and thereafter every 3 months for two and a half years. The latent class mixed models (LCMM) were used to identify subgroups of PD patients with similar longitudinal trajectories of DPI. The relation between DPI (baseline and longitudinal data) and survival was examined using Cox model to estimate death hazard ratios. Meanwhile, different formulae were used to assess nitrogen balance. Results The results showed that baseline DPI ≤ 0.60g/kg/day was associated with the worst outcome in PD patients. Patients with DPI 0.80–0.99g/kg/day and DPI ≥ 1.0g/kg/day both presented positive nitrogen balance; patients with DPI 0.61–0.79g/kg/day presented obviously negative nitrogen balance. Longitudinal association between time-dependent DPI and survival was found in PD patients. The consistently low DPI' (0.61–0.79g/kg/d) group was correlated with increased death risk as compared with the 'consistently median DPI' group (0.80–0.99g/kg/d, HR = 1.59, p = 0.008), whereas there was no difference in survival between 'consistently median DPI' group and 'high-level DPI' group (≥1.0 g/kg/d, p > 0.05). Conclusion Our study revealed that DPI ≥ 0.8 g/kg/day was beneficial to the long-term outcome for the PD population.

Sustainability of peritoneal dialysis and renal function with proactive combination therapy.

Most combined peritoneal dialysis and hemodialysis therapies are used to compensate for the lack of dialysis volume and efficiency in pre-started peritoneal dialysis patients. The aim was to determine the effects on both peritoneal dialysis and residual renal function when proactively combined therapy is started at dialysis induction. This report was based on observation of 10 patients who initiated dialysis therapy with a combination of peritoneal and hemodialysis at induction, and the control group consisted of 24 patients with peritoneal monotherapy in a single dialysis center. The technical survival of peritoneal dialysis therapy and urinary volume and creatinine clearance as residual renal function were assessed. Technical survival of peritoneal dialysis during the 5-year observation period was much better in patients who started with proactive combination therapy than with peritoneal dialysis monotherapy. Between induction and 24months later, median urinary volume (interquartile value) changed from 1500 (1100-1583) to 800 (545-1875) mL/day and from 1600 (1300-2150) to 1480 (115-1885) mL/day for peritoneal alone and for combination therapy, respectively. Creatinine clearance values changed from 7.0 (6.0-8.7) to 2.0 (1.0-3.0) mL/min for peritoneal alone and from 6.0 (4.0-7.3) to 3.0 (0.5-4.0) mL/min for combination therapy. Though some possible confounding factors, including selection bias, cannot be ruled out, this investigation suggests the benefit of proactive combination dialysis therapy on the sustainability of peritoneal dialysis and residual renal function.

The availability of support and peritoneal dialysis survival: A cohort study.

Providing support is important to maintain a patient on peritoneal dialysis (PD), though its impact on outcomes has not been investigated thoroughly. We examined the association between having support and risk of a transfer to hemodialysis. In this retrospective observational cohort study, we used data captured in the Dialysis Measurement Analysis and Reporting system about patients who started PD in Alberta, Canada, between 1 January 2013 and 30 September 2018. Support was defined as the availability of a support person in the home who was able, willing and available to provide support for PD in the patient's residence. The outcome of interest was a transfer to hemodialysis for at least 90 days. We estimated the cumulative incidence of a transfer over time accounting for competing risks and hazard ratios to summarise the association between support and a transfer. We split follow-up time as hazard ratios varied over time. Six hundred and eighty-three incident PD patients, median age 58 years (IQR: 47-68) and 35% female, were followed for a median of 15 months. The cumulative incidence of a transfer to hemodialysis at 24 months was 26%. Having support was associated with a reduced risk of a transfer between 3 and 12 months after the start of dialysis (HR3-12mo: 0.44; 95% CI: 0.25-0.78), but not earlier (hazard ratio (HR)<3mo: 0.96; 95% confidence interval (CI): 0.55-1.69) or later (HR>12mo: 1.19; 95% CI: 0.65-2.17). A transfer to hemodialysis is common. Having a support person at home is associated with a short-term protective effect after the initiation of PD.

Association of Ratio of Apolipoprotein B to Apolipoprotein A1 With Survival in Peritoneal Dialysis.

BackgroundAlthough the ratio of apolipoprotein B (apo B) to apolipoprotein A1 (apo A1) (apo B/apo A1) seems to be associated with mortality in hemodialysis (HD) patients, the association of apo B/apo A1 ratio with death remains not clear in peritoneal dialysis (PD) patients.AimsThe study targets to examine the relationship of apo B/apo A1 ratio with survival in patients receiving PD treatment.MethodsIn this single-center prospective observational cohort study, we enrolled 1,616 patients receiving PD treatment with a median follow-up time of 47.6 months. We used a multivariable Cox proportional hazards model to examine the relationship between apo B/apo A1 ratio and cardiovascular (CV) and all-cause mortality. The association of apo B/apo A1 ratio with atherosclerotic and non-atherosclerotic CV mortality was further evaluated by competing risk regression models.ResultsDuring the follow-up, 508 (31.4%) patients died, 249 (49.0%) died from CV events, of which 149 (59.8%) were atherosclerotic CV mortality. In multivariable models, for 1-SD increase in apo B/apo A1 ratio level, the adjusted hazard ratios for CV and all-cause mortality were 1.26 [95% confidence interval (CI), 1.07–1.47; P = 0.005] and 1.20 (95% CI, 1.07–1.35; P = 0.003), respectively. The adjusted subdistribution hazard ratios for atherosclerotic and non-atherosclerotic CV mortality were 1.43 (95% CI, 1.19–1.73; P < 0.001) and 0.85 (95% CI, 0.64–1.13; P = 0.256), respectively. For quartile analysis, patients in quartile 4 had higher CV, all-cause, and atherosclerotic CV mortality compared with those in quartile 1. Moreover, apo B/apo A1 ratio had a diabetes-related difference in CV, all-cause, and atherosclerotic CV mortality.ConclusionElevated apo B/apo A1 ratio level was significantly associated with CV, all-cause, and atherosclerotic CV mortality in patients undergoing PD. Moreover, the association was especially statistically significant in patients with diabetes.

Understand the difference between clinical measured ultrafiltrationand real ultrafiltration in peritoneal dialysis

BackgroundIt has been noticed for years that ultrafiltration (UF) is important for survival in peritoneal dialysis. On the other hand, precise and convenient UF measurement suitable for patient daily practice is not as straight forward as it is to measure UF in the lab. Both overfill and flush before fill used to be source of measurement error for clinical practice. However, controversy finding around UF in peritoneal dialysis still exists in some situation. The current study was to understand the difference between clinical measured UF and real UF. The effect of evaporation and specific gravity in clinical UF measurement were tested in the study.MethodsFour different brands of dialysate were purchased from the market. The freshest dialysate available in the market were intentionally picked. The bags were all 2 L, 2.5% dextrose and traditional lactate buffered PD solution. They were stored in four different conditions with controlled temperature and humidity. The bags were weighted at baseline, 6 months and 12 months of storage. Specific gravity was measured in mixed 24 h drainage dialysate from 261 CAPD patients when they come for their routine solute clearance test.ResultsThere was significant difference in dialysate bag weight at baseline between brands. The weight declined significantly after 12 month’s storage. The weight loss was greater in higher temperature and lower humidity. The dialysate in non-PVC package lose less weight than PVC package. The specific gravity of dialysate drainage was significantly higher than pure water and it was related to dialysate protein concentration.ConclusionStorage condition and duration, as well as the type of dialysate package have significant impact in dialysate bag weight before use. Evaporation is likely to be the reason behind. The fact that specific gravity of dialysate drainage is higher than 1 g/ml overestimates UF in manual exchanges, which contributes to systemic measurement error of ultrafiltration in CAPD.Trial registrationClinicalTrials.gov ID: NCT03864120 (March 8, 2019) (Understand the Difference Between Clinical Measured Ultrafiltration and Real Ultrafiltration).

MO687FREE WATER TRANSPORT AND ABSOLUTE DIP OF DIALYSATE SODIUM CONCENTRATION: EARLY CLINICAL PARAMETERS FOR PERITONEAL FIBROSIS IN PD PATIENTS?

Abstract Background and Aims Reduction of peritoneal salt and water removal is an important cause of shortened patient and technique survival in peritoneal dialysis (PD). The aim of this study was to longitudinally analyze changes in fluid and solute transport parameters in PD patients during the first year of treatment, using peritoneal equilibration test (PET). Method Retrospective observational study of incident PD patients who underwent 4-hour 3.86% glucose PET with additional measurement of ultrafiltration at 1 hour, 1 month after PD initiation and 12 months later. Parameters of peritoneal transport such as dialysate-to-plasma ratio of creatinine (D/Pcreat), ultrafiltration at 1 and 4 hours, small-pore ultrafiltration (SPUF), free water transport (FWT), sodium removal and absolute dip of dialysate sodium concentration (ΔDNa) at 1 hour (as an expression of sodium sieving), were calculated. Serum cancer antigen 125 (CA-125) was also assessed. Clinical, analytical and demographic data were analyzed. Statistical analysis was performed using SPSS (Version 23 for Mac OSX). Results The average age of 16 incident PD patients was 58.69 ± 8.51 years, 10 (62.5%) were male and 5 (31.8%) were diabetic. Ten patients (62.5%) were on automated peritoneal dialysis (APD). One month after PD initiation, membrane characteristics were: D/P = 0.684 ± 0.589, total UF at 4h = 0.696 ± 0.283L, UF at 1h = 0.487 ± 0.162L, SPUF = 0.303 ± 0.359L, FWT = 0.207 ± 0.738L, %FWT = 51.855 ± 11.828%, sodium removal = 38.048 ± 16.087mmol/L and ΔDNa = 11.125 ± 3.34mmol/L. Average serum CA-125 was 51.206 ± 22.6U/mL. A paired sample t-test was performed to compare these parameters 1 and 12 months after PD initiation and revealed a statistically significant increase of 0.11± 0.196L (p=0.042) on SPUF and 18.607 ± 7.1mmol/L (p=0.019) on sodium removal. ΔDNa showed a decrease of 2.5 ± 0.743mmol/L (p=0.005) and % FWT of 11.782 ± 12.831% (p=0.002). FWT also showed a decrease of 0.168 ± 0.019L, total UF at 4h of 0.206 ± 0.142L and UF at 1h of 0.114 ± 0.243L, however did not reach statistical significance. D/Pcreat remained stable. CA-125 showed a mild decrease of 3.644 ± 22.364U/mL although not statistically significant. Pearson correlation revealed a positive correlation between the variation of total UF at 4h and the variation of FWT (r=0.553, p=0.026) and ΔDNa (r=0.503, p=0.047), but not with SPUF, sodium removal, D/Pcreat or CA-125, during the study follow-up period. Conclusion The reduction of FWT through aquaporins and, particularly, the reduction of ΔDNa as a sodium sieving measure, appear to be the first functional changes in peritoneal membrane, suggesting that fibrosis may begin soon after PD initiation. Our results indicate that FWT and ΔDNa can be used to access fibrotic peritoneal alterations earlier than other conventional parameters such as D/Pcreat.

Mortality, hospitalization and transfer to haemodialysis and hybrid therapy, in Japanese peritoneal dialysis patients.

Survival of peritoneal dialysis (PD) patients in Japan is high, but few reports exist on cause-specific mortality, transfer to haemodialysis (HD) or hybrid dialysis and hospitalisation risks. We aimed to identify reasons for transfer to HD, hybrid dialysis and hospitalisation in the Japan Peritoneal Dialysis and Outcomes Practice Patterns Study. This observational study included 808 adult PD patients across 31 facilities in Japan in 2014-2017. Information on all-cause and cause-specific mortality and hospitalisation and permanent transfer to HD and PD/HD hybrid therapy were prospectively collected and rates calculated. Median follow-up time was 1.66 years where 162 patients transferred to HD, 79 transferred to hybrid dialysis and 74 patients died. All-cause and cardiovascular disease (CVD)-related mortality rates were 5.1 and 1.7 deaths/100 patient-years, respectively. Rates of transfer to HD and hybrid therapy were 11.2 and 5.5 transfers/100 patient-years, respectively. Among HD transfers, 40% were due to infection (including peritonitis), while 20% were due to inadequate solute/water clearance. Eighty-one percent of hybrid dialysis transfers were due to inadequate solute/water clearance. All--cause, peritonitis-related and CVD-related hospitalisation rates were 120.4, 21.1 and 15.6/100 patient-years, respectively. Median hospital length of stay was 19 days. Mortality, hospitalisation and transfer to HD/hybrid dialysis rates are relatively low in Japan compared to many other countries with hybrid transfers, accounting for one-third of dialysis transfers from PD. Further study is needed to explain the high inter-facility variation in hospitalisation rates and how to further reduce hospitalisation rates for Japanese PD patients.

The negative impact of depressive symptoms on patient and technique survival in peritoneal dialysis: a prospective cohort study.

The relationship between depression and long-term clinical outcomes in peritoneal dialysis is unclear. This study was to explore the effect of depressive symptoms on patient survival and technique survival in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients who had received CAPD therapy for ≥ 3months were recruited from January to June, 2009, with follow-up until June, 2019. The Beck Depression Inventory-II (BDI-II) was used to evaluate depressive symptoms (BDI scores ≥ 14) at baseline. The primary outcome was all-cause mortality, and the secondary outcome was technique failure. Participants were 275 CAPD patients (mean age 49.6 ± 15.9years, male 54.2%). Of these, 86 (31.3%) experienced depressive symptoms. The depressive group had fewer males, longer PD duration at enrollment, higher calcium levels, and lower residual glomerular filtration rates (all P < 0.05) than the non-depressive group. Long-term patient survival (P = 0.037) and technique survival (P = 0.003) were significantly poorer in depressive group than in non-depressive group. After adjustment for confounders in multivariate Cox proportional hazard regression models, depressive symptoms remained independent predictors of mortality risk [hazard ratio (HR) 1.60, 95% confidence interval (CI) 1.03-2.48; P = 0.035] and technique failure (HR 1.92, 95% CI 1.07-3.47; P = 0.029). The prevalence of patients with depressive symptoms was 31.3% in this cohort. The patient survival rate and technique survival rate in depressive group were lower than in non-depressive group. Depressive symptoms were independent risk factors for long-term mortality and technique failure in CAPD patients.

MON-065 Relation of Serum ProBNP level and Echocardiographic and Bio-impedance Analysis Findings in Chronic Hemodialysis Patients

Although ProBNP has been reported as a predictor of survival in peritoneal dialysis,the role of ProBNP in hydration status and cardiac disorders of chronic hemodialysis(HD) patients is not clear. So, the aim of this study was assessment of relationship of serum ProBNP level and clinical exams, echocardiographic and bio-impedance analysis (BIA) findings.

SUN-068 RE-EVALUATION OF THE UTILITY OF BACK-UP ARTERIOVENOUS FISTULAS IN A CONTEMPORARY COHORT OF PERITONEAL DIALYSIS PATIENTS

The technique survival of peritoneal dialysis (PD) is limited, and transitions to haemodialysis (HD) are often unpredictable, due to events such as peritonitis or catheter malfunction. As such, there is a high risk of central venous catheter (CVC) use amongst patients who transition from PD to HD. Formation of a ‘back-up’ arteriovenous fistula (AVF) at the commencement of PD may reduce the risk of later CVC use, but risks exposing patients to complications of an AVF that may never be needed. Studies in the 1990s concluded that few AVFs created as back-ups were ever used, and recommended against routine formation of back-up AVFs.

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.

Vitamin D and cinacalcet are associated with increased survival in peritoneal dialysis but not with residual renal function preservation .

Active vitamin D and cinacalcet, a treatment for secondary hyperparathyroidism and also with potential anti-inflammatory properties, have been associated with lower risk of death among dialysis patients. Vitamin D has also been described to decrease proteinuria in CKD patients. This study aims to assess the relationship of vitamin D and cinacalcet with survival and residual renal function preservation among peritoneal dialysis patients. In a retrospective peritoneal dialysis cohort of 581 subjects, we assessed if vitamin D and cinacalcet therapy are associated with increased risk of death and residual renal function loss using Kaplan-Meier analysis and Cox proportional hazard analysis. Vitamin D treatment was associated with a 56% reduction in the risk of death (HR 0.44, 95% CI 0.28-0.67) and cinacalcet also with a 54% lower risk of death (HR 0.46, 95% CI 0.31-0.69) in multivariate models adjusting for each other. Hyperphosphatemia (> 6 mg/dL) was associated with an 85% increase in mortality (HR 1.85, 95% CI 1.30-2.65). Neither vitamin D (HR 1.04, 95% CI 0.45-2.39) nor cinacalcet (HR 0.74, 95% CI 0.45-1.20) were associated with a lower risk of anuria. Vitamin D and cinacalcet therapy was associated with a lower risk of death but not anuria, beyond other known risk factors among peritoneal dialysis patients. .

Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment

BackgroundIcodextrin could reduce the risk of technique failure and improve patient survival in peritoneal dialysis (PD) patients. This study compared the survival between incident hemodialysis (HD) and PD patients, with and without diabetes, in the era of icodextrin treatment. MethodsFrom the Taiwan health insurance database, 53,103 incident end-stage renal disease patients undergoing dialysis were identified from 2005 to 2010. The mortality risks among HD and PD patients with or without icodextrin treatment were compared. The follow-up period started from the date of dialysis initiation to December 31, 2011. The competing-risks regression model was used to estimate the subhazard ratio (SHR) of death with considering renal transplantation as a competing event. ResultsCompared with the corresponding HD patients, mortality risks were higher in diabetic PD patients with icodextrin treatment (Bonferroni adjusted SHR=1.16, 98.3% CI=1.04–1.30) and without the treatment (Bonferroni adjusted SHR=1.35, 98.3% CI=1.16–1.57), particularly for elderly patients. Mortality risks for patients without diabetes were not different among the three cohorts. The time-dependent competing-risks model showed that PD patients with icodextrin treatment exhibited a reduced risk of death for diabetic patients, compared with those without icodextrin treatment (adjusted SHR=0.84, 95% CI=0.72–0.97). ConclusionsIcodextrin could attenuate the survival disadvantage for PD relative to HD in diabetic patients, particularly for the elderly patients.

Dialysis vintage and cardiovascular injury as factors influencing long-term survival in peritoneal dialysis and hemodialysis.

Cardiovascular (CV) incidents are the major cause of mortality in maintenance dialysis (MD) patients undergoing peritoneal dialysis (PD) or hemodialysis (HD). CV injury indicators may be useful to investigate the dialysis modality influence on survival. The aim of this study was to compare selected laboratory and echocardiographic (ECHO) markers of CV injury in terms of dialysis vintage (DV), CV-related mortality and all-cause mortality. The study involved 301 patients on HD (n = 301) and PD (n = 58), who were divided into subgroups according to DV. The subjects' medical histories included diabetes mellitus (DM), myocardial infarction (MI), stroke, CV deaths and deaths from non-CV causes. Their CV parameters were measured with ECHO for the left ventricle ejection fraction (EF), posterior wall (LVW) and interventricular septum (IVS). Serum analyses of cardiac troponin T (TnT) and N-terminal pro-brain natriuretic peptide (BNP) were also carried out. In the subgroup with a DV of 4 years, the PD and HD patients were of a similar age, and had similar mortality and morbidity rates and CV markers, except for thicker IVS in the HD patients. Focusing on the data analysis based on mortality, and both laboratory and echocardiographic markers of cardiovascular injury, PD seems to be a more favorable method of dialysis. The advantage of PD was noted in subjects with a DV < 2 years. HD showed no outcome benefit over PD in longer DV.

Laparoscopic Left Hemicolectomy for Colon Cancer in Peritoneal Dialysis Patients: A Valid and Safe Surgical Technique to Ensure Peritoneal Dialysis Survival

A laparoscopic approach represents an effective alternative to open surgery in patients undergoing peritoneal dialysis (PD). In these patients, conventional thinking provides for removal of the peritoneal catheter during left colon resections because of higher risk of patient contamination and peritonitis. The present paper describes 3 cases of laparoscopic left hemicolectomy for colon cancer performed in PD patients without complications and without peritoneal catheter removal, leading to subsequent early PD resumption.Three normotype PD patients affected by early-stage sigmoid colon adenocarcinoma (T1-T2, M0, N0) underwent integrated surgical and nephrological management to reduce peritoneum stress, infective risk and postoperative complications. The day before surgery, patients were shifted to isovolumetric hemodialysis through tunneled central venous catheter. All patients underwent laparoscopic left hemicolectomy without Tenckhoff catheter removal. The postoperative period was uneventful, with concomitant antibiotic prophylaxis until the fifth day after surgery. Flushing of the PD catheter was performed twice a week postoperatively. Peritoneal dialysis was recovered 4 weeks after surgery in 2 cases with a well-maintained dialytic adequacy. One patient did not proceed to PD due to improvement of renal function after surgery.In selected PD patients, a minimally invasive surgical approach combined with careful nephrological management may represent a valid and safe strategy to treat early-stage colon cancer, avoiding PD drop-out.

Icodextrin decreases technique failure and improves patient survival in peritoneal dialysis patients.

It remains unclear whether long-term daily icodextrin use can decrease technique failure and improve survival in peritoneal dialysis (PD) patients. The aim of the present study was to investigate whether icodextrin use, once daily, can decrease technique failure and prolong patient survival in incident PD patients. Incident PD patients who survived more than 90 days were recruited from the China Medical University Hospital, Taiwan, between 1 January 2007 and 31 December 2011. All patients were followed until transfer to haemodialysis (HD), renal transplantation, transfer to another centre, death, or 31 December 2011. A total of 306 incident PD patients (89 icodextrin users, 217 icodextrin non-users) were recruited during the study period. Icodextrin users were more likely to have hypertension, diabetes and high or high-average peritoneal transport compared with non-users. During the follow-up period, 43 patients were transferred to HD: seven (7.87%) of the icodextrin group, and 36 (16.59%) of the non-icodextrin group. Thirty-two patients died during the follow-up period: five (5.62%) of the icodextrin group, and 27 (12.44%) of the non-icodextrin group. Icodextrin use was significantly associated with a better prognosis, in terms of technique failure (adjusted HR = 0.32; 95% CI = 0.14-0.72). With regard to patient survival, icodextrin use (adjusted HR = 0.33; 95% CI = 0.12-0.87) was associated with a significantly lower risk of death. The use of icodextrin once daily may decrease technique failure and improve survival in incident PD patients.