Abstract P151: Cardiovascular Effects Of Peritoneal Dialysis In The 5/6 Nephrectomy Rat Model

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Victoria Nasci ◽  
Alison J Kriegel
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Statistical Significance ◽  
Cardiovascular Effects ◽  
Heart Weight ◽  
Sprague Dawley ◽  
Home Dialysis ◽  
Post Surgery ◽  
Stage Renal Disease ◽  
End Stage

In the US more than 130,000 people are diagnosed with end stage renal disease (ESRD) each year. Of those only 3% receive a kidney transplant while the remaining 97% are reliant on dialysis for survival. Among dialysis patients, cardiovascular (CV) related events are the leading cause of death. Despite therapeutic advancements the continued CVD following the onset of dialysis poses an interesting clinical challenge that necessitates studies into the effects and effectiveness of dialysis. Furthermore, home dialysis, particularly peritoneal dialysis (PD), has been utilized increasingly in ESRD care (up 10% in 2018) thus the need to understand PD effects on the CV system is urgent. Based on clinical outcomes, we hypothesized that PD would have no effect on CV outcomes in chronic kidney disease (CKD). To study CKD, we performed 5/6 nephrectomy (5/6Nx) or sham surgery, on 10 week old male Sprague-Dawley rats. Peritoneal catheters were then implanted 6 weeks post-surgery and PD was initiated 2 days later in some of the 5/6Nx and sham animals (15ml [Baxter PD-2 2.5%] 1-hour dwell 3x/day for 9 days). Echocardiography was performed at baseline, 6-, and 7-weeks post-surgery. At week 7 pressure volume analysis was performed prior to serum and tissue collection. Statistical significance was determined by two-way ANOVA. 5/6Nx increased heart weight (5/6Nx 0.43±0.02 vs. Sham 0.34±0.01; p<0.05). PD had no effect on heart weight in sham rats, but attenuated the increase in 5/6Nx rats (5/6Nx 0.43±0.02 vs. 5/6Nx PD 0.40±0.01; p<0.05). 5/6Nx increased systolic blood pressure (5/6Nx 133.6±5.6 vs. Sham 111.1±5.9; p<0.05). PD had no effect on blood pressure in either sham or 5/6Nx rats. 5/6Nx increased cholesterol (5/6Nx 134.9±8.3 vs. Sham 104.3±11; p<0.05), but PD attenuated the rise in cholesterol in 5/6Nx rats (5/6Nx 134.9±8.3 vs. 5/6Nx PD 115.7±9; p<0.05), and greatly increased triglycerides (5/6Nx 65.6±11 vs. 5/6Nx PD 165.5±11.9; p<0.05). CV echocardiography parameters in sham animals and in 5/6Nx were unchanged by PD. These data combined suggests that PD may have little to no effects on some CV parameters while worsening others. These findings indicate more studies focused on the CV effects of dialysis are necessary to help improve outcomes in the ESRD population.

The Use of Community Nurses for Home Peritoneal Dialysis: Is it Cost -Effective?

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 479-482 ◽  
Author(s):  
Gillian Brunier ◽  
Barbara Gray ◽  
Nancy Coulis ◽  
Judy Savage ◽  
Arif Manuel ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Members ◽  
Cost Effective ◽  
Peritoneal Dialysis Patient ◽  
Severe Disabilities ◽  
Dialysis Patients ◽  
Home Dialysis ◽  
Complex Needs ◽  
Stage Renal Disease ◽  
End Stage

In the late 1970s, continuous ambulatory peritoneal dialysis was first introduced as a mode of treatment for patients with end-stage renal disease. Since that time many patients, themselves or with the help of family members, have routinely performed the therapy at home. There are now 2935 home peritoneal dialysis patients in Canada (36% of the total dialysis population}. Today, however, the average patient on dialysis is likely to be older and have other complicating illnesses; moreover, patients may live alone, or have family members who are working. Over the past three years, through the use of innovative assistive devices and strong educational links with community nursing agencies, we have been able to manage peritoneal dialysis patients with complex needs in the home. We performed a retrospective analysis of 18 patients, with severe comorbid conditions, who were managed in the home with the help of community nurses. We will show that this is an economic, efficient, and effective method of caring for home dialysis patients with severe disabilities. Home care agencies need our support so that they can continue to help us manage the complex peritoneal dialysis patient in the 1990s.

scholarly journals P1159MILD BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH BETTER SURVIVAL IN PATIENTS WITH END STAGE RENAL DISEASE AND PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hanri Afghahi ◽  
Salmir Nasic ◽  
Khaled Alhomsi ◽  
Henrik Hadimeri ◽  
Helena Rydell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Mortality Risk ◽  
End Stage Renal Disease ◽  
Laboratory Findings ◽  
Risk Of Mortality ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Recently, variability in blood pressure (BP) has been recognized as a risk factor for mortality and cardiovascular events in the general population. However, most studies included patients with normal or near normal kidney function. Aim To study the association between BP variability and the risk of all-cause mortality in patients with end stage renal disease (ESRD) and peritoneal dialysis (PD) treatment. Method From 2008 until the end of 2017, 2329 patients with ESRD and at least three months of PD (mean age: 63.8 years, men: 67.5%) were followed for 16 months in median (interquartile range: 11-28 months). Data were extracted from the Swedish Renal Register (SNR). The coefficient variation (CV = the ratio of the standard deviation (SD) to the mean value) was defined as BP variability in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) [SBP(SD)/SBP(mean), DBP(SD)/ DBP(mean), and MAP(SD)/MAP(mean), respectively]. The relationships between BP variability and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidity. Results During the follow-up period, 1054 (45%) deaths occurred. The mean level of BP variability was CV=0.10± 0.1. The highest rate of mortality was observed in the patients with the highest variability in SBP (CV&gt;0.25; 64% of those patients died). In the multivariate model, for each of the BP variables, we compared the risk of mortality in the lowest variability group (CV≤ 0.05) with that in the CV=0.10-0.15 group (reference): SBP: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p&lt;0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p&lt;0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk. We then compared the highest variability group (CV&gt;0.25) with the CV=0.10-0.15 group (reference): SBP: (HR 1.60, 95% CI 1.14- 2.25; p&lt;0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p&lt;0.001). Thus, for all BP variables, the highest variability was related to increased mortality risk. Conclusion In this study, the association between BP variability and the risk of mortality was U-shaped in patients with ESRD and PD. Thus, both very low and high levels of BP variability were related to higher risk of mortality. Mild BP variability was associated with the lowest risk of mortality, which could suggest that, non-intensive and long duration of ultrafiltration (UF) with PD was probably beneficial in terms of survival

Intermittent Peritoneal Dialysis in the Treatment of Diabetics with End-stage Renal Disease

1981 ◽  
Vol 2 (1_suppl) ◽  
pp. 15-16
Author(s):  
Stavros Karanicolas ◽  
Douglas Thompson
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Patient Survival ◽  
Subcutaneous Insulin ◽  
Hospital Patients ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

Intermittent peritoneal dialysis (IPD) in diabetics has varied outcomes. Sixteen patients with end-stage renal disease and diabetes were treated with IPD during the last four years at St. Joseph's Hospital. Patients received subcutaneous insulin besides small amounts intraperitoneally on the days of dialysis. One-year patient survival was 48%. Blood pressure, serum potassium, fluid and blood sugar control was poor compared to CAPD. However, for patients who can not be placed on CAPD, IPD still has its role. For this reason we should continue our efforts to improve the effectiveness of this mode of peritoneal dialysis.

scholarly journals Underutilization of Home Dialysis in the United States: missed opportunities for quality improvement.

2018 ◽  
Vol 1 (2) ◽  
pp. 59-64
Author(s):  
Vo D Nguyen
Keyword(s):  
United States ◽  
Peritoneal Dialysis ◽  
National Policy ◽  
The United States ◽  
Data System ◽  
Missed Opportunities ◽  
Home Dialysis ◽  
The Us ◽  
Stage Renal Disease ◽  
End Stage

Peritoneal dialysis may offer many potential advantages over in-center hemodialysis: lower cost, better quality of care and lower mortality. However, the United States Renal Data System (USRDS) which is a national data system that collects, analyzes, and distributes information about chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the United States, indicates that the incidence and prevalence of home dialysis remains under-utilized compared with in-center hemodialysis. Future changes in national policy on dialysis may bring about an increase in home dialysis and potentially improve the care and cost in dialysis. This paper is mostly based on the 2017 USRDS Annual Report and centered on the potential missed opportunity caused by the underuse of peritoneal dialysis in the US.

scholarly journals A Qualitative Assessment of Mismatch between Dialysis Modality Selection and Initiation

2016 ◽  
Vol 36 (4) ◽  
pp. 463-466 ◽  
Author(s):  
Susan Ziolkowski ◽  
Scott Liebman
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Replacement Therapy ◽  
Renal Disease ◽  
Replacement Therapy ◽  
End Stage Renal Disease ◽  
Qualitative Assessment ◽  
Dialysis Modality ◽  
Home Dialysis ◽  
Stage Renal Disease ◽  
End Stage

At our institution, we have noted that end-stage renal disease patients choosing a home dialysis modality after education often initiate renal replacement therapy with in-center hemodialysis (HD) instead. We interviewed 24 such patients (23 choosing peritoneal dialysis [PD], one choosing home HD) to determine reasons for this mismatch. The most common reasons cited for not starting home dialysis were: lack of confidence/concerns about complications, lack of space or home-related issues, a feeling of insufficient education, and perceived medical or social contraindications. We propose several potential strategies to help patients start with their preferred modality.

Iron Chelation Therapy in CAPD: A New and Effective Treatment of Iron Overload Disease in Esrd Patients

1983 ◽  
Vol 3 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Glen H Stanbaugh ◽  
A. W, Holmes Diane Gillit ◽  
George W. Reichel ◽  
Mark Stranz
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Overload ◽  
End Stage Renal Disease ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Peritoneal Dialysate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

A patient with end-stage renal disease on CAPD, and with massive iron overload is reported. This patient had evidence of myocardial and hepatic damage probably as a result of iron overload. Treatment with desferoxamine resulted in removal of iron in the peritoneal dialysate. On the basis of preliminary studies in this patient it would appear that removal of iron by peritoneal dialysis in conjunction with chelation therapy is safe and effective. This finding should have wide-ranging signficance for patients with ESRD.

scholarly journals Delayed bowel perforation after instilling over warmed peritoneal dialysate

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueli Lai ◽  
Mingming Nie ◽  
Xiaodong Xu ◽  
Yuanjie Chen ◽  
Zhiyong Guo
Keyword(s):  
Peritoneal Dialysis ◽  
Bowel Perforation ◽  
Exploratory Laparotomy ◽  
Peritoneal Dialysis Patient ◽  
Case Presentation ◽  
Abdominal Organs ◽  
Home Based ◽  
Dialysis Solution ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

Outcomes of infants <28 days old treated with peritoneal dialysis for end-stage renal disease

2009 ◽  
Vol 24 (10) ◽  
pp. 2035-2039 ◽  
Author(s):  
Michelle N. Rheault ◽  
Jurat Rajpal ◽  
Blanche Chavers ◽  
Thomas E. Nevins
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage
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