Recovery of Renal Function and the Discontinuation of Dialysis in Patients Treated with Continuous Peritoneal Dialysis

Objective Previous studies have shown that patients with end-stage renal disease (ESRD) treated with continuous peritoneal dialysis (CPD) have better preservation of endogenous renal function than patients treated with hemodialysis (HD). We wondered if this better preservation of endogenous renal function seen with CPD patients translates into the improved likelihood of recovery of endogenous renal function in those patients with potentially reversible causes of renal failure. Methods To evaluate this question, we reviewed the records of all 1200 patients that completed CPD training at a large, freestanding peritoneal dialysis center in New Haven, Connecticut, between 1979 and 1999, and the records of all patients completing CPD training in New England between 1993 and 1998. In New Haven, about half the new patients with ESRD were started on CPD compared to only 15% in New England. We then compared the chances of recovery of renal function in these two cohorts of CPD patients to the chances of recovery of renal function in two groups of HD patients. The first group consisted of all patients that started on HD in New England between 1993 and 1998. The second group consisted of all patients that started HD in our HD unit in New Haven, Connecticut, between 1993 and 1999. The data on the New England patients were provided by the ESRD Network of New England. All patients entered into the present study had to have been on dialysis for a minimum of 3 months, as in the United States Renal Data System database, and had to have recovered sufficient renal function to be able to be maintained off dialysis for a minimum of 30 days. Results 29 of 1200 CPD patients (2.4%) trained in New Haven recovered sufficient renal function to permit the discontinuation of dialysis for a minimum of 30 days. In comparison, only 305 of 19 032 patients (1.6%) managed with HD in New England ( p < 0.05 compared to New Haven CPD patients) and 3 of 430 patients (0.7%) in our HD center ( p < 0.05 compared to New Haven CPD patients) recovered sufficient glomerular filtration rate (GFR) to allow the discontinuation of dialysis for at least 30 days. If only those CPD patients that initiated dialysis between 1993 and 1999 in New Haven were analyzed, 15 of 369 (4.1%) recovered sufficient GFR to allow discontinuation of dialysis for at least 30 days ( p < 0.025 compared to both groups of HD patients). Of the 2924 patients completing CPD training in New England, 60 (2.1%) recovered renal function; this percentage is not significantly different from the percent of HD patients in New England recovering renal function. Conclusion Although the present study is a retrospective study and the actual criteria for selection of CPD and HD therapy are not controlled for, the data raise the question of whether there may be a therapeutic advantage to treating newly diagnosed ESRD patients, that have a potentially reversible cause of renal failure, with CPD.

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Peritoneal Dialysis

10.2310/nephro.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

In peritoneal dialysis (PD), the peritoneum serves as a biological dialyzing membrane. The endothelium of the vast capillary network perfusing the peritoneum functions as a semipermeable membrane and allows bidirectional solute and water transfer between the intravascular space and dialysate fluid dwelling in the peritoneal cavity. PD is a renal replacement strategy for patients presenting with end-stage renal disease. It can also be offered for ultrafiltration in patients with diuretic-resistant fluid overload even in those without advanced renal failure. PD can also be used for patients with acute kidney injury, although in the developed world this occurs rarely compared to the use of extracorporeal therapies. This review contains 9 videos, 8 figures, 4 tables, and 73 references. Keywords: peritoneal dialysis, peritoneal cavity, catheter, dialysis fluid, ultrafiltration, tunnel infection, osmotic pressure, renal failure

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Dynamic changes in calcium and phosphate plasma concentrations in the patients on peritoneal dialysis

Vojnosanitetski pregled ◽

10.2298/vsp0601027j ◽

2006 ◽

Vol 63 (1) ◽

pp. 27-30

Author(s):

Natasa Jovanovic ◽

Mirjana Lausevic ◽

Biljana Stojimirovic

Keyword(s):

Vitamin D ◽

Renal Failure ◽

Peritoneal Dialysis ◽

End Stage Renal Disease ◽

Calcium Concentration ◽

Phosphate Binders ◽

Active Vitamin ◽

Active Vitamin D ◽

Stage Renal Disease ◽

End Stage

Background/Aim. The disturbances of active forms of vitamin D synthesis and disturbances in calcium and posphate metabolism develop early in chronic renal failure, when creatinine clearance is about 30 ml/min. Chronic hemodialysis and peritoneal dialysis only partially correct the biochemical environment of patients on chronic renal replacement therapy because of end-stage renal disease. These dialysis modalities can?t significantly affect the endocrine disturbances of chronic renal failure and they have minimal modulatory effect. The management of disturbed calcium (Ca) and phosphate (P) metabolism and the maintainance of Ca ? P product below 4.4 mmol/l thanks to the use of dialysate solutions with the appropriate calcium concentration and the careful dosage of phosphate binders, calcium and active vitamin D metabolits, are extremely important for the prevention of renal osteodystrophy, secondary hyperparathyroidism as well as low-bone turnover disease. The aim of the study was to analyze the plasma levels of calcium, phosphate, albumin, alkaline phosphatase and parathormon (PTH) in 58 patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) from March to August 2003. The use of phosphate binders and the substitution with active vitamin D metabolits were also analyzed. Methods. We examined 58 patients, 30 males and 28 female, mean-age 52 years (range, 26-78 years), affected by end-stage renal disease of the different leading cause. The average time on peritoneal dialysis program was 20 months (2-66 months). Most of the patients were treated by CAPD, while only few of them performed automatic, cyclic or intermittent peritoneal dialysis. Most of the patients used a dialysate with 1.75 mmol/l calcium concentration. Results. The study showed that our patients on chronic CAPD program during several months had normal calcemia, phosphatemia and the level of alkaline phosphatase, and that they had Ca ? P product in the recommended range. PTH serum level ranged from 16 to 490 pg/l in our patients. Conclusion. The study showed that a balanced diet and a correct dosage of phosphate binders, as well as a careful substitution with active vitamin D metabolits render a good control of calcium and phosphate serum balance, as well as an effective prevention of renal osteodystrophy development in the patients on chronic peritoneal dialysis treatment.

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Skin Examination: An Important Diagnostic Tool in Renal Failure Patients

Blood Purification ◽

10.1159/000485156 ◽

2018 ◽

Vol 45 (1-3) ◽

pp. 187-193 ◽

Cited By ~ 1

Author(s):

Karen M. Van de Velde-Kossmann

Keyword(s):

Renal Failure ◽

Renal Disease ◽

Genetic Disorders ◽

The United States ◽

Underlying Disease ◽

Careful Examination ◽

Common Skin ◽

Important Diagnostic Tool ◽

Stage Renal Disease ◽

End Stage

Renal failure is common in the United States with an estimated prevalence of 660,000 treated end-stage renal disease patients in 2015 [<xref ref-type="bibr" rid="ref1">1</xref>]. Causes of renal failure are many, and complications from renal failure, underlying disease, and treatment are not infrequent. Examples of common skin manifestations include xerosis, pigmentary change, and nail dystrophies. Frequent disease-specific skin changes may be helpful in the diagnosis of primary disorders leading to renal disease or severity of disease including bullosis diabeticorum, sclerodactyly, or leukoctoclastic vasculitis. Some cutaneous changes, such as the multiple angiokeratomas of Fabry disease or the plexiform neurofibromas of neurofibromatosis, are pathognomonic of genetic disorders, which often lead to renal failure. Careful examination of the skin can provide crucial clues to diagnosis of renal failure causation and aid in monitoring complications.

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Peritoneal Dialysis

10.2310/im.12057 ◽

2019 ◽

Author(s):

Karlien François ◽

Joanne M. Bargman

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Peritoneal Cavity ◽

Fluid Overload ◽

Kidney Injury ◽

Dialysis Fluid ◽

Keywords Peritoneal Dialysis ◽

Stage Renal Disease ◽

End Stage ◽

Developed World

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Acid–Base Disturbances

The Brigham Intensive Review of Internal Medicine ◽

10.1093/med/9780199358274.003.0059 ◽

2014 ◽

pp. 594-602

Author(s):

Julian L. Seifter

Keyword(s):

United States ◽

Cardiovascular Disease ◽

Peritoneal Dialysis ◽

Renal Transplantation ◽

End Stage Renal Disease ◽

The United States ◽

Cardiovascular Complications ◽

Diabetic Patients ◽

Stage Renal Disease ◽

End Stage

According to projections from the United States Renal Data Service (USRDS), 〉600,000 individuals in the United States will have end-stage renal disease (ESRD) by 2010. The leading cause of ESRD in the United State is diabetes, followed by hypertension. As the care of diabetic patients has improved, particularly in the area of cardiovascular disease, they are living through their cardiovascular complications long enough to develop ESRD. As a consequence, since the inception of the Medicare ESRD program. the dialysis population has gradually become older with increasing numbers of comorbid conditions. Renal replacement therapy in the form of hemodialysis or peritoneal dialysis may serve as a bridge to the best form of renal replacement, renal transplantation. The demand for suitable kidneys for transplantation far exceeds the supply, leaving many patients on dialysis for extended periods of time.

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

Peritoneal Dialysis International ◽

10.1177/0896860820914858 ◽

2020 ◽

pp. 089686082091485

Keyword(s):

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Renal Disease ◽

End Stage Renal Disease ◽

Residual Renal Function ◽

Stage Renal Disease ◽

End Stage

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

Peritoneal Dialysis International ◽

10.1177/0896860819893818 ◽

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.

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Endothelial Function in Pediatric Patients on Peritoneal Dialysis: The Need for Data

Peritoneal Dialysis International ◽

10.1177/089686080502503s33 ◽

2005 ◽

Vol 25 (3_suppl) ◽

pp. 127-129 ◽

Cited By ~ 1

Author(s):

Marc R. Lilien ◽

Cornelis H. Schröder ◽

Hein A. Koomans

Keyword(s):

Risk Factors ◽

Renal Failure ◽

Peritoneal Dialysis ◽

Endothelial Function ◽

Pediatric Patients ◽

Cardiovascular Complications ◽

Adult Patients ◽

Failure Data ◽

Stage Renal Disease ◽

End Stage

Cardiovascular complications are emerging as the primary cause of death for patients with childhood end-stage renal disease. Children with end-stage renal failure are subjected to many of the risk factors for cardiovascular disease identified in adult patients. Dysfunction of the endothelium is presently regarded as a first but reversible step in the development of atherosclerosis. Noninvasive techniques to assess endothelial function have been recently developed and have been proven to predict future mortality in adult patients. These techniques are readily applicable to pediatric patients. Endothelial dysfunction has been demonstrated in children in all stages of renal failure. Data on pediatric patients treated with peritoneal dialysis are currently lacking, however. Considering the abundance of cardiovascular risk factors specific to treatment with peritoneal dialysis, such studies should be initiated.

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Reactivation of Systemic Lupus in three Patients Undergoing CAPD

Peritoneal Dialysis International ◽

10.1177/089686088600600103 ◽

1986 ◽

Vol 6 (1) ◽

pp. 6-9 ◽

Cited By ~ 15

Author(s):

George G. Wu ◽

D.R. Gelbart ◽

James A. Hasbargen ◽

Robert Inman ◽

Peter McNamee ◽

...

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Immune System ◽

Chronic Renal Failure ◽

Lupus Nephritis ◽

End Stage Renal Disease ◽

Systemic Lupus ◽

Immunological Changes ◽

Stage Renal Disease ◽

End Stage

Generally patients with end-stage renal disease (ESRD) due to lupus nephritis, have minimal extrarenal disease activity <Juring hemodialysis. This may be related to immunological changes secondary to chronic renal failure or the dialysis procedure itself, or both. This paper describes three patients with lupus nephritis undergoing continuous ambulatory peritoneal dialysis (CAPD) in whom we observed reactivation of SLE, by both clinical and serological criteria. This may suggest that in patients undergoing CAPD the immune system is more nearly intact than in hemodialysis. These cases should heighten awareness that patients may suffer flare-ups of SLE during CAPD even long after the onset of renal failure.

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CDC Group EO-4 and Candida tropicalis Peritonitis in a Patient on Peritoneal Dialysis after Upper Endoscopy, Colonoscopy and Coil Embolization of the Gastroduodenal Artery

Case Reports in Gastroenterology ◽

10.1159/000452201 ◽

2016 ◽

Vol 10 (3) ◽

pp. 728-732 ◽

Cited By ~ 1

Author(s):

Shameek Gayen ◽

Yonah Ziemba ◽

Shikha Jaiswal ◽

Adam Frank ◽

Yasmin Brahmbhatt

Keyword(s):

United States ◽

Peritoneal Dialysis ◽

Coil Embolization ◽

The United States ◽

Annual Data ◽

Fungal Peritonitis ◽

First Case ◽

Ct Angiogram ◽

Stage Renal Disease ◽

End Stage

Peritoneal dialysis (PD) is an excellent form of renal replacement therapy for many patients with end-stage renal disease (ESRD). Over 10,000 patients receive PD in the United States [United States Renal Data System: 2015 USRDS Annual Data Report: Epidemiology of Kidney Disease in the United States, 2015]. PD has superior outcomes compared to hemodialysis in the first 2 years of ESRD [Sinnakirouchenan and Holley: Adv Chronic Kidney Dis 2011;18: 428–432]. However, peritonitis is a known complication and may result in significant morbidity and necessitate transition to hemodialysis, which increases medical costs [Holley and Piraino: Semin Dial 1990;3: 245–248]. We report the first case of a PD patient who underwent endoscopy, colonoscopy and CT angiogram with coil embolization for gastrointestinal bleeding without antibiotic prophylaxis and subsequently developed CDC group EO-4 organism and fungal peritonitis.

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