scholarly journals 24-h Glycaemic profiles in peritoneal dialysis patients and non-dialysis controls with advanced kidney disease

2021 ◽  
pp. 089686082110477
Author(s):  
Jennifer Williams ◽  
Mark Gilchrist ◽  
William David Strain ◽  
Donald Fraser ◽  
Angela Shore
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Glucose Monitoring ◽  
Future Research ◽  
Night Time ◽  
Significant Drop ◽  
Cross Sectional ◽  
Monitoring Period ◽  
High Concentrations ◽  
Average Glucose

Background: For patients on peritoneal dialysis (PD), the deleterious effects of high concentrations of dialysate glucose on the peritoneal membrane are well-documented. Systemic effects of peritoneally absorbed glucose are more poorly defined. Using continuous glucose monitoring (CGM), we aimed to describe 24-h glycaemic profiles of PD patients without diabetes and compare with non-dialysis controls with stage 5 chronic kidney disease (CKD-5). Methods: In this cross-sectional, case-control study, 15 patients on PD (9 automated PD (APD) and 6 continuous ambulatory PD (CAPD)) and 16 CKD-5 controls underwent 72 h of CGM and metabolic profiling. CGM was used to derive average glucose concentrations and within-participant standard deviation (SD) of glucose. Data were analysed for the whole 72-h monitoring period and as daytime (09.00 to 21.00) and night-time (21.00 to 09.00). Results: Average glucose concentrations and within-participant SD of glucose for the whole monitoring period were not different between the three groups ( p ≥ 0.5). Daytime average glucose concentrations were also similar across the three groups ( p = 0.729). APD was associated with a significantly higher nocturnal glucose than CAPD (5.25 mmol/L ± 0.65 vs. 4.28 ± 0.5, p = 0.026). A significant drop in nocturnal glucose compared with daytime average seen in both CAPD patients and controls was absent in APD patients. Conclusions: Systematically different glycaemic patterns were observed in non-diabetic APD and CAPD patients, including an absence of physiological nocturnal glucose dipping in patients on APD. Comprehensive CGM data sets highlight subtleties not appreciated by traditional metabolic biomarkers; this has implications when choosing the most appropriate outcome measures in future research addressing the metabolic impact of PD.

scholarly journals Differences in the quality of life of chronic kidney disease patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Ika Setyo Rini ◽  
Titik Rahmayani ◽  
Efris Kartika Sari ◽  
Retno Lestari
Keyword(s):  
Quality Of Life ◽  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Life Quality ◽  
P Value ◽  
Minimal Amount ◽  
Cross Sectional

Background: Chronic kidney disease (CKD) is defined as a progressive disease that causes renal failure and requires extended and long-term therapies. CKD patients need to choose one of these therapies to improve their quality of life. This study aims to investigate differences in the quality of life of chronic kidney disease patients undergoing hemodialysis and continuous ambulatory peritoneal dialysis (CAPD).Design and Methods: The study design used is similar to the cross-sectional design. Therefore, in this study observations were carried out, a EQ_5D life quality questionnaire sheet was administered to respondents, and a purposive sampling method was used. The total number of respondents was 250 and consisted of 125 hemodialysis and CAPD patients each.Results: The results obtained using the Mann Whitney method was a p-value (0.515)> α (0.05). These results also included five components, namely the ability to move/walk to an acceptable degree, adequate self-care, performance of usual activities, minimal amount of pain/discomfort during hemodialysis and CAPD, and acceptable levels of anxiety/sadness.Conclusions: This research concludes that there is no difference in the quality of life between CKD patients  undergoing hemodialysis and CAPD.

scholarly journals Alarm Settings of Continuous Glucose Monitoring Systems and Associations to Glucose Outcomes in Type 1 Diabetes

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Yu Kuei Lin ◽  
Danielle Groat ◽  
Owen Chan ◽  
Man Hung ◽  
Anu Sharma ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
Continuous Glucose Monitor ◽  
Cross Sectional ◽  
Therapeutic Goals ◽  
Glucose Levels ◽  
Alarm Threshold ◽  
Negative Impacts ◽  
Average Glucose

Abstract Context Little evidence exists regarding the positive and negative impacts of continuous glucose monitor system (CGM) alarm settings for diabetes control in patients with type 1 diabetes (T1D). Objective Evaluate the associations between CGM alarm settings and glucose outcomes. Design and Setting A cross-sectional observational study in a single academic institution. Patients and Main Outcome Measures CGM alarm settings and 2-week CGM glucose information were collected from 95 T1D patients with > 3 months of CGM use and ≥ 86% active usage time. The associations between CGM alarm settings and glucose outcomes were analyzed. Results Higher glucose thresholds for hypoglycemia alarms (ie, ≥ 73 mg/dL vs < 73 mg/dL) were related to 51% and 65% less time with glucose < 70 and < 54 mg/dL, respectively (P = 0.005; P = 0.016), higher average glucose levels (P = 0.002) and less time-in-range (P = 0.005), but not more hypoglycemia alarms. The optimal alarm threshold for < 1% of time in hypoglycemia was 75 mg/dL. Lower glucose thresholds for hyperglycemia alarms (ie, ≤ 205 mg/dL vs > 205 mg/dL) were related to lower average glucose levels and 42% and 61% less time with glucose > 250 and > 320 mg/dL (P = 0.020, P = 0.016, P = 0.007, respectively), without more hypoglycemia. Lower alarm thresholds were also associated with more alarms (P < 0.0001). The optimal alarm threshold for < 5% of time in hyperglycemia and hemoglobin A1c ≤ 7% was 170 mg/dL. Conclusions Different CGM glucose thresholds for hypo/hyperglycemia alarms are associated with various hypo/hyperglycemic outcomes. Configurations to the hypo/hyperglycemia alarm thresholds could be considered as an intervention to achieve therapeutic goals.

scholarly journals Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study

2019 ◽  
Vol 104 (10) ◽  
pp. 4356-4364 ◽  
Author(s):  
Viral N Shah ◽  
Stephanie N DuBose ◽  
Zoey Li ◽  
Roy W Beck ◽  
Anne L Peters ◽  
...  
Keyword(s):  
Prospective Study ◽  
Median Time ◽  
Continuous Glucose Monitoring ◽  
Age Groups ◽  
Glucose Monitoring ◽  
Future Research ◽  
Glucose Levels ◽  
Sensor Glucose ◽  
Multicenter Prospective Study ◽  
Average Glucose

Abstract Context Use of continuous glucose monitoring (CGM) is increasing for insulin-requiring patients with diabetes. Although data on glycemic profiles of healthy, nondiabetic individuals exist for older sensors, assessment of glycemic metrics with new-generation CGM devices is lacking. Objective To establish reference sensor glucose ranges in healthy, nondiabetic individuals across different age groups using a current generation CGM sensor. Design Multicenter, prospective study. Setting Twelve centers within the T1D Exchange Clinic Network. Patients or Participants Nonpregnant, healthy, nondiabetic children and adults (age ≥6 years) with nonobese body mass index. Intervention Each participant wore a blinded Dexcom G6 CGM, with once-daily calibration, for up to 10 days. Main Outcome Measures CGM metrics of mean glucose, hyperglycemia, hypoglycemia, and glycemic variability. Results A total of 153 participants (age 7 to 80 years) were included in the analyses. Mean average glucose was 98 to 99 mg/dL (5.4 to 5.5 mmol/L) for all age groups except those over 60 years, in whom mean average glucose was 104 mg/dL (5.8 mmol/L). The median time between 70 to 140 mg/dL (3.9 to 7.8 mmol/L) was 96% (interquartile range, 93 to 98). Mean within-individual coefficient of variation was 17 ± 3%. Median time spent with glucose levels >140 mg/dL was 2.1% (30 min/d), and median time spent with glucose levels <70 mg/dL (3.9 mmol/L) was 1.1% (15 min/d). Conclusion By assessing across age groups in a healthy, nondiabetic population, normative sensor glucose data have been derived and will be useful as a benchmark for future research studies.

scholarly journals DIFFERENCES IN DENTAL CALCULUS INDICES AND SALIVARY CALCIUM AND PHOSPHATE LEVELS IN CHILDREN WITH CHRONIC KIDNEY DISEASE UNDERGOING HEMODIALYSIS AND PERITONEAL DIALYSIS THERAPY

2018 ◽  
Vol 11 (3) ◽  
pp. 339
Author(s):  
Thea Kirana ◽  
Heriandi Sutadi ◽  
Sarworini B Budiardjo
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Calcium Level ◽  
Cross Sectional Study ◽  
Dental Calculus ◽  
Cross Sectional ◽  
Calculus Formation ◽  
Unstimulated Saliva ◽  
Phosphate Analysis

 Objective: The objective of this study is to analyze the differences in dental calculus indices and calcium and phosphate levels in children with chronic kidney disease undergoing hemodialysis (HD) and peritoneal dialysis (PD) therapy.Methods: In this cross-sectional study, 15 children undergoing HD therapy and 15 undergoing PD therapy were subjected to intraoral examination for dental calculus indices. Whole unstimulated saliva samples of all subjects were collected and subjected to calcium and phosphate analysis. Statistical analyses were conducted using the Mann–Whitney and independent t-tests.Results: The dental calculus indices were significantly lower and salivary calcium level was significantly higher in the PD group than those in the HD group (p<0.05). The salivary phosphate level was lower in the PD group (p≥0.05) but without significance.Conclusion: The PD group had lower dental calculus indices and higher salivary calcium level. The higher salivary phosphate levels in the HD group may have contribute to the higher dental calculus indices, probably because phosphate plays an important role in dental calculus formation.

scholarly journals Evaluation of Physical Symptoms in Patients on Peritoneal Dialysis

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Ana Elizabeth Figueiredo ◽  
Cate Goodlad ◽  
Michelle Clemenger ◽  
San San Haddoub ◽  
Jacqueline McGrory ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Statistical Difference ◽  
Cross Sectional Study ◽  
Physical Symptoms ◽  
Poor Sleep ◽  
Sectional Study ◽  
Cross Sectional ◽  
Loss Of Appetite ◽  
Over Time

Introduction. Little is known about physical symptoms in peritoneal dialysis (PD) Patients. This study aims to determine the prevalence of symptoms (general and abdominal) in PD patients.Methods. A cross-sectional study, with subsequent followup, using an author-designed 21 symptoms questionnaire (15 nonabdominal and 6 abdominal). Each symptom was assessed on a scale 0–3 for severity (none–severe) and frequency (never–every day).Results. We studied 41 patients, mean age years, 56% male, 19.5% diabetics, and 51.5% on APD. Mean number of symptoms was and total symptoms score was with abdominal scores of . Most frequent symptoms were lack of energy, itching, cramps, poor sleep, and loss of appetite. A second evaluation in 20 patients disclosed no statistical difference between the first and second assessments, or between subgroups. Cramps were the only symptoms which decreased over time (). Lack of energy did not correlate with haemoglobin, neither did itching with phosphate level.Conclusions. Physical symptoms are frequent and troublesome; they relate to advanced kidney disease and not specifically to PD. Symptoms remain stable over time and do not appear to relate to dialysis parameter markers.

scholarly journals Non-steroidal anti-inflammatory drugs in chronic kidney disease: a systematic review of prescription practices and use in primary care

2019 ◽  
Vol 13 (1) ◽  
pp. 63-71 ◽  
Author(s):  
Claire Lefebvre ◽  
Jade Hindié ◽  
Michael Zappitelli ◽  
Robert W Platt ◽  
Kristian B Filion
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Observational Research ◽  
Quality Improvement Intervention ◽  
Future Research ◽  
Cross Sectional ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Background Chronic kidney disease (CKD) management focuses on limiting further renal injury, including avoiding nephrotoxic medications such as non-steroidal anti-inflammatory drugs (NSAIDs). We performed a systematic review to evaluate the prevalence of primary care NSAID prescribing in this population. Methods We systematically searched MEDLINE and Embase from inception to October 2017 for observational studies examining NSAID prescribing practices or use in CKD patients in a primary care setting. The methodological quality of included studies was assessed independently by two authors using a modified version of the Agency for Healthcare Research and Quality’s Methodological Evaluation of Observational Research checklist. Results Our search generated 8055 potentially relevant publications, 304 of which were retrieved for full-text review. A total of 14 studies from 13 publications met our inclusion criteria. There were eight cohort and three cross-sectional studies, two quality improvement intervention studies and one prospective survey, representing a total of 49 209 CKD patients. Cross-sectional point prevalence of NSAID use in CKD patients ranged from 8 to 21%. Annual period prevalence rates ranged from 3 to 33%. Meta-analysis was not performed due to important clinical heterogeneity across study populations. Conclusions Evidence suggests that NSAID prescriptions/use in primary care among patients with CKD is variable and relatively high. Future research should explore reasons for this to better focus knowledge translation interventions aimed at reducing NSAID use in this patient population.

Eligibility and patient barriers to peritoneal dialysis in patients with advanced chronic kidney disease

2021 ◽  
pp. 089686082199820
Author(s):  
Saleem Abdulkarim ◽  
Jasmit Shah ◽  
Ahmed Twahir ◽  
Ahmed P Sokwala
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Cross Sectional Study ◽  
Definitive Treatment ◽  
Related Factors ◽  
Cross Sectional ◽  
Kidney Replacement Therapy ◽  
Physical Barriers ◽  
The Impact

Introduction: The burden of chronic kidney disease (CKD) is increasing in Kenya and is a significant cause of morbidity and mortality. While definitive treatment is renal transplantation, many patients require kidney replacement therapy with haemodialysis (HD) or peritoneal dialysis (PD). The predominant modality utilized in Kenya is currently HD. There is a need to explore why PD remains underutilized and whether patient factors may be contributory to barriers that limit the uptake of PD. Methods: This was a descriptive cross-sectional study where patients with advanced CKD were assessed by a multidisciplinary team for PD eligibility using a standardized tool. Contraindications and barriers to the modality were recorded as was the presence or absence of support for the provision of PD. Demographic and clinical data were recorded using a standardized questionnaire. The impact of support on PD eligibility was determined. Results: We found that 68.9% patients were eligible for PD. Surgery-related abdominal scarring was the most common contraindication. Barriers to PD were identified in 45.9% and physical barriers were more common than cognitive barriers. Presence of support was associated with a significant increase in PD eligibility ( p < 0.001). Conclusion: The rate of eligibility for PD in this study was similar to that found in other populations. Surgical-related factors were the most commonly identified contraindication. Physical and cognitive barriers were commonly identified and may be overcome by the presence of support for PD.

scholarly journals Association of circulating cardiac biomarkers with electrocardiographic abnormalities in chronic kidney disease

2020 ◽  
Author(s):  
Alexander J Kula ◽  
Ronit Katz ◽  
Leila R Zelnick ◽  
Elsayed Soliman ◽  
Alan Go ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Troponin T ◽  
Myocardial Dysfunction ◽  
Cardiac Biomarkers ◽  
Future Research ◽  
Qtc Interval ◽  
Cross Sectional ◽  
Galectin 3

Abstract Background Among patients with chronic kidney disease (CKD), the circulating cardiac biomarkers soluble ST2 (SST2), galectin-3, growth differentiation factor-15 (GDF-15), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity troponin-T (hsTnT) possibly reflect pathophysiologic processes and are associated with clinical cardiovascular disease. Whether these biomarkers are associated with electrocardiographic findings is not known. The aim of this study was to test the association between serum cardiac biomarkers and the presence of electrocardiographic changes potentially indicative of subclinical myocardial disease in patients with CKD. Methods We performed a cross-sectional analysis using 3048 participants from the Chronic Renal Insufficiency Cohort (CRIC) without atrial fibrillation, atrioventricular block, bundle branch block or a pacemaker at the baseline visit. Using logistic regression, we tested the association of each of the five cardiac biomarkers with baseline electrocardiogram (ECG) findings: PR interval &gt;200 ms, QRS interval &gt;100 ms and a prolonged QTc interval. Models were adjusted for demographic variables, measures of kidney function, prevalent cardiovascular disease and cardiovascular risk factors. Results In adjusted models, hsTnT levels associated with prolonged PR {odds ratio [OR] 1.23 [95% confidence interval (CI) 1.08–1.40]}, QRS [OR 1.28 (95% CI 1.16–1.42)] and QTc [OR 1.94 (95% CI 1.50–2.51)] intervals. NT-proBNP levels were associated with prolonged QRS [OR 1.11 (95% CI 1.06–1.16)] and QTc [OR 1.82 (95% CI 1.58–2.10)] intervals. SST2, galectin-3 and GDF-15 were not significantly associated with any of the ECG parameters. Conclusions hsTnT and NT-proBNP were associated with ECG measures indicative of subclinical myocardial dysfunction. These results may support future research investigating the significance of myocardial ischemia and volume overload in the pathogenesis of dysfunctional myocardial conduction in CKD.

scholarly journals Spectrum of Complications of Patients with Chronic Kidney Disease on Maintenance Continuous Ambulatory Peritoneal Dialysis: An Experience of Tertiary Nephrology Center in Najaf City-Iraq

2021 ◽  
Vol 9 (B) ◽  
pp. 1529-1534
Author(s):  
Evan Noori ◽  
Rawaa Hadi ◽  
Yasir Sharba ◽  
Zahraa Fathi Sharba
Keyword(s):  
Chronic Kidney Disease ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Kidney Failure ◽  
Chronic Kidney Failure ◽  
Infectious Complications ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Open Operation ◽  
Significant Difference

BACKGROUND: Chronic kidney disease (CKD), also called chronic kidney failure, is described as gradual loss of kidney function. CKD can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or kidney transplant. Peritoneal dialysis (PD) has a widespread renal replacement therapy with great acceptance because of simplicity, flexibility, and independence. AIM: The aim of this study was to evaluate the complications of continuous ambulatory PD (CAPD) in patients with CKD. METHODS: A cross-sectional study, involved 140 patients, aged between 18 and 80 years old and suffered from CKD under maintenance CAPD in the dialysis unit of the renal center. All data regarding the sociodemographic profile of the patient, vitals, etiological diagnosis, frequency and duration of dialysis, and dialysis-related complications were taken. RESULTS: In the current study, there is a significant difference in the distribution of complications among gender where the female patients had a higher incidence of both infectious and non-infectious complications. The study also reported that there is much lower rate of complications among patients on laparoscope operation in compared with the open operation. In addition, patients with open abdomen PD developed the complications earlier than those with laparoscope maintenance CAPD. CONCLUSION: Peritoneal infection is the most prevalent complication among the other complications in the current study. There is much lower rate of complications among patients on PD in compared with hemodialysis and on laparoscope in compared with the open operation.

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