Treatment Targets for Diabetic Patients on Peritoneal Dialysis: Any Evidence?

2007 ◽  
Vol 27 (2_suppl) ◽  
pp. 176-179 ◽  
Author(s):  
Chiu-Ching Huang
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Clinical Outcome ◽  
Small Molecules ◽  
Residual Renal Function ◽  
Diabetic Patients ◽  
Peritoneal Membrane ◽  
Comorbid Conditions ◽  
Dialysis Solutions

Diabetic patients are often affected by comorbid conditions that influence clinical outcome. Taking care of diabetic peritoneal dialysis (PD) patients is a challenge for nephrologists, not only because these patients have more complications and comorbidities, but also because of their difficulties in maintaining glycemic control with the use of current glucose-containing dialysis solutions. In addition, the increased transport of small molecules and proteins by the peritoneal membrane in diabetic patients adds the further problems of ultrafiltration deficit and malnutrition. The present article reviews pertinent evidence toward establishing the best strategy for the care of diabetic PD patients. With better glycemic control, improved nutrition, improved fluid balance, and optimal preservation of residual renal function, there is hope for improving the survival of diabetic PD patients.

Loss of Residual Renal Function was Not Associated with Glycemic Control in Patients on Peritoneal Dialysis

2011 ◽  
Vol 31 (2) ◽  
pp. 154-159 ◽  
Author(s):  
Su-Ah Sung ◽  
Young-Hwan Hwang ◽  
Sejoong Kim ◽  
Sung Gyun Kim ◽  
Jieun Oh ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Glycemic Control ◽  
Hemoglobin A1c ◽  
Diastolic Pressure ◽  
Residual Renal Function ◽  
First Year ◽  
Diabetic Patients ◽  
Measured Glomerular Filtration Rate ◽  
The Relationship

BackgroundBetter glycemic control has been reported to slow the progression of nephropathy in predialysis diabetic patients. However, the relationship between glycemic control and residual renal function (RRF) in patients on peritoneal dialysis (PD) is uncertain.Methods89 incident diabetic patients on PD were recruited from 5 centers. We measured glomerular filtration rate (GFR) and hemoglobin A1c (HbA1c) within 2 months (baseline) after the start of PD and at 6 and 12 months. GFR was calculated as the average of renal creatinine and urea clearances. We analyzed whether mean HbA1c was associated with change in GFR (ΔGFR) over 1 year.ResultsDuring the first year of PD, ΔGFR was -1.7 ± 3.4 mL/min/1.73 m2and was not affected by mean HbA1c. Acute hemodialysis before starting PD and mean arterial diastolic pressure were related to the decline of GFR in a multivariate analysis.ConclusionGlycemic control was not associated with change in RRF in diabetic patients during the first year after starting PD.

scholarly journals Survival Comparison between Hemodialysis and Peritoneal Dialysis Based on Matched Doses of Delivered Therapy

2002 ◽  
Vol 13 (suppl 1) ◽  
pp. S48-S52
Author(s):  
Prakash Keshaviah ◽  
Allan J. Collins ◽  
Jennie Z. Ma ◽  
David N. Churchill ◽  
Kevin E. Thorpe
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Residual Renal Function ◽  
Dialysis Session ◽  
Comorbid Conditions ◽  
Urea Nitrogen ◽  
Risk Of Death ◽  
Patients With Diabetes

ABSTRACT. Several studies have recently confirmed that hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) survival is highly associated with delivered therapy Kt/Vurea. A direct comparison of equivalently dosed CAPD and HD has not previously been performed. A total of 968 incident HD patients at the Regional Kidney Disease Program from 1987 to June 1995 were studied, and these results were compared with those of the Canadian-United States prospective trial (CANUSA) consisting of 680 incident CAPD patients from September 1990 to December 31, 1992, with follow-up through December 31, 1993. All patients had quantitation of urea nitrogen for a total delivered dialysis session. On HD, in vivo, 2-pool, pre- and post-blood urea nitrogen kinetic modeling was performed with residual renal function determined every 6 mo. Patients were characterized by age, gender, race, renal diagnosis, and comorbid conditions. A Cox proportional hazards model was used to evaluate the effect of the individual comorbid conditions and the effect of dialysis therapy in the time-dependent method. The mean total Kt/V, both residual renal function and dialytic therapy in the HD patients, was 1.59. The CANUSA-delivered weekly Kt/V was 2.38 at the beginning of the baseline period and 1.99 after 24 mo of follow-up. When the peak concentration hypothesis was used, a Kt/V of 1.59 on HD was equivalent to a weekly CAPD dose of 2.1 to 2.2. A 1-unit increase in Kt/V was associated with 7% lower risk of death on HD and with a similar 8% lower risk of death while on CAPD. Patients with diabetes aged 46 to 60 yr had virtually identical 2-yr survival estimates on HD (83 to 90%), compared with CAPD (83 to 89%), with Kt/V ranges from 0.84 to 1.70 in HD and from 1.6 to 2.2 weekly Kt/V on peritoneal dialysis. Comparisons between HD and CAPD in older patients with diabetes yielded comparable results. Patient survival is highly influenced by delivered dialysis in both HD and peritoneal dialysis. Carefully matching of the therapies with delivered Kt/V demonstrates little differences in the survival outcome of HD and peritoneal dialysis patients, in contrast to some previous reports.

scholarly journals Incremental peritoneal dialysis

2020 ◽  
Vol 40 (3) ◽  
pp. 320-326 ◽  
Author(s):  
Peter G Blake ◽  
Jie Dong ◽  
Simon J Davies
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Renal Clearance ◽  
Observational Studies ◽  
Controlled Trial ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Full Dose ◽  
Randomized Controlled ◽  
Initiation Of Dialysis

Incremental peritoneal dialysis (PD) has been variably defined. It involves taking advantage of the residual renal function that is usually present at initiation of dialysis to initially prescribe less onerous lower doses of PD while still achieving individualized clearance goals. We propose that incremental PD be defined as a strategy, rather than a particular regime, in which: (1) less than standard “full-dose” PD is initially prescribed in recognition of the value of residual renal function; (2) peritoneal clearance is initially less than the individualized clearance goal but the combination of peritoneal plus renal clearance achieves or exceeds that goal clearance; and (3) there is a clear intention to increase dose of PD as renal clearance declines and/or symptoms appear. Incremental PD by its nature lessens the workload of dialysis for those doing PD, reduces cost and exposure of the peritoneal membrane to glucose, and may lessen mechanical symptoms. Evidence that incremental PD improves clinical outcomes compared to the use of full-dose PD is lacking but one randomized controlled trial, multiple observational studies, and a systematic review all suggest that outcomes are at least as good. Given that incremental PD costs less and is inherently less onerous, it is reasonable, pending larger randomized trials, to adopt this strategy.

scholarly journals Effects of Roxadustat on the Anemia and Iron Metabolism of Patients Undergoing Peritoneal Dialysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Keiji Hirai ◽  
Hiroaki Nonaka ◽  
Moeka Ueda ◽  
Junki Morino ◽  
Shohei Kaneko ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Ferritin ◽  
Iron Metabolism ◽  
Residual Renal Function ◽  
Plasma Creatinine ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Urea Clearance ◽  
Membrane Function

Background: We investigated the effects of roxadustat on the anemia, iron metabolism, peritoneal membrane function, and residual renal function; and determined the factors associated with the administration of roxadustat in patients who were undergoing peritoneal dialysis.Methods: We retrospectively analyzed the changes in hemoglobin, serum ferritin, transferrin saturation (TSAT), 4-h dialysate/plasma creatinine, and renal weekly urea clearance over the 24 weeks following the change from an erythropoiesis-stimulating agent (ESA) to roxadustat in 16 patients who were undergoing peritoneal dialysis and had anemia (Roxadustat group). Twenty-three peritoneal dialysis patients who had anemia and continued ESA served as a control group (ESA group).Results: There were no significant differences in hemoglobin, serum ferritin, TSAT, 4-h dialysate/plasma creatinine, or renal weekly urea clearance between the two groups at baseline. The hemoglobin concentration was significantly higher in the Roxadustat group than in the ESA group after 24 weeks (11.6 ± 1.0 g/dL vs. 10.3 ± 1.1 g/dL, p < 0.05), whereas the ferritin concentration and TSAT were significantly lower (139.5 ± 102.0 ng/mL vs. 209.2 ± 113.1 ng/mL, p < 0.05; and 28.1 ± 11.5% vs. 44.8 ± 10.4%, p < 0.05, respectively). The changes in 4-h dialysate/plasma creatinine and renal weekly urea clearance did not differ between the two groups. Linear regression analysis revealed that the serum potassium concentration correlated with the dose of roxadustat at 24 weeks (standard coefficient = 0.580, p = 0.019).Conclusion: Roxadustat may improve the anemia and reduce the serum ferritin and TSAT of the peritoneal dialysis patients after they were switched from an ESA, without association with peritoneal membrane function or residual renal function.

N-Acetylcysteine Improves Residual Renal Function in Peritoneal Dialysis Patients: A Pilot Study

2011 ◽  
Vol 31 (5) ◽  
pp. 545-550 ◽  
Author(s):  
Leonid Feldman ◽  
Michal Shani ◽  
Shai Efrati ◽  
Ilia Beberashvili ◽  
Iris Yakov–Hai ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Urine Volume ◽  
Residual Renal Function ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Optimal Care ◽  
Membrane Function ◽  
End Of Treatment ◽  
Sodium Sieving

BackgroundPreservation of peritoneal membrane function and residual renal function is important for the optimal care of peritoneal dialysis patients. N-Acetylcysteine may ameliorate oxidative stress, which is thought to be involved in peritoneal membrane dysfunction. In addition, N-acetylcysteine may have a positive effect on renal function in the setting of nephrotoxic contrast media administration. The aim of this study was to investigate the effect of N-acetylcysteine on peritoneal and residual renal function in peritoneal dialysis patients.MethodsTen prevalent peritoneal dialysis patients were administered oral N-acetylcysteine 1200 mg twice daily for 4 weeks. At baseline and at the end of treatment, peritoneal membrane function and residual renal function were assessed using a 4.25% dextrose peritoneal equilibration test and 24-hour dialysate and urine collection for calculation of peritoneal and residual renal Kt/V and mean urea and creatinine residual renal clearance.ResultsNo significant changes were demonstrated in peritoneal membrane function, including dialysate-to-plasma creatinine ratio, sodium sieving, and net ultrafiltration. Residual renal function improved significantly: urine volume increased from 633 ± 426 to 925 ± 552 mL/24 hours ( p = 0.022), residual renal Kt/V increased from 0.56 ± 0.41 to 0.75 ± 0.47 ( p = 0.037), and mean residual urea and creatinine clearance increased from 4.96 ± 3.96 to 5.95 ± 4.08 mL/min/1.73 m2( p = 0.059).ConclusionsN-acetylcysteine may improve residual renal function in patients treated with peritoneal dialysis.

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