Dialysis at Home in the West of Scotland: A Comparison of Hemodialysis and Continuous Ambulatory Peritoneal Dialysis in Age and Sex-Matched Controls

1992 ◽  
Vol 12 (4) ◽  
pp. 365-368 ◽  
Author(s):  
Alexander C. Grant ◽  
R. Stuart C. Rodger ◽  
Catherine A. Howie ◽  
Brian J.R. Junor ◽  
J. Douglas Briggs ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
The West ◽  
Home Dialysis ◽  
Technique Survival ◽  
Significant Difference ◽  
Age And Sex ◽  
At Home

Objective To audit the outcome of patients treated at home by hemodialysis and continuous ambulatory peritoneal dialysis (CAPD). Design Retrospective comparison of nondiabetic hemodialysis patients with age and sex-matched nondiabetic patients treated by CAPD. Setting Renal Units, Stobhill General Hospital and Western Infirmary, Glasgow, providing the home dialysis service for the West of Scotland. Patients Between 1982 and 1988, 139 hemodialysis patients starting treatment at home, compared with 139 matched patients starting CAPD over the same time period. Main Outcome Measures Patient characteristics and cardiovascular risk factors at the start of home treatment. Patient and technique survival with both forms of dialysis. Results Patients selected for home hemodialysis were less likely to be smokers (p<0.02) and to have electrocardiographic evidence of ischemia or left ventricular hypertrophy (p<0.05) than patients treated by CAPD. Patient survival and technique survival (excluding death and renal transplantation) at 3 years were 93.8% versus 86.2% (p<0.05) and 94.2% versus 80.8% (p<0.04) for hemodialysis and CAPD, respectively. Cardiovascular events were responsible for the majority of deaths in both groups, but there was a greater proportion of deaths from other causes in patients treated by CAPD. There was no significant difference in the transplantation rate between the two treatment groups. Conclusions Home dialysis is an effective method of renal replacement treatment for patients with end-stage renal disease. The results of hemodialysis are superior to CAPD, but this may be partly due to selection bias.

scholarly journals Continuous Ambulatory Peritoneal Dialysis in Limpopo Province, South Africa: Predictors of Patient and Technique Survival

2014 ◽  
Vol 34 (5) ◽  
pp. 518-525 ◽  
Author(s):  
Ramon A. Tamayo Isla ◽  
Darlington Mapiye ◽  
Charles R. Swanepoel ◽  
Nadiya Rozumyk ◽  
Jerome E. Hubahib ◽  
...  
Keyword(s):  
South Africa ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Tap Water ◽  
Average Distance ◽  
Limpopo Province ◽  
Composite Outcome ◽  
Technique Survival ◽  
At Home

Introduction and aimContinuous ambulatory peritoneal dialysis (CAPD) is not a frequently used modality of dialysis in many parts of Africa due to several socio-economic factors. Available studies from Africa have shown a strong association between outcome and socio-demographic variables. We sought to assess the outcome of patients treated with CAPD in Limpopo, South Africa.MethodsThis was a retrospective study of 152 patients treated with CAPD at the Polokwane Kidney and Dialysis Centre (PKDC) from 2007 to 2012. We collected relevant demographic and biochemical data for all patients included in the study. A composite outcome of death while still on peritoneal dialysis (PD) or CAPD technique failure from any cause requiring a change of modality to hemodialysis (HD) was selected. The peritonitis rate and causes of peritonitis were assessed from 2008 when all related data could be obtained.ResultsThere were 52% males in the study and the average age of the patients was 36.8 ± 11.4 years. Unemployment rate was high (71.1%), 41.1% had tap water at home, the average distance travelled to the dialysis center was 122.9 ± 78.2 kilometres and half the patients had a total income less than USD ($)180 per month. Level of education, having electricity at home, having tap water at home, body mass index (BMI), serum albumin and hemoglobin were significantly different between those reaching the composite outcome and those not reaching it ( p < 0.05). The overall peritonitis rate was 0.82/year with 1-year, 2-year and 5-year survival found to be 86.7%, 78.7% and 65.3% (patient survival) and 83.3%, 71.7% and 62.1% (technique survival). Predictors of the composite outcome were BMI ( p = 0.011), serum albumin ( p = 0.030), hemoglobin ( p = 0.002) and more than 1 episode of peritonitis ( p = 0.038).ConclusionTreatment of anemia and malnutrition as well as training and re-training of CAPD patients and staff to prevent recurrence of peritonitis can have positive impacts on CAPD outcomes in this population.

Comparison of Patient and Technique Survival in Continuous Ambulatory Peritoneal Dialysis (Capd) and Hemodialysis: A Multicenter Study

1990 ◽  
Vol 10 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Kenneth D. Serkes ◽  
Christopher R. Blagg ◽  
Karl D. Nolph ◽  
Edward F. Vonesh ◽  
Fred Shapiro
Keyword(s):  
Peritoneal Dialysis ◽  
Relative Risk ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Significant Risk ◽  
Diabetic Patients ◽  
Average Hospital ◽  
Technique Survival ◽  
Significant Difference ◽  
Hospital Visits ◽  
Hospital Days

Patient and technique survival were compared in adult patients new to continuous ambulatory peritoneal dialysis (CAPD) or (primarily) center hemodialysis (HD) in the time period 1981 to 1983, and followed-up in March 1985. Risk factors were identified at entrance into the study, and results were analyzed using Cox's proportional hazards model. For nondiabetic patients, the difference in survival which favored CAPD (relative risk = 0.62) was not significant at the 5% level (p = 0.08). Age was a significant risk factor in both groups. The average number of hospital visits was the same; however, CAPD showed a small but significant increase in average annual hospital days per year (10.14 vs. 9.18). For diabetic patients, there was no significant difference in survival between CAPD and HD. The CAPD group showed a significant increase in hospital visits (relative risk 1.81 vs. 1.40) and average hospital days per year (19.43 vs. 13.41). Both CAPD groups showed significantly higher treatment changeover rates.

Comparison of Two Different Kt/V Methods in Continuous Ambulatory Peritoneal Dialysis Patients

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 514-516
Author(s):  
Canan Sanlidag ◽  
Caner Ccedil;avdar ◽  
Aykut Sifil ◽  
Sadiye Hastaoglu ◽  
Pinar üretmen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Venous Blood ◽  
Urine Samples ◽  
Renal Unit ◽  
Dialysis Adequacy ◽  
Modified Method ◽  
Classic Method ◽  
Significant Difference ◽  
At Home

Dialysis adequacy has gained particular interest for the assessment of the quality of dialysis in patients undergoing hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD). Kt/V is used as a test of dialysis adequacy in HD and CAPD patients. The aim of this study was to compare two different Kt/V methods in CAPD patients. A practical method for the calculation of Kt/V will be suggested at the end of this prospective study. The study group included 28 patients. Each patient received CAPD therapy four times per day. During the study, CAPD dialysate samples for a period of 24 hours were obtained by two different methods. One is a modified method for obtaining samples by the patient at home; the other is the conventional method. For study purposes only, we told the patients using the modified method to bring all the bags to the center (contrary to the aim of the modified method). In the first method (modified method), CAPD patients collected 24-hour dialysate and urine samples at home and brought all of the materials to the hospital. A 10 mm3 dialysate sample was drawn from each CAPD dialysate bag, and then a total of 40 mm3 dialysate was mixed in a beaker. A sample of 10 mm3 of dialysate was taken from the mixture in the beaker, and then this dialysate sample, urine, and 5 mm3 venous blood were sent to the laboratory for urea nitrogen (UN) and creatinine level determinations. In addition to these tests, 24-hour dialysate and urine volumes and the patients’ weight and height were measured, and Kt/V values were calculated. In the second method (classic method), all the bags from the 24-hour period were collected and mixed in a big bucket, and then a 10 mm3 sample was taken. The remaining procedures were the same as for the first method. Mean Kt/V values were calculated separately for the two methods and were found to be 2.48 by the modified method and 2.52 by the classic method. The results of the two methods were compared with the Wilcoxon paired t-test, which showed no statistically significant difference (p = 0.5228). In conclusion, two different Kt/V methods can be used in CAPD patients. However, the modified method is easily performed, and CAPD patients can collect and take the dialysate and urine samples at home, and bring these materials to the renal unit without transportation problems.

scholarly journals The Impact of Dialysis Modality on Left Ventricular Function in Patient with End Stage Kidney Disease

2020 ◽  
Vol 5 (2) ◽  
pp. 2-9
Author(s):  
Abhishek Maskey ◽  
Navaraj Paudel ◽  
Subash Sapkota ◽  
Pooja Jha
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hemodialysis Patients ◽  
Left Ventricular ◽  
Dialysis Patients ◽  
End Stage Kidney Disease ◽  
End Stage

Introduction: Cardiovascular disease is frequent in end-stage kidney disease patients, and is a major cause of morbidity and mortality. This study was carried out to assess the comparative cardiac effects of hemodialysis and continuous ambulatory peritoneal dialysis on left ventricular function.Methods: A prospective observational study was carried out in patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis at least for 6 months. The duration of the study was from June 2019 to May 2020. CAPD consists of 3 to 4 exchanges/day and haemodialysis 2-3 times/week for 4 hours. Baseline characteristics age, gender, dialysis duration, hypertension, diabetes and hyperlipidaemia were collected. The same cardiologist performed all echocardiography at the end of hemodialysis session in hemodialysis patients and after the drain of dialysate in peritoneal dialysis patients.Results: Sixty patients (40 hemodialyses, 20 peritoneal dialyses) were enrolled. The mean age of the patient was 53.71±13.00 years (range 25-76). There was a slightly higher number of male in the hemodialysis group (p= 0.065). Systolic and diastolic blood pressure were significantly higher in hemodialysis groups (p<0.001). Regarding left ventricular parameters, hemodialysis patients had a higher prevalence of left ventricular diastolic dysfunction, left ventricular hypertrophy, left ventricular mass compared to peritoneal dialysis patients. Pericardial effusion and thickening were present higher in hemodialysis patients and was statistically significant (p<0.05).Conclusion: The modality of dialysis influence left ventricular function. Left ventricle dysfunction is prevalent among hemodialysis patients compared to peritoneal dialysis. Echocardiographic follow up is essential as this could improve the management of cardiovascular complications in dialysis patients.

Association between Serum N-Terminal Pro-Brain Natriuretic Peptide Concentration and Left Ventricular Dysfunction and Extracellular Water in Continuous Ambulatory Peritoneal Dialysis Patients

2006 ◽  
Vol 26 (3) ◽  
pp. 360-365 ◽  
Author(s):  
Jung-Ahn Lee ◽  
Do-Hyoung Kim ◽  
Soo-Jeong Yoo ◽  
Dong-Jin Oh ◽  
Suk-Hee Yu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Ejection Fraction ◽  
Brain Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Left Ventricular ◽  
Extracellular Water ◽  
Volume Load ◽  
Lv Dysfunction ◽  
Lv Ejection Fraction

Background This study investigated the association between serum N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels and extracellular water (ECW%) and left ventricular (LV) dysfunction in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods The study involved 30 stable CAPD patients: 14 males, 16 females; mean age 52 ± 14 years; mean CAPD duration 34 ± 12 months; 12 with diabetes mellitus (DM) and 18 non-DM. Serum NT-pro-BNP levels were determined using electrochemiluminescence immunoassay. Baseline echocardiography was performed using a Hewlett-Packard Sonos 1000 (Andover, Massachusetts, USA) device equipped with a 2.25-MHz probe, allowing M-mode, two-dimensional, and pulsed Doppler measurements. Left ventricular mass index (LVMI) was calculated according to the Penn formula. A multifrequency bioimpedance analyzer was used; ECW% was calculated as a percentage of total body water and was considered the index of volume load. Results ( 1 ) Serum NT-pro-BNP level, ECW%, LVMI, and LV ejection fraction in CAPD patients were 3924 (240 – 74460) pg/mL, 36.7% ± 2.2%, 158 ± 48 g/m2, and 60.5% ± 11.2%, respectively. ( 2 ) Patients were divided into three tertiles (10 patients each) according to their serum NT-pro-BNP concentration [1st tertile 1168 (240 – 2096), 2nd tertile 4856 (2295 – 20088), 3rd tertile 35012 (20539 – 74460) pg/mL]. The tertiles did not differ significantly in terms of age, sex, presence of DM, body mass index, or PD duration. Patients in the 3rd tertile (highest serum NT-pro-BNP concentration) had the highest LVMI (126 ± 45 vs 160 ± 41 vs 200 ± 23 g/m2 for 1st, 2nd, 3rd tertiles, respectively) and the lowest LV ejection fraction (66% ± 11% vs 62% ± 6% vs 55% ± 9%). ECW% did not differ significantly between tertiles (35.5% ± 2.0% vs 37.5% ± 2.0% vs 36.5% ± 2.0%). ( 3 ) In CAPD patients, serum NT-pro-BNP levels correlated positively with LVMI ( r = 0.628, p = 0.003) and negatively with LV ejection fraction ( r = –0.479, p = 0.033). Serum NT-pro-BNP levels did not correlate with ECW% ( r = 0.227, p = 0.25). ( 4 ) Stepwise regression analysis showed that LV ejection fraction (b = -0.610, p = 0.015) and LVMI (b = 0.415, p = 0.007) were independently associated with the serum NT-pro-BNP concentration. Conclusions There was no link between ECW% and serum NT-pro-BNP concentration. Thus, serum NT-pro-BNP levels may not provide objective information with respect to pure hydration status in CAPD patients. In contrast, serum NT-pro-BNP levels were linked to LVMI and LV ejection fraction in CAPD patients. Therefore, while the serum NT-pro-BNP concentration might not be a useful clinical marker for extracellular fluid volume load, it appears useful for evaluating LV hypertrophy and LV dysfunction in CAPD patients.

National Comparisons: Optimal Peritoneal Dialysis Outcomes among Japanese Patients

1999 ◽  
Vol 19 (3_suppl) ◽  
pp. 9-16 ◽  
Author(s):  
Yoshindo Kawaguchi
Keyword(s):  
Peritoneal Dialysis ◽  
Positive Selection ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Therapeutic Intervention ◽  
Scoring System ◽  
Japanese Patients ◽  
Current Status ◽  
Technique Survival ◽  
Ultrafiltration Failure ◽  
Dialysis Outcomes

This paper describes the current status of chronic dialysis in Japan and the guidelines used to initiate dialysis (scoring system), and reports the outcome of continuous ambulatory peritoneal dialysis (CAPD), focusing upon our center's experience. Fifty percent of CAPD technique survival was 6.9 ± 1.3 years among those patients classified as “positive selection.” The major causes of withdrawal from CAPD were ultrafiltration failure, the patients’ inability to continue on CAPD by themselves, and peritonitis. The clinical issues that most concern nephrologists in CAPD management are prevention and management of ultrafiltration failure, prevention/therapeutic intervention in encapsulating peritoneal sclerosis, catheter-related infections, and prevention of underdialysis.

Anemia and Oxygen Affinity in Patients on Continuous Ambulatory Peritoneal Dialysis

1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 1-3
Author(s):  
Bruce S. Spinowitz ◽  
Judith Sherwood ◽  
Marilyn Galler ◽  
Chaim Chary Tan
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Anabolic Steroids ◽  
Oxygen Affinity ◽  
Hemodialysis Patients ◽  
Iron Supplements

Contrary to previous reports, our patients maintained on CAPD for periods up to 25 months showed no improvement in their hematocrit. However, in comparison with a group of hemodialysis patients, our CAPD patients required transfusions, anabolic steroids and iron supplements less frequently. A small but not statistically significant increase in hematocrit was noted among patients transferred from hemodialysis to CAPD. Oxygen affinity, measured by P50, did not reveal the previously described elevation among hemodialysis patients. The reason(s) for this difference are only speculative at this time.

Procalcitonin and Conventional Markers of Inflammation in Peritoneal Dialysis Patients and Peritonitis

2006 ◽  
Vol 26 (2) ◽  
pp. 240-248 ◽  
Author(s):  
Galip Guz ◽  
Bulent Colak ◽  
Kenan Hizel ◽  
Kadriye A. Reis ◽  
Yasemin Erten ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Hemodialysis Patients ◽  
Biochemical Tests ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Median Serum ◽  
Significant Difference

Objectives To determine the significance of a newly described marker of inflammation procalcitonin (PCT), and to investigate its relationship to conventional markers of inflammation, such as C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR), in patients on peritoneal dialysis (PD) and with peritonitis. Design A prospective, observational clinical study. Setting The Nephrology Division of a University-affiliated teaching hospital. Patients and Methods 51 consecutive patients on PD were included in the study. Of this number, 16 developed peritonitis during the observational period. Baseline PCT, CRP, and fibrinogen concentrations and ESR of 51 PD patients were determined at a time point (TB) prior to any evidence of infection. These results were compared with laboratory values from 74 hemodialysis patients and 34 nonuremic control subjects. All PD patients then were followed prospectively for evidence of peritonitis. In addition to routine blood tests, including hemoglobin and leukocyte count, and routine biochemical tests, blood samples were taken to measure PCT, CRP, and fibrinogen concentrations and ESR at the time (T0) when patients first were diagnosed with PD peritonitis and also on the 4th (T4) and the 14th (T14) days after treatment for peritonitis was initiated. PCT was assayed by immunoluminometry. Results No significant difference was observed between baseline median serum PCT concentrations in PD and hemodialysis patients; however, in both groups, baseline median PCT concentrations were significantly higher than those of nonuremic controls ( p < 0.05). The 16 patients on PD who developed peritonitis had 21 PD peritonitis episodes during the study period. The increased PCT concentration observed at T0 in PD peritonitis episodes decreased with therapy, and this change was statistically significant ( p < 0.05). In a receiver operating characteristic curve analysis for peritonitis, the area under the curve (AUC) for PCT was 0.80, which was significantly lower than the AUC for CRP and greater than the AUCs for fibrinogen and ESR. The sensitivity of PCT for peritonitis was lower than the sensitivity of conventional markers of inflammation; however, the specificity of PCT was higher. Conclusions Median serum PCT concentration in PD patients was significantly higher than in nonuremic controls but not hemodialysis patients. Serum PCT concentrations may serve as a useful adjunct to traditional markers of inflammation in detecting and monitoring inflammation and peritonitis in PD patients.

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