Incremental peritoneal dialysis is a safe and feasible prescription in incident patients with preserved residual kidney function

Nephrology ◽  
2021 ◽  
Author(s):  
Louis L. Huang ◽  
Jia Y. Mah ◽  
Jennifer Howard ◽  
Matthew A. Roberts ◽  
Lawrence P. McMahon
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Residual Kidney Function

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

2019 ◽  
Vol 39 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Yasuhiro Kawai ◽  
Shigeru Tanaka ◽  
Hisako Yoshida ◽  
Masatoshi Hara ◽  
Hiroaki Tsujikawa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Natriuretic Peptide ◽  
Subgroup Analysis ◽  
Proportional Hazards Model ◽  
Urine Volume ◽  
Cox Proportional Hazards Model ◽  
University Hospital ◽  
Residual Kidney Function ◽  
Increased Risk

Background 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. Methods 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. Results 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. Conclusions 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.

Volume management as a key dimension of a high-quality PD prescription

2020 ◽  
Vol 40 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Jie Dong ◽  
Xiao Xu ◽  
Simon Davies
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Clinical Care ◽  
Small Sample ◽  
Volume Status ◽  
Volume Control ◽  
High Quality ◽  
Volume Management ◽  
Residual Kidney Function

Background: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for “High-quality PD prescription” necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. Methods: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. Results: There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only “practice points” were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. Conclusions: High-quality goal-directed PD prescription should include volume management as one of the key dimensions.

scholarly journals High rates of protein intake are associated with an accelerated rate of decline of residual kidney function in incident peritoneal dialysis patients

2019 ◽  
Vol 34 (8) ◽  
pp. 1394-1400 ◽  
Author(s):  
Pablo Otero Alonso ◽  
Miguel Pérez Fontán ◽  
Antía López Iglesias ◽  
Teresa García Falcón ◽  
Ana Rodríguez-Carmona
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Odds Ratio ◽  
Protein Intake ◽  
First Year ◽  
Main Study ◽  
Study Variable ◽  
Residual Kidney Function ◽  
Rate Of Decline

AbstractBackgroundPreservation of residual kidney function (RKF) is a relevant objective in peritoneal dialysis (PD) patients. The influence of dietary protein intake (PI) on this variable has not been adequately investigated.MethodsFollowing an observational design, we studied 336 patients incident on PD, with a minimum follow-up of 6 months. The main study variable was the mean PI [normalized rate of protein nitrogen appearance (nPNA)] during the first 4 months on PD. The main outcome variables were the absolute rate of decline of RKF and the proportion of patients presenting a >50% decay of their RKF during the first year of follow-up. We applied univariate and multivariate strategies of analysis, taking into consideration the main control variables bearing a correlation with nPNA and/or RKF.ResultsMean nPNA (first 4 months) was 1.23 ± 0.33 g/kg/day, while the overall rate of decline of RKF was −0.13 ± 0.29 mL/min/month; 69 patients (25.1%) had lost >50% of their initial RKF by the end of the first year. Univariate analysis disclosed consistent associations between the main study variable on one hand and baseline RKF (r = 0.32, P < 0.0005) and its rate of decline (r = −0.23, P < 0.0005) on the other. The latter two variables were also significantly correlated (r = −0.36, P < 0.0005). Multivariate analysis identified mean nPNA as an independent predictor of the rate of decline of RKF [odds ratio 1.09 per 0.10 g/kg/day, 95% confidence interval (CI) 0.99–1.19, P = 0.058] and, in particular, of the probability of losing >50% of the baseline RKF during the first year of treatment (odds ratio 1.15 per 0.10 g/kg/day, 95% CI 1.04–1.27, P = 0.006).ConclusionHigher rates of PI during the first months of therapy are associated with a faster decline of RKF among patients incident on PD. Our results underline the convenience of keeping an adequate balance between sufficient protein ingestion, to prevent malnutrition and wasting, and sensible restriction in stable, adequately nourished individuals with rates of intake in the higher range or above-recommended allowances.

scholarly journals Intermittent Peritoneal Dialysis: Urea Kinetic Modeling and Implications of Residual Kidney Function

2012 ◽  
Vol 32 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Steven Guest ◽  
Alp Akonur ◽  
Arshia Ghaffari ◽  
James Sloand ◽  
John K. Leypoldt
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Low Dose ◽  
High Dose ◽  
Urea Clearance ◽  
Home Setting ◽  
Residual Kidney Function ◽  
Baxter Healthcare ◽  
Fill Volume ◽  
Treatment Adequacy

♦BackgroundIntermittent peritoneal dialysis (IPD) is an old strategy that has generally been eclipsed, in the home setting, by daily peritoneal therapies. However, for a select group of patients with exhausted vascular access or inability to receive PD at home, in-center IPD may remain an option or may serve as an incremental strategy before initiation of full-dose PD. We investigated the residual kidney clearance requirements necessary to allow thrice-weekly IPD regimens to meet current adequacy targets.♦MethodsThe 3-pore model of peritoneal transport was used to examine 2 thrice-weekly IPD dialysis modalities: 5 – 6 dwells with 10 – 12 L total volume (low-dose IPD), and 50% tidal with 20 – 24 L total volume (high-dose IPD). We assumed an 8-hour dialysis duration and 1.5% dextrose solution, with a 2-L fill volume, except in tidal mode. The PD Adequest application (version 2.0: Baxter Healthcare Corporation, Deerfield, IL, USA) and typical patient kinetic parameters derived from a large dataset [data on file from Treatment Adequacy Review for Gaining Enhanced Therapy (Baxter Healthcare Corporation)] were used to model urea clearances. The minimum glomerular filtration rate (GFR) required to achieve a total weekly urea Kt/V of 1.7 was calculated.♦ResultsIn the absence of any dialysis, the minimum residual GFR necessary to achieve a weekly urea Kt/V of 1.7 was 9.7 mL/min/1.73 m2. Depending on membrane transport type, the low-dose IPD modality met urea clearance targets for patients with a GFR between 6.0 mL/min/1.73 m2and 7.6 mL/min/1.73 m2. Similarly, the high-dose IPD modality met the urea clearance target for patients with a GFR between 4.7 mL/min/1.73 m2and 6.5 mL/min/1.73 m2.♦ConclusionsIn patients with residual GFR of at least 7.6 mL/min/1.73 m2, thrice-weekly low-dose IPD (10 L) achieved a Kt/V urea of 1.7 across all transport types. Increasing the IPD volume resulted in a decreased residual GFR requirement of 4.7 mL/min/1.73 m2(24 L, 50% tidal). In patients with residual kidney function and dietary compliance, IPD may be a viable strategy in certain clinical situations.

scholarly journals Effectiveness of Renin-Angiotensin-Aldosterone System Blockade on Residual Kidney Function and Peritoneal Membrane Function in Peritoneal Dialysis Patients: A Network Meta-Analysis

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Sirayut Phatthanasobhon ◽  
Surapon Nochaiwong ◽  
Kednapa Thavorn ◽  
Kajohnsak Noppakun ◽  
Setthapon Panyathong ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Active Control ◽  
Meta Analysis ◽  
Urine Volume ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Membrane Function ◽  
Raas Blockade ◽  
Residual Kidney Function

AbstractWe performed a network meta-analysis of randomised controlled trials (RCTs) and non-randomised studies in adult peritoneal dialysis patients to evaluate the effects of specific renin-angiotensin aldosterone systems (RAAS) blockade classes on residual kidney function and peritoneal membrane function. Key outcome parameters included the following: residual glomerular filtration rate (rGFR), urine volume, anuria, dialysate-to-plasma creatinine ratio (D/P Cr), and acceptability of treatment. Indirect treatment effects were compared using random-effects model. Pooled standardised mean differences (SMDs) and odd ratios (ORs) were estimated with 95% confidence intervals (CIs). We identified 10 RCTs (n = 484) and 10 non-randomised studies (n = 3,305). Regarding changes in rGFR, RAAS blockade with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) were more efficacious than active control (SMD 0.55 [0.06–1.04] and 0.62 [0.19–1.04], respectively) with the protective effect on rGFR observed only after usage ≥12 months, and no differences among ACEIs and ARBs. Compared with active control, only ACEIs showed a significantly decreased risk of anuria (OR 0.62 [0.41–0.95]). No difference among treatments for urine volume and acceptability of treatment were observed, whereas evidence for D/P Cr is inconclusive. The small number of randomised studies and differences in outcome definitions used may limit the quality of the evidence.

Trimethylamine-N-oxide (TMAO) and clinical outcomes in patients with end-stage kidney disease receiving peritoneal dialysis

2021 ◽  
pp. 089686082110518
Author(s):  
Dongyuan Chang ◽  
Xiao Xu ◽  
Zhikai Yang ◽  
Tiantian Ma ◽  
Jing Nie ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Kidney Function ◽  
Competing Risk ◽  
First Episode ◽  
Residual Kidney Function ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Cvd Mortality

Background: Trimethylamine-N-oxide (TMAO) is a gut bacteria-derived metabolite of l-carnitine and choline. A high concentration of TMAO has been proven to relate to cardiovascular disease (CVD), all-cause mortality and chronic kidney disease progression. We aimed to investigate the relation between the value of serum TMAO and outcomes for peritoneal dialysis (PD) patients. Methods: This is a prospective cohort study with data retrospectively analysed. All incident PD patients were enrolled and followed up. Log-rank test, competing risk survival analysis and COX regression were performed to test the effect of serum TMAO on developing first-episode peritonitis, all-cause and CVD mortality. Results: A wide distribution of serum TMAO concentration was observed in 513 PD patients, with a median level of 72.3 (43.7, 124.7) µmol/L. Patients with lower TMAO concentration were more likely to be without diabetes and hypertension. Patients with lower TMAO concentration showed better residual kidney function and solute clearance at baseline. Participants in the higher three TMAO quartiles showed an increased risk for first-episode peritonitis ( p = 0.039). By competing risk survival analysis, after adjusting for age, sex, diabetes mellitus, CVD, body mass index, albumin, high-sensitive C-reactive protein, potassium, phosphorus, residual kidney function, normalised protein equivalent of total nitrogen appearance and calendar year of catheter implantation, patients in the higher three TMAO quartiles had a statistically or marginally higher risk for first-episode peritonitis compared with patients in the lowest quartile, with hazard ratio (HR) 1.65 (1.05, 2.58), 1.46 (0.92, 2.31) and 1.66 (1.05, 2.61), respectively. In the COX model, patients in the third quartile TMAO group had significantly higher CVD mortality risk compared with the lowest quartile group, as HR 2.27 (1.02, 5.05) after adjusting for various factors. As for all-cause mortality, TMAO did not show any associated effects. Conclusions: Serum TMAO concentration is associated with the risk of first-episode peritonitis and CVD mortality in PD patients. No obvious association between serum TMAO and all-cause mortality was observed.

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