Osteoprotegerin Is the Strongest Predictor for Progression of Arterial Calcification in Peritoneal Dialysis Patients

2017 ◽  
Vol 46 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Marcela Avila ◽  
Carmen Mora ◽  
María del Carmen Prado ◽  
Miriam Zavala ◽  
Ramón Paniagua ◽  
...  
Keyword(s):  
Risk Factor ◽  
Peritoneal Dialysis ◽  
Mineral Metabolism ◽  
Arterial Calcification ◽  
Rapid Progression ◽  
High Systolic Blood Pressure ◽  
Logistic Analysis ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

Background: Arterial calcification (AC) is frequent in patients with end stage renal disease and is also considered a risk factor for later morbidity and mortality. However, long-term factors associated with the process are not well known. We analyzed the trends over time of biomarkers related with development and progression of AC in incident patients on peritoneal dialysis (PD). Methods: We performed a prospective study with 186 patients on PD followed up for 1 year. We analyzed the progression of AC in the abdominal aorta and pelvic vessels by calcification score (CaSc), using16-cut computerized multidetector tomography at baseline and 1 year. Variables related with PD treatment, inflammation, and mineral metabolism were measured at baseline, 6, and 12 months of follow-up. Changes in biochemical variables were analyzed for their relationship with changes in AC. Results: Over 1 year, the number of patients with AC increased from 47 to 56%, and CaSc from 355 (interquartile range [IQR] 75-792) to 529 (IQR 185-1632). A total of 43.5% of patients remained free of calcification, 11.7% had new calcifications, and 44.8% had progression of calcification. Older age, diabetes, high systolic blood pressure, body mass index, cholesterol, and osteoprotegerin (OPG), as well as lower levels of albumin, serum creatinine, and osteocalcin, were associated with development of new, and rapid progression of, calcification. In multivariate logistic analysis, OPG remained the most significant (OR 1.27, 95% CI 1.11-1.47, p < 0.001). Conclusion: OPG was the strongest risk factor associated with new development and rapid progression of AC in incident PD patients.

scholarly journals Sustainability of the Peritoneal Dialysis-First Policy in Hong Kong

2015 ◽  
Vol 40 (4) ◽  
pp. 320-325 ◽  
Author(s):  
Agnes Shin-Man Choy ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Financial Burden ◽  
Training Programme ◽  
Number Of Patients ◽  
Ultrafiltration Failure ◽  
Average Annual Cost ◽  
The Government ◽  
Stage Renal Disease ◽  
End Stage

In Hong Kong, the average annual cost of haemodialysis (HD) per patient is more than double of that of peritoneal dialysis (PD). As the number of patients with end-stage renal disease (ESRD) has surged, it has posed a great financial burden to the government and society. A PD-first policy has been implemented in Hong Kong for three decades based on its cost-effectiveness, and has achieved successful outcomes throughout the years. A successful PD-first policy requires medical expertise in PD, the support of dedicated staff and a well-designed patient training programme. Addressing patients' PD problems is the key to sustainability of the PD-first policy. In this article, we highlight three important groups of patients: those with frequent peritonitis, ultrafiltration failure or inadequate dialysis. Potential strategies to improve the outcomes of these groups will be discussed. Moreover, enhancing HD as back-up support and promoting organ transplantation are needed in order to maintain sustainability of the PD-first policy.

Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

1980 ◽  
Vol 1 (5) ◽  
pp. 54-58 ◽  
Author(s):  
Norbert H. Lameire ◽  
Marc De Paepe ◽  
Raymond Vanholder ◽  
Johan Verbanck ◽  
Severin Ringoir
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Average Rate ◽  
Sodium Concentration ◽  
Risk Category ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

Peritoneal dialysis

2015 ◽  
Author(s):  
Anjali Bhatt Saxena
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Mineral Metabolism ◽  
Pressure Control ◽  
Dialysis Adequacy ◽  
Waste Products ◽  
Stage Renal Disease ◽  
End Stage ◽  
Small Solute

Dialysis adequacy is a term used to describe how well any dialysis therapy effectively mitigates some of the uraemic complications of end-stage renal disease. In the simplest terms, dialysis adequacy measures the dose of dialysis and judges it to be sufficient (adequate) or insufficient (inadequate). In peritoneal dialysis, adequacy refers to the ability of dialysis to perform any or all of myriad tasks including (a) removing metabolic waste products, (b) maintaining proper fluid balance and blood pressure control, (c) removing excess electrolytes, (d) correcting acid–base imbalances, (e) maintaining healthy bone mineral metabolism, and (f) promoting the maintenance of a proper nutritional status. In practice, peritoneal dialysis adequacy is most often measured mono-dimensionally, in terms of small solute (i.e. urea) clearances; however, it is most useful to incorporate a wider view of dialysis adequacy when caring for patients with end-stage renal disease.

Peritoneal Dialysis in Iran and the Middle East

2009 ◽  
Vol 29 (2_suppl) ◽  
pp. 217-221 ◽  
Author(s):  
Iraj Najafi
Keyword(s):  
Saudi Arabia ◽  
Peritoneal Dialysis ◽  
Middle East ◽  
End Stage Renal Disease ◽  
National Income ◽  
Number Of Patients ◽  
The Mean ◽  
Per Capita ◽  
Stage Renal Disease ◽  
End Stage

The countries of the Middle East have a cumulative population of 261.1 million and a mean gross national income per capita of US$9500. The total number of patients with end-stage renal disease (ESRD) in the Middle East is almost 100000, the mean prevalence being 430 per million population (pmp). The first implementation of intermittent peritoneal dialysis (PD) in the Middle East occurred in Turkey in 1968; continuous ambulatory PD started in Saudi Arabia, Turkey, and Kuwait in the 1980s; and automated PD, in Turkey in 1998. The total active PD patients in the region number approximately 8170. With 5750 patients, Turkey ranks first, followed by Iran and Saudi Arabia with 1150 and 771 patients respectively. Penetration of PD with respect to the ESRD population is 7.5%, and with respect to dialysis overall is 10.2%. The dialysis rate in the region, 312 pmp, is almost half the European number of 581 pmp, with a PD prevalence of 32 pmp (range: 0 – 81 pmp). The number of active PD patients has risen dramatically in the main countries since the end of the 1990s: Turkey, to 5750 from 1030; Saudi Arabia, to 771 from 132; and Iran to 1150 from 0.

Development of the “Peritoneal Dialysis First” Model in Hong Kong

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 53-55 ◽  
Author(s):  
Alex Wai-Yin Yu ◽  
Ka-Foon Chau ◽  
Yiu-Wing Ho ◽  
Philip Kam-Tao Li
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Survival Rates ◽  
Chronic Hemodialysis ◽  
Dialysis Unit ◽  
Number Of Patients ◽  
Maintenance Dialysis ◽  
The 1960S ◽  
Stage Renal Disease ◽  
End Stage

Maintenance dialysis is an expensive treatment modality for patients with end-stage renal-disease (ESRD). The number of patients on maintenance dialysis is rising rapidly and will reach 2.5 million globally by 2010. The predicted expenditure will be US$1 trillion. Since the 1960s, Hong Kong has faced financial restraints on the provision of dialysis. Continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis at home were found to be less expensive than in-centre chronic hemodialysis. The development of a “peritoneal dialysis first” (PD-First) policy has contributed significantly to a successful dialysis program in Hong Kong since 1960. Currently in Hong Kong, 80% of ESRD patients on maintenance dialysis are on PD, mainly CAPD; 20% are on hemodialysis. The success of the PD-First policy is a combination of accumulated experience of PD in each dialysis unit that has at least 200 CAPD patients under care and of impressive technique and patient survival rates for this modality. Concerted effort by government and charity organizations and commitment on the part of nephrologists and nursing staff to patient education are also important in making the PD program in Hong Kong a successful one.

Arterial Calcifications in Patients Undergoing Chronic Peritoneal Dialysis: Incidence, Progression and Regression

1985 ◽  
Vol 5 (4) ◽  
pp. 241-245 ◽  
Author(s):  
H. Erik Meema ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Diabetes Mellitus ◽  
Renal Failure ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
Chronic Renal Failure ◽  
End Stage Renal Disease ◽  
Arterial Calcification ◽  
Chronic Peritoneal Dialysis ◽  
Stage Renal Disease ◽  
End Stage

The authors graded radiologically detectable arterial calcification (A.C.) in 168 patients with end-stage renal disease treated with peritoneal dialysis; 41 of them had diabetes mellitus (DM). Comparison of DM and nondiabetic (ND) patients showed that during an average dialysis period of more than two years, the incidence of A.C. increased from 37% before dialysis to 45% at the last examination in the ND patients, and from 90% to 100% in DM patients. Both prevalence and progression of A.C. were significantly higher in DM patients (P < 0.001 and <0.05 respectively). Regressions of A.C., unrelated to parathyroidectomy or renal transplantation, were observed in 5 ND and 4 DM patients. This 9% incidence of regressions should encourage further investigations to detect the factors responsible because severe A.C. sometimes is associated with gangrene and other complications. Although numerous publications on radiologic changes in renal osteodystrophy include descriptions of arterial calcifications (A. C.), only a few have focused on the latter (1–4). Furthermore, none have looked at the relative proportions of diabetic (DM) and non-diabetic (ND) patients with A.C. and chronic renal failure. The main purpose of this paper is to make such a comparison.

Various Obstacles to Peritoneal Dialysis Development in Japan: Too Much Money? Too Much Fear?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 56-58
Author(s):  
Yoshindo Kawaguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Kidney Transplant ◽  
End Stage Renal Disease ◽  
Penetration Rate ◽  
Dialysis Patients ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
Almost All ◽  
End Stage

At 31 December 2005, the number of patients on maintenance dialysis in Japan was 257,765, with 9599 patients having started dialysis that year. Kidney transplant cases in Japan number about 1000 annually. Thus, almost all end-stage renal disease patients in Japan are likely to live on dialysis for the remainder of their lives. For various reasons, peritoneal dialysis has a lower penetration rate among Japanese dialysis patients, and work to educate patients and nephrologists about PD needs to be done.

scholarly journals Opinion: Peritoneal Dialysis In Pakistan: An Insider’s View. State of Affairs and Planning?

2021 ◽  
Vol 4 (2) ◽  
Author(s):  
Ahad Qayyum
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Dialysis Patients ◽  
Number Of Patients ◽  
Maintenance Dialysis ◽  
State Of Affairs ◽  
Stage Renal Disease ◽  
End Stage ◽  
Chronic Ambulatory Peritoneal Dialysis

Pakistan has an estimated population of 212 million while the incidence of end stage renal disease in Pakistan is 100 patients per million; hence approximately 22,000 patients require maintenance dialysis to sustain life in our country. Remarkably peritoneal dialysis (PD) as a form of maintenance renal replacement is utilized in less than one per cent of these patients.  In the absence of a formal dialysis registry, we place the total number of chronic ambulatory peritoneal dialysis patients (CAPD) in Pakistan at approximately 76 excluding holiday patients who are visiting from abroad (*This figure was estimated by enquiring the total number of patients each PD units care in Pakistan. This figure was corroborated with the sole distributor of CAPD fluids in Pakistan.).

scholarly journals Association between bone mineral metabolism and vascular calcification in end-stage renal disease

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Louise Aaltonen ◽  
Niina Koivuviita ◽  
Marko Seppänen ◽  
Heikki Kröger ◽  
Xiaoyu Tong ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Bone Turnover ◽  
Vascular Calcification ◽  
End Stage Renal Disease ◽  
Mineral Metabolism ◽  
Arterial Calcification ◽  
Weak Association ◽  
Calcification Score ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Development of vascular calcification is accelerated in patients with end-stage renal disease. In addition to traditional risk factors of cardiovascular disease (CVD) abnormal bone and mineral metabolism together with many other factors contribute to the excess cardiovascular burden in patients on dialysis. Aortic calcification score and coronary calcification score are predictive of CVD and mortality. The aim of this study was to evaluate the possible relationship between arterial calcification and bone metabolism. Methods Thirty two patients on dialysis were included. All patients underwent a bone biopsy to assess bone histomorphometry and a 18F-NaF PET scan. Fluoride activity was measured in the lumbar spine (L1 – L4) and at the anterior iliac crest. Arterial calcification scores were assessed by computerized tomography for quantification of coronary artery calcification score and lateral lumbar radiography for aortic calcification score. Results This study group showed high prevalence of arterial calcification and 59% had verified CVD. Both CAC and AAC were significantly higher in patients with verified CVD. Only 22% had low turnover bone disease. There was a weak association between fluoride activity, which reflects bone turnover, measured in the lumbar spine, and CAC and between PTH and CAC. There was also a weak association between erosion surfaces and AAC. No significant association was found between calcification score and any other parameter measured. Conclusions The results in this study highlight the complexity, when evaluating the link between bone remodeling and vascular calcification in patients with multiple comorbidities and extensive atherosclerosis. Several studies suggest an impact of bone turnover on development of arterial calcification and there is some evidence of reduced progression of vascular calcification with improvement in bone status. The present study indicates an association between vascular calcification and bone turnover, even though many parameters of bone turnover failed to show significance. In the presence of multiple other factors contributing to the development of calcification, the impact of bone remodeling might be diminished. Trial registration The study is registered in ClinicalTrials.gov protocol registration and result system, ID is NCT02967042. Date of registration is 17/11/2016. 

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