scholarly journals Sodium loss, extracellular volume overload and hypertension in peritoneal dialysis patients treated by automated peritoneal dialysis cyclers

2019 ◽  
Vol 43 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Ahmed Mohamed ◽  
Andrew Davenport
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Urine Output ◽  
Extracellular Water ◽  
Dialysis Patients ◽  
Protein Nitrogen ◽  
Co Morbidity ◽  
Sodium Loss

Introduction: Achieving sodium balance is important for peritoneal dialysis patients, as sodium excess may lead to hypertension and extracellular water expansion. We wished to determine whether greater sodium removal had adverse consequences. Methods: We calculated 24-h urinary and peritoneal sodium losses in peritoneal dialysis patients treated by automated cyclers, when attending for peritoneal membrane and bioimpedance assessments. Results: We reviewed 439 peritoneal dialysis patients, 56.7% male, average age 54.6 years, median sodium loss 110 (68–155) mmol/day. Sodium loss was strongly associated with urine volume, r = 0.37, protein nitrogen appearance rate, r = 0.29, and body cell mass, r = 0.21, all p < 0.001. We found no association with blood pressure or anti-hypertensive medication prescription, or extracellular water. On multivariable logistic regression analysis, sodium loss was associated with greater urine output, odds ratio 1.001, 95% confidence interval 1.00–1.001, p < 0.001, and protein nitrogen appearance (odds ratio 1.023, confidence interval 1.006–1.04), p = 0.008. Adjusting for body weight, sodium loss was associated with urine output (odds ratio 1.001, confidence interval 1.001–1.002, p < 0.001), and negatively with body fat index (odds ratio 0.96, confidence interval 0.93–0.99, p = 0.008) and co-morbidity grade (odds ratio 0.58, confidence interval 0.36–0.39, p = 0.023). Conclusion: Heavier peritoneal dialysis patients with greater estimated dietary protein intake (protein nitrogen appearance), those with greater residual renal function and peritoneal clearances, along with lower co-morbidity, had greater daily sodium losses. Adjusting for body weight, then sodium losses were greater with higher daily urine output, and lower in patients with proportionately more body fat and co-morbidity. Sodium losses would appear to primarily determined by body size and not associated with hypertension or extracellular water expansion.

scholarly journals EXPERIMENTAL DEHYDRATION: CHEMICAL CHANGES IN THE BLOOD OF THE DOG CONTRASTED WITH THOSE FOLLOWING OBSTRUCTION OF THE CARDIAC END OF THE STOMACH

1929 ◽  
Vol 49 (6) ◽  
pp. 945-953 ◽  
Author(s):  
Russell L. Haden ◽  
Thomas G. Orr
Keyword(s):  
Body Weight ◽  
Total Protein ◽  
Urine Output ◽  
Average Duration ◽  
Chemical Study ◽  
Protein Nitrogen ◽  
Chemical Changes ◽  
Urea Nitrogen

A comparative chemical study of the blood and the urine of the dog with experimental dehydration and with obstruction of the cardiac end of the stomach is reported. The average duration of life is slightly longer with dehydration than with obstruction. The urine output per kilo of body weight is almost twice as great in dehydration as with obstruction. The increase in non-protein nitrogen and urea nitrogen is much the same in the two groups although somewhat more marked with obstruction. The chlorides of the blood are markedly increased with dehydration and slightly decreased with obstruction. The increase in fibrinogen and total protein is twice as great with obstruction as with dehydration. These findings indicate that there must be some factor or factors in addition to dehydration producing the toxemia of cardiac obstruction.

Impact of remote biometric monitoring on cost and hospitalization outcomes in peritoneal dialysis

2018 ◽  
Vol 25 (10) ◽  
pp. 581-586 ◽  
Author(s):  
Susie Q Lew ◽  
Neal Sikka ◽  
Clinton Thompson ◽  
Manya Magnus
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Hospital Length ◽  
Cost Of Care ◽  
Hospital Length Of Stay ◽  
Inpatient Setting ◽  
Post Intervention

IntroductionPeritoneal dialysis is a home-based therapy for individuals with end-stage renal disease. Telehealth, and in particular – remote monitoring, is making inroads in managing this cohort.MethodsWe examined whether daily remote biometric monitoring (RBM) of blood pressure and weight among peritoneal dialysis patients was associated with changes in hospitalization rate and hospital length of stay, as well as outpatient, inpatient and overall cost of care.ResultsOutpatient visit claim payment amounts (in US dollars derived from CMS data) decreased post-intervention relative to pre-intervention for those at age 18-54 years. For certain subgroups, non- or nearly-significant changes were found among female and Black participants. There was no change in inpatient costs post-intervention relative to pre-intervention for females and while the overall visit claim payment amounts increased in the outpatient setting slightly (US$511.41 (1990.30) vs. US$652.61 (2319.02), p = 0.0783) and decreased in the inpatient setting (US$10,835.30 (6488.66) vs. US$10,678.88 (15,308.17), p = 0.4588), these differences were not statistically significant. Overall cost was lower if RBM was used for assessment of blood pressure and/or weight (US$–734.51, p < 0.05). Use of RBM collected weight was associated with fewer hospitalizations (adjusted odds ratio 0.54, 95% confidence interval 0.33–0.89) and fewer days hospitalized (adjusted odds ratio 0.46, 95% confidence interval 0.26–0.81). Use of RBM collected blood pressure was associated with increased days of hospitalization and increased odds of hospitalization.ConclusionsRBM offers a powerful opportunity to provide care to those receiving home therapies such as peritoneal dialysis. RBM may be associated with reduction in both inpatient and outpatient costs for specific sub-groups receiving peritoneal dialysis.

scholarly journals P1161CUTANEOUS MICROCIRCULATORY DYSFUNCTION IN PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Jennifer Williams ◽  
Mark Gilchrist ◽  
Donald Fraser ◽  
David Strain ◽  
Angela Shore
Keyword(s):  
Peritoneal Dialysis ◽  
Statistical Significance ◽  
Microvascular Function ◽  
Healthy Controls ◽  
Dialysis Patients ◽  
Skin Microcirculation ◽  
Doppler Flowmetry ◽  
Microvascular Reactivity ◽  
Co Morbidity ◽  
Forearm Skin

Abstract Background and Aims Microvascular impairment is an early step in cardiovascular disease (CVD), the major cause of morbidity and mortality in patients with CKD. Changes in skin microvascular reactivity have been shown to reflect more widespread changes in the systemic and coronary microcirculation. Microvascular function is attenuated by advancing age and conditions that commonly coexist with CKD such as diabetes and hypertension. We investigated whether skin microvascular reactivity is impaired in peritoneal dialysis (PD) patients compared with healthy controls and whether this impairment is independent of comorbidity. Method Forearm skin vasculature was examined in 27 healthy controls, 27 patients on PD and 27 controls matched to the PD patients for age, gender, diabetes and previous CV events. Microvascular function was assessed using laser Doppler flowmetry in combination with post-occlusive reactive hyperaemia (a test of generalised microvascular function) and iontophoretic application of acetylcholine (ACh) and sodium nitroprusside (SNP) to investigate endothelium dependant and non-endothelium dependant vasodilation respectively. Results Peak post-occlusive flow was lower in the PD patients than in both the healthy controls and the co-morbidity matched group; 90.45 AU (60.9-128.35) in healthy controls, 73AU (58.8-134.4) in matched controls and 56.95AU (45.1-89.8) in PD patients (p=0.0239 healthy controls versus patients, p=0.0373 matched controls versus patients). SNP-mediated vasodilatation was statistically lower in the PD group compared with healthy controls (p= 0.016), ACh response was lower but did not reach statistical significance (p= 0.076). ACh and SNP-mediated vasodilatation trended towards being lower in PD patients than matched controls but did not reach statistical significance. Conclusion The PD patients were characterised by a generalised dysfunction of the skin microcirculation compared with healthy controls and controls matched for factors known to affect the microcirculation. This appears to be the result of impaired endothelium dependant and independent vasodilatory mechanisms.

scholarly journals Thrombolysis related symptomatic intracranial hemorrhage in estimated versus measured body weight

2019 ◽  
Vol 15 (2) ◽  
pp. 159-166
Author(s):  
T Truc My Nguyen ◽  
Stephanie IW van de Stadt ◽  
Adrien E Groot ◽  
Marieke JH Wermer ◽  
Heleen M den Hertog ◽  
...  
Keyword(s):  
Body Weight ◽  
Clinical Outcome ◽  
Confidence Interval ◽  
Intracranial Hemorrhage ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Weight Group ◽  
Tissue Plasminogen ◽  
Symptomatic Intracranial Hemorrhage

Background and aim In acute ischemic stroke, under- or overestimation of body weight can lead to dosing errors of recombinant tissue plasminogen activator with consequent reduced efficacy or increased risk of hemorrhagic complications. Measurement of body weight is more accurate than estimation of body weight but potentially leads to longer door-to-needle times. Our aim was to assess if weight modality (estimation of body weight versus measurement of body weight) is associated with (i) symptomatic intracranial hemorrhage rate, (ii) clinical outcome, and (iii) door-to-needle times. Methods Consecutive patients treated with intravenous thrombolysis between 2009 and 2016 from 14 hospitals were included. Baseline characteristics and outcome parameters were retrieved from medical records. We defined symptomatic intracranial hemorrhage according to the European Cooperative Acute Stroke Study (ECASS)-III definition and clinical outcome was assessed with the modified Rankin Scale. The association of weight modality and outcome parameters was estimated with regression analyses. Results A total of 4801 patients were included. Five hospitals used measurement of body weight (n = 1753), six hospitals used estimation of body weight (n = 2325), and three hospitals (n = 723) changed from estimation of body weight to measurement of body weight during the study period. In 2048 of the patients (43%), measurement of body weight was used and in 2753 (57%), estimation of body weight. In the measurement of body weight group, an inbuilt weighing bed was used in 1094 patients (53%) and a patient lift scale in 954 patients (47%). In the estimation of body weight group, policy regarding estimation was similar. Estimation of body weight was not associated with increased symptomatic intracranial hemorrhage risk (adjusted odds ratio = 1.16; 95% confidence interval 0.83–1.62) or favorable outcome (adjusted odds ratio = 0.99; 95% confidence interval 0.82–1.21), but it was significantly associated with longer door-to-needle times compared to measurement of body weight using an inbuilt weighing bed (adjusted B = 3.57; 95% confidence interval 1.33–5.80) and shorter door-to-needle times compared to measurement of body weight using a patient lift scale (−3.96; 95% confidence interval −6.38 to −1.53). Conclusion We did not find evidence that weight modality (estimation of body weight versus measurement of body weight) to determine recombinant tissue plasminogen activator dose in intravenous thrombolysis eligible patients is associated with symptomatic intracranial hemorrhage or clinical outcome. We did find that estimation of body weight leads to longer door-to-needle times compared to measurement of body weight using an inbuilt weighing bed and to shorter door-to-needle times compared to measurement of body weight using a patient lift scale.

scholarly journals Association of the Hemoglobin to Serum Creatinine Ratio with In-Hospital Adverse Outcomes after Percutaneous Coronary Intervention among Non-Dialysis Patients: Insights from a Japanese Nationwide Registry (J-PCI Registry)

2020 ◽  
Vol 9 (11) ◽  
pp. 3612
Author(s):  
Yohei Numasawa ◽  
Taku Inohara ◽  
Hideki Ishii ◽  
Kyohei Yamaji ◽  
Shun Kohsaka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Bleeding Complications ◽  
Dialysis Patients ◽  
Nationwide Registry ◽  
Percutaneous Coronary

Although baseline hemoglobin and renal function are both important predictors of adverse outcomes after percutaneous coronary intervention (PCI), scarce data exist regarding the combined impact of these factors on outcomes. We sought to investigate the impact and threshold value of the hemoglobin to creatinine (Hgb/Cr) ratio, on in-hospital adverse outcomes among non-dialysis patients in a Japanese nationwide registry. We analyzed 157,978 non-dialysis patients who underwent PCI in 884 Japanese medical institutions in 2017. We studied differences in baseline characteristics and in-hospital clinical outcomes among four groups according to their quartiles of the Hgb/Cr ratios. Compared with patients with higher Hgb/Cr ratios, patients with lower ratios were older and had more comorbidities and complex coronary artery disease. Patients with lower hemoglobin and higher creatinine levels had a higher rate of in-hospital adverse outcomes including in-hospital mortality and procedural complications (defined as occurrence of cardiac tamponade, cardiogenic shock after PCI, emergency operation, or bleeding complications that required blood transfusion). On multivariate analyses, Hgb/Cr ratio was inversely associated with in-hospital mortality (odds ratio: 0.91, 95% confidence interval: 0.89–0.92; p < 0.001) and bleeding complications (odds ratio: 0.92, 95% confidence interval: 0.90–0.94; p < 0.001). Spline curve analysis demonstrated that these risks started to increase when the Hgb/Cr ratio was <15, and elevated exponentially when the ratio was <10. Hgb/Cr ratio is a simple index among non-dialysis patients and is inversely associated with in-hospital mortality and bleeding complications after PCI.

Sign in / Sign up

Export Citation Format

Share Document