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Advances in Peritoneal Dialysis

Sohail Abdul Salim, Yougandhar Akula, Swetha Kandhuri, Sabahat Afshan, Lajos Zsom, Mehul P Dixit, Tibor Fülöp
Peritoneal dialysis (PD) obviates the need for temporary vascular access in end-stage renal disease; however, extremely heavy weight has been viewed as a relative contraindication to PD.We performed a cross-sectional review of multiple clinical and laboratory variables for 75 current or past PD patients (vintage > 6 months), comparing dialysis adequacy parameters for those with a large body weight (>100 kg, LWS group) and with a normal body weight (<75 kg, NWS group).In the LWS group (n = 17), mean weight was 117...
2016: Advances in Peritoneal Dialysis
Michael M Strauss, Anupkumar Shetty, Daniel Witheiler
Bullous lesions in patients with end-stage renal disease are uncommon and can pose diagnostic and therapeutic challenges. We present a female patient with end-stage renal disease, bullous skin lesions affecting mainly sun-exposed areas, and high ferritin levels. She also had hepatitis C. Her serum porphyrin panel was suggestive of porphyria cutanea tarda. Skin biopsy excluded inflammatory pathologies. Phlebotomy during each hemodialysis, continuation of darbepoetin, and avoidance of any further doses of intravenous iron, with close monitoring of hemoglobin, resulted in a gradual drop in ferritin level and improvement of the skin lesions...
2016: Advances in Peritoneal Dialysis
Anupkumar Shetty, Jeffrey Klein
Calciphylaxis is a major cause of morbidity and mortality in end-stage renal disease (ESRD). Intravenous sodium thiosulfate (STS) is the mainstay of therapy for calciphylaxis. In peritoneal dialysis (PD) patients with calciphylaxis, intravenous STS poses logistic and financial challenges. Even though pharmacokinetic studies show poor bioavailability of oral STS, we report successful use of oral STS in 2 PD patients with calciphylaxis.A 55-year-old Latina American woman with diabetes was initiated on PD after access failure and chronic hypotension...
2016: Advances in Peritoneal Dialysis
Satoshi Shimada, Takefumi Mori, Kenji Koizumi, Shinichi Sato, Ikuko Oba-Yabana, Yusuke Ohsaki, Emiko Sato, Eri Naganuma, Naho Kurasawa, Mihoko Tsuchikawa, Sadayoshi Ito
Neutral icodextrin peritoneal dialysis (PD) fluid (n-ICO) has become available for use in Japan. However, removal of water and solutes remains to be elucidated in detail. The present study was designed to determine removal of water, electrolytes, and small, middle, and large molecules in a period of 16 hours. In addition, biocompatibility with respect to peritoneal mesothelial cells was determined.Three stable patients undergoing PD at Tohoku University Hospital were administered n-ICO. Water removal was monitored every 2 hours...
2016: Advances in Peritoneal Dialysis
Takefumi Mori, Naho Kurasawa, Yusuke Ohsaki, Kenji Koizumi, Shinichi Sato, Ikuko Oba-Yabana, Satoshi Shimada, Emiko Sato, Eri Naganuma, Mihoko Tsuchikawa, Sadayoshi Ito
In the present study, we assessed the effect of chronic tolvaptan treatment and compared it with the effect of conventional treatment without tolvaptan. In addition, changes in cardiac load and body fluid composition were compared.The study enrolled 22 patients undergoing peritoneal dialysis who had been receiving tolvaptan for more than 1 year and 10 patients undergoing peritoneal dialysis who had been treated with conventional diuretics. Left ventricular mass index (LVMI), left ventricular ejection fraction (LVEF), and E/e' index were measured by echocardiography at baseline and after 12 months of tolvaptan treatment (or an equivalent period)...
2016: Advances in Peritoneal Dialysis
Natraj Katta, Sudarshan Balla, Poonam Velagapudi, Mayank Mittal, Harsh Agrawal, Arun Kumar, Kul Aggarwal
Cardiovascular disease is the major cause of morbidity and mortality in chronic kidney disease patients. Because of a higher occurrence of asymptomatic coronary artery disease and increased perioperative cardiovascular mortality in kidney transplant patients, screening for coronary artery disease before transplant surgery is essential. Various studies have shown that cardiac stress testing is an unreliable screening method in these patients because of significant variability in sensitivity and negative predictive value...
2016: Advances in Peritoneal Dialysis
Hany Refaat, Dawlat Sany, Amr Mohab, Haitham Ezzat
Patients undergoing dialysis are at high risk for cardiovascular disease (CVD). Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. The question of whether dialysis modality affects the risk for CVD remains to be addressed.In the present study, we evaluated the influence of hemodialysis (HD) and peritoneal dialysis (PD) on survival and the risk of developing de novo CVD. Our observational prospective study enrolled 157 end-stage renal disease patients on HD or PD for 12 months...
2016: Advances in Peritoneal Dialysis
Radhames Ramos De Oleo, Hugo Villanueva, Lin Lwin, Madhavi Katikaneni, Jinil Yoo
Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication that is observed mostly in patients on long-term peritoneal dialysis (PD). However it can occur after short-term PD, in association with "second hit" risk factors such as peritonitis, acute cessation of PD, or kidney transplantation with the use of calcineurin inhibitors.In our case, a young woman with second-hit risk factors presented with clinical and abdominal computed tomography findings consistent with EPS after short-term PD...
2016: Advances in Peritoneal Dialysis
Ali I Gardezi, Karen W Schlageter, Dawn M Foster, Brad C Astor, Micah R Chan, Sana Waheed
Infection remains the leading complication of peritoneal dialysis (PD). Topical mupirocin and gentamicin are frequently used to prevent infections. Mupirocin ointment has been reported to cause damage to both polyurethane and silicone PD catheters. Gentamicin cream has not been associated with physical damage to catheters.A 64-year-old woman on PD developed relapsing peritonitis with Staphylococcus epidermidis. Because of a drainage problem and white discoloration at the exit site, which is known as " frosting," she underwent catheter exchange...
2016: Advances in Peritoneal Dialysis
Ashwin Jaikishen, Adam Lick, Jonathan G Owen, Mihran V Naljayan
Urgent-start peritoneal dialysis (PD) refers to the initiation of PD in new-start end-stage renal disease patients who present either emergently in the hospital or urgently in clinic. These patients are called "late-referred patients." Our academic practice group, like many private practice and academic groups, currently functions within 4 hospitals and 4 clinics. The patient base consists of a large indigent population with limited access to health care and also of insured patients. An urgent-start PD program was initiated to provide all patients with a choice of dialysis modality...
2016: Advances in Peritoneal Dialysis
Shigeki Kojima, Tsutomu Sakurada, Kenichiro Koitabashi, Kaori Kojima, Shiika Watanabe, Daisuke Uchida, Nagayuki Kaneshiro, Yusuke Konno, Yugo Shibagaki
Peritoneal dialysis (PD)-related infections (PDIs) such as peritonitis, exit-site infection, and tunnel infection are serious complications affecting patients on PD. Because patients with diabetes (DM) and of older age have increased in number in Japan, the number of patients with visual impairment is estimated also to have increased. Near vision is necessary for performing proper PD daily care. However, no studies have reported whether visual impairment is likely to increase the risk of PDIs.Our study included 31 PD patients (16 men, 15 women; mean age: 61...
2016: Advances in Peritoneal Dialysis
Nagayuki Kaneshiro, Tsutomu Sakurada, Rina Hachisuka, Michiko Hisamichi, Masahiko Yazawa, Yugo Shibagaki
Rupture of the peritoneal dialysis (PD) catheter is rare complication. Here, we report a case of catheter rupture that occurred because of exercise after partial catheter reimplantation.A 66-year-old man with a history of end-stage kidney disease secondary to diabetic nephropathy experienced refractory exit-site and tunnel infection. After the infected parts of the catheter were excised, a partial catheter reimplantation was performed. At the time of that surgery, a presternal location was selected for the new exit site, and a titanium extender was used to connect the two catheters...
2016: Advances in Peritoneal Dialysis
Shoji Koga, Hiroyuki Ito
To investigate whether peritoneal dialysis (PD) is useful as a first modality in Japan, where hemodialysis (HD) is used in 97% of all patients on maintenance dialysis, we used intention-to-treat (ITT) and as-treated analyses to examine patient survival at our center, where HD and PD are used almost equally. In the ITT analysis, survival was significantly better in the PD group than in the HD group (p = 0.009). Meanwhile, the as-treated analysis did not reveal any significant differences in survival between the HD and PD groups...
2015: Advances in Peritoneal Dialysis
Anna Machowska, Mark Dominik Alscher, Satyanarayana Reddy Vanga, Michael Koch, Michael Aarup, Peter Rutherford
Unplanned start of dialysis is still a common and important problem for dialysis units in Europe and across the world: 30%-50% of patients can commence therapy in that way. Such patients are known to experience increased morbidity and mortality, to make greater demands on health care resources, and to be less likely to receive their dialysis modality choice. We therefore aimed to meet the specific needs of unplanned-start patients by developing and implementing an Unplanned Start Educational Programme in dialysis units...
2015: Advances in Peritoneal Dialysis
Naoki Washida, Kayoko Aikawa, Shuji Inoue, Takahiro Kasai, Keisuke Shinozuka, Kohkichi Morimoto, Kozi Hosoya, Koichi Hayashi, Hiroshi Itoh
Peritoneal dialysis (PD) is an excellent dialysis mo- dality, but it is underutilized in the United States and Japan. In the present study, we evaluated the impact of interventional nephrology in PD on the impres- sions held by patients and nurses about selection of a renal replacement therapy and the complications associated with PD therapy. Over aperiod of 7 years, PD catheter insertion in 120 patients with end-stage renal disease (age: 63.0 ± 13.3 years) was performed by nephrologists at Keio University Hospital or Saitama Medical Center...
2015: Advances in Peritoneal Dialysis
Enrico Vidal, Franz Schaefer
Hypotension represents a very serious clinical problem in patients receiving renal replacement therapy, and it is associated with a significant increase in mortality risk. Infants on chronic peritoneal dialysis (CPD) can be particularly prone to chronic hypotension because of the hyponatremic hypovolemia risk related to their primary renal disease, their nutritional needs, and their peritoneal membrane characteristics. In this setting, if an acute clinical event leads to a further decline in systolic blood pressure, the counteract and perfusion pressure autoregulatory mechanisms can both be impaired, leading to severe complications...
2015: Advances in Peritoneal Dialysis
Kei Yokota, Tsutomu Sakurada, Kenichiro Koitabashi, Yugo Shibagaki, Kazuomi Kario, Kenjiro Kimura
Visit-to-visit blood pressure (BP) variability has recently been recognized as an important risk factor for decline of residual kidney function (RKF) in patients with chronic kidney disease. However little is known about the impact of visit-to-visit BP variability on RKF in peritoneal dialysis (PD) patients. We retrospectively studied the association between RKF and visit-to-visit BP variability in 42 patients who started on PD between February 2006 and March 2012. Residual kidney function was defined as the mean of the urea and creatinine clearances in the patients...
2015: Advances in Peritoneal Dialysis
Paul A Fein, Stacey Weiss, Morrell M Avram, Francis Ramos, Priyanka Singh, Sein Yin See, Madeeha Shahzadi, Jyotiprakas Chattopadhyay
The normalized protein catabolic rate (nPCR) reflects daily dietary protein intake in stable dialysis patients. In peritoneal dialysis (PD) patients, reports about the importance of nPCR as marker of nutrition and outcome have been inconsistent. The objective of the present study was to investigate the relationships of nPCR with body composition parameters, micronutrient electrolytes, and long-term survival in PD patients. From November 2000 to May 2008, 57 PD patients were enrolled in the study. On enrollment, demographic, clinical, and biochemical data were recorded...
2015: Advances in Peritoneal Dialysis
Naho Kurasawa, Takefumi Mori, Eri Naganuma, Emiko Sato, Kenji Koizumi, Shinichi Sato, Ikuko Oba, Mihoko Tsuchikawa, Sadayoshi Ito
Home blood pressure (HBP) is an independent predictor of cardiovascular and renal function. However, no particular guidelines have been established for optimal HBP in peritoneal dialysis (PD) patients. Bioelectrical impedance analysis (BIA) is a beneficial tool for determining body composition. In the present study, we used BIA to determine body composition parameters that might play a role in the regulation of HBP in PD patients, and we compared HBP with office blood pressure (BP). Our study enrolled 15 patients (11 men, 4 women) receiving PD at Tohoku University Hospital, who, for 1 year, agreed to monitor HBP and to undergo body composition analysis...
2015: Advances in Peritoneal Dialysis
Eri Okada, Daisuke Oishi, Tsutomu Sakurada, Takashi Yasuda, Yugo Shibagaki
In recent years, it has become possible to examine an individual's daily glucose profile with a continuous glucose monitoring system (CGMS). The aim of the present study was to use a CGMS to evaluate the difference in glucose fluctuation between diabetic patients on automated peritoneal dialysis (APD) and those on continuous ambulatory peritoneal dialysis (CAPD). We retrospectively studied 20 diabetic patients on peritoneal dialysis (16 men, 4 women; mean age: 55 ± 10 years) who used a CGMS a total of 23 times (12 times by APD users, 11 times by CAPD users)...
2015: Advances in Peritoneal Dialysis
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