Serum Concentration of Indoxyl Sulfate in Peritoneal Dialysis Patients and Low-Flux Hemodialysis Patients

2019 ◽  
Vol 48 (2) ◽  
pp. 183-190 ◽  
Author(s):  
Ting Xie ◽  
Manchen Bao ◽  
Pan Zhang ◽  
Xiaoyan Jiao ◽  
Jianzhou Zou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Serum Level ◽  
Serum Concentration ◽  
High Performance ◽  
Residual Renal Function ◽  
Indoxyl Sulfate ◽  
Dialysis Modality ◽  
Cross Sectional ◽  
Dialysis Vintage

Background/Aims: To compare the serum concentration of Indoxyl sulfate (IS) in patients on continuous ambulatory peritoneal dialysis (CAPD) and low-flux hemodialysis (HD), and analyze the risk factors associated with IS. Methods: We performed a single-center, cross-sectional observational study including 169 patients on CAPD and 115 patients on low-flux HD. Patients were divided into the anuric HD group, anuric peritoneal dialysis (PD) group, and non-anuric PD group on the basis of dialysis modality and residual urinary output. Serum concentration of IS was determined by high-performance liquid chromatography electrospray tandem mass spectrometry. Results: After matching the urinary volume and dialysis vintage, 58 anuric patients on PD and 58 anuric patients on HD were enrolled. The serum level of IS was significantly lower in patients on PD than that in those on HD (28.05 ± 13.98 vs. 39.64 ± 18.25 μg/mL; p < 0.001). This result persisted even after adjustment for confounding risk factors including nutritional status (β = 0.338, p < 0.001). In addition, the serum level of IS was significantly lower in non-anuric PD patients than that anuric PD patients (18.70 ± 11.21 vs. 28.05 ± 13.98 μg/mL; p < 0.001). After the adjustment for risk factors such as dialysis vintage, IS serum concentration in patients on PD was still significantly correlated with residual renal function (RRF; β = –0.355, p < 0.001). Conclusions: Dialysis modality is the independent risk factor of IS serum concentration and it is substantially lower in patients on CAPD than that in those on low-flux HD. Additionally, RRF was independently associated with IS serum concentration in CAPD patients, and the better the RRF is, the lower IS serum concentration.

Clinical characteristics associated with the properties of gut microbiota in peritoneal dialysis patients

2020 ◽  
pp. 089686082097698
Author(s):  
Na Jiang ◽  
Chenhong Zhang ◽  
Hao Feng ◽  
Jiangzi Yuan ◽  
Li Ding ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Gut Microbiota ◽  
Clinical Characteristics ◽  
High Throughput Sequencing ◽  
Residual Renal Function ◽  
Microbial Composition ◽  
Cross Sectional ◽  
Dialysis Duration ◽  
Glucose Exposure

Background: Gut microbiota alters in patients with end-stage renal disease, which contributes to inflammation, atherosclerosis, and results in increased incidence of cardiovascular diseases. The present study investigated the potential clinical factors, which influence the gut microbial structure and function in patients undergoing peritoneal dialysis (PD). Methods: This is a cross-sectional study performed in 81 prevalent PD patients. Gut microbiota was assessed by high throughput sequencing of 16S ribosomal ribonucleic acid gene in fecal samples. Gas chromatography was conducted to measure stool short-chain fat acid (SCFA) concentrations. Demographic parameters and clinical characteristics, including dialysis regimen, residual renal function, nutrition, and inflammation, were retrieved and related to the properties of gut microbiota. Results: PD duration, peritoneal glucose exposure, and estimated glomerulus filtration rate (eGFR) were identified to be associated with microbial variations. Significant separation of microbial composition was shown between patients with short or long PD duration ( p = 0.015) and marginal differences were found between patients grouped by different levels of peritoneal glucose exposure ( p = 0.056) or residual renal function ( p = 0.063). A couple of gut bacteria showed different abundance at amplicon sequencing variant level between these patient groups ( p < 0.05). In addition, stool isobutyric and isovaleric acid concentrations were significantly reduced in patients with longer dialysis duration, higher peritoneal glucose exposure, or declined eGFR ( p < 0.05). Conclusions: This pilot study demonstrated that long dialysis duration, high peritoneal glucose exposure, and loss of residual renal function were associated with gut microbiota alteration and reduced branched-chain SCFA production in PD patients.

scholarly journals P1145ADEQUACY AND SURVIVAL IN PERITONEAL DIALYSIS: TEN YEARS EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vincenzo Terlizzi ◽  
Elena Pezzini ◽  
Roberta Cortinovis ◽  
Diana Bertoni ◽  
Alessandra Pola ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Protective Factor ◽  
Residual Renal Function ◽  
Dialysis Modality ◽  
Dialysis Adequacy ◽  
Dialysis Treatment ◽  
Increased Risk ◽  
Uremic Patients

Figure: Background and Aims in Italy only a minority of uremic patients perform peritoneal dialysis (PD). In dialysis centers where PD is practiced and proposed the prevalence is no more than 23%. Proposed advantages of PD over HD are a more preserved Residual renal function (RRF), that has been associated with better survival, and better Quality of life (Qol) due to possible more preservation of previous lifestyle, independence, possibility of traveling, and flexibility. Incremental peritoneal dialysis is a promising way to further improve Qol and to preserve RRF. Lastly, PD is less expensive than HD. Aim of this study has been to retrospectively evaluate our ten-years experience of PD treatment on survival, dialysis adequacy, preservation of RRF and nutrition in uremic patients followed at our Dialysis Center. Method We retrospectively evaluated all the incident patients that started PD treatment due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. The exclusion criteria were time of dialysis treatment less than 3 months and absence of previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded. Data on dialysis adequacy, nutrition, RRF and PD dialysis modality performed were also recorded. Results During the observation period 329 patients started PD. 60 were excluded due to follow-up of less than 3 months. Therefore, 269 patients (males 160, 59%) were studied. The average age was 65±16 years, BMI 24±4 kg/m2. Comorbidities were: hypertension (87%), diabetes mellitus (32%), cerebral vascular disease (26%) and ischemic heart disease (25%). The mean duration of dialysis treatment was 2.1±1.5 years. At the end of ten-years follow-up 24% of patients have had a kidney transplant, 18% were on PD treatment, 17% have had a shift towards HD, 39% had died. The main causes of death were: infection (39%) and cardiovascular disease (31%). The most common dialysis modality performed was APD (61%); CAPD was performed in 39% of pts. Dialysis modality (CAPD; APD), nutrition parameters (PNA; BMI), as well as RRF, expressed as an average value during follow-up, are shown in Figure 1. 81 patients (30%) were treated with incremental PD; 85% of them with manual exchanges. The comparison of dialysis parameters between incremental PD and standard PD are shown in Figure 2. Multivariate analysis with survival as dependent variable (Figure 3), showed that age, diabetes mellitus, and low wKt/V were independently associated with an increased risk of mortality. Diuresis volume and male gender were protective factors. No independent influence on mortality of the dialysis treatment modality was found. Conclusion In this ten-years experience of patients undergoing PD at our Center, incremental PD seems to be a protective factor for the maintenance of a preserved diuresis and better dialysis adequacy, and these factors are associated with better survival of the patients.

Clinical Utility of Potassium-Sparing Diuretics to Maintain Normal Serum Potassium in Peritoneal Dialysis Patients

2017 ◽  
Vol 37 (1) ◽  
pp. 63-69 ◽  
Author(s):  
Tibor Fülöp ◽  
Lajos Zsom ◽  
Betzaida Rodríguez ◽  
Sabahat Afshan ◽  
Jamie V. Davidson ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Potassium ◽  
Residual Renal Function ◽  
Normal Serum ◽  
Dialysis Adequacy ◽  
Cross Sectional ◽  
Laboratory Variables ◽  
Stage Renal Disease ◽  
End Stage ◽  
Vexing Problem

BackgroundHypokalemia is a vexing problem in end-stage renal disease patients on peritoneal dialysis (PD), and oral potassium supplements (OPS) have limited palatability. Potassium-sparing diuretics (KSD) (spironolactone, amiloride) may be effective in these patients.MethodsWe performed a cross-sectional review of 75 current or past (vintage > 6 months) PD patients with regard to serum potassium (K+), OPS, and KSD utilization. We reviewed charts for multiple clinical and laboratory variables, including dialysis adequacy, residual renal function, nutritional status and co-existing medical therapy.ResultsThe cohort was middle-aged with a mean age of 49.2 years (standard deviation [SD] = 14.7) and overweight with a body mass index of 29.5 (6.7) kg/m2. Of all the participants, 57.3% were female, 73.3% African-American, and 48% diabetic with an overall PD vintage of 28.2 (24.3) months at the time of enrollment. Weekly Kt/V was 2.12 (0.43), creatinine clearance was 73.5 (33.6) L/week/1.73 m2with total daily exchange volume of 10.8 (2.7) L. Residual urine output (RUO) measured at 440 (494) mL (anuric 30.6%). Three-month averaged serum K+measured at 4 (0.5) mmol/L with 36% of the participants receiving K+supplements (median: 20 [0;20] mmol/day) and 41.3% KSD (spironolactone dose: 25 – 200 mg/day; amiloride dose: 5 – 10 mg/day). Serum K+correlated positively with weekly Kt/V (r = 0.239; p = 0.039), PD vintage (r = 0.272; p = 0.018) but not with PD modality, daily exchange volume, RUO, or KSD use. However, KSD use was associated with decreased use of OPS (r = -0.646; p < 0.0001).ConclusionsPotassium-sparing diuretics were effective in this cohort of PD patients and decreased the need for OPS utilization.

scholarly journals SP494CORRELATION OF RESIDUAL RENAL FUNCTION WITH CARDIOVASCULAR RISK FACTORS IN PERITONEAL DIALYSIS PATIENTS: A MULTICENTRE STUDY

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii542-iii542
Author(s):  
Nikolina Basic-Jukic ◽  
Josipa Radic ◽  
Bozidar Vujicic ◽  
Zeljka Grdan ◽  
Marko Jakic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Cardiovascular Risk ◽  
Multicentre Study ◽  
Cardiovascular Risk Factors ◽  
Residual Renal Function ◽  
Dialysis Patients

Risk factors for loss of residual renal function in children with end-stage renal disease undergoing automatic peritoneal dialysis

2020 ◽  
Vol 40 (4) ◽  
pp. 368-376
Author(s):  
Qian Shen ◽  
XiaoYan Fang ◽  
YiHui Zhai ◽  
Jia Rao ◽  
Jing Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Daily Urine ◽  
Glucose Exposure ◽  
Stage Renal Disease ◽  
End Stage

Background: This study analysed children with end-stage renal disease treated with automated peritoneal dialysis (APD) in our centre to explore the risk factors associated with residual renal function (RRF) loss. Methods: Children treated with APD as the initial renal replacement therapy regimen from January 2008 to December 2016 were included. All the children had a daily urine volume of ≥100 ml/m2 when APD was initiated and a dialysis follow-up time of ≥12 months. A daily urine volume of <100 ml/m2 after 12 months of APD treatment was defined as loss of RRF. Possible risk factors that may be associated with RRF loss were analysed. Results: A total of 66 children were included in the study. After 12 months of APD treatment, the daily urine volume decreased by 377.45 ± 348.80 ml/m2, the residual glomerular filtration rate decreased by 6.39 ± 3.69 ml/min/1.73 m2 and 29 of the patients (43.9%) developed RRF loss. The higher risk of RRF loss after 1 year of APD treatment was most pronounced in patients with daily urine volume of ≤400 ml/m2 before treatment, higher glucose exposure and higher ultrafiltration volume, while the lower risk of RRF loss was in patients with administration of diuretics. Each increase of 1 g/m2/day glucose exposure was associated with a 5% increase in RRF loss (odds ratio (OR) 1.05, p = 0.023) and each increase of 1 ml/m2/day ultrafiltration volume was associated with a 1% increase in RRF loss (OR 1.01, p = 0.013). Conclusion: In children undergoing APD, the risk for loss of RRF is associated with low urine volume at the start of APD, high glucose loading and high peritoneal ultrafiltration volume, while preservation of RRF is associated with the usage of diuretics.

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

Rate of Decline of Residual Renal Function in Patients on Continuous Peritoneal Dialysis and Factors Affecting It

2000 ◽  
Vol 20 (4) ◽  
pp. 429-438 ◽  
Author(s):  
Manoj K. Singhal ◽  
Shaunmukhum Bhaskaran ◽  
Edward Vidgen ◽  
Joanne M. Bargman ◽  
Stephen I. Vas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Outcome Measure ◽  
Residual Renal Function ◽  
Left Ventricular ◽  
Male Gender

Objective We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. Study Design Single-center, prospective cohort study. Setting Home PD unit of a tertiary care University Hospital. Patients The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. Measurement All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. Outcome Measure The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. Results There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate ( p = 0.0001), higher rate of peritonitis ( p = 0.0005), higher use of AG ( p = 0.0006), presence of diabetes mellitus ( p = 0.005), larger body mass index (BMI) ( p = 0.01), and no use of antihypertensive medications ( p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. Conclusion Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.

Effect of Dialysis Modality and Membrane Transport Characteristics on Dialysate Protein Losses of Patients on Peritoneal Dialysis

1997 ◽  
Vol 17 (5) ◽  
pp. 449-454 ◽  
Author(s):  
Pranay Kathuria ◽  
Harold L. Moore ◽  
Ramesh Khanna ◽  
Zbylut J. Twardowski ◽  
Sharad Goel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Membrane Transport ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Cross Sectional Study ◽  
Dialysis Modality ◽  
Test Results ◽  
Sectional Study ◽  
Peritoneal Equilibration Test ◽  
Cross Sectional ◽  
Individual Preferences

Objective To determine if peritoneal dialysis modality has an impact on protein losses in dialysate. Design Retrospective, cross-sectional study. Patients 190 patients who had selected peritoneal dialysis were classified into one of four transport categories (high, high-average, low-average, or low) based on standard peritoneal equilibration test results. Patients were then assigned to continuous ambulatory peritoneal dialysis (CAPD) or nightly intermittent peritoneal dialysis (NIPD) based on membrane transport characteristics and individual preferences. Results Patients with similar membrane transport characteristics had essentially no differences in dialysate protein and albumin losses whether treated with CAPD or NIPD. Conclusions Although high transporters may be better managed with short -dwell therapies such as nocturnal intermittent peritoneal dialysis or daily ambulatory peritoneal dialysis, consistent marked decreases in protein losses cannot be cited as a benefit of NIPD over CAPD.

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