scholarly journals Peritoneal Dialysis Guidelines 2019 Part 2: Main Text (Position paper of the Japanese Society for Dialysis Therapy)

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Munekazu Ryuzaki ◽  
Yasuhiko Ito ◽  
Hidetomo Nakamoto ◽  
Yuichi Ishikawa ◽  
Noritomo Itami ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Working Group ◽  
Japanese Society ◽  
Angiotensin Receptor Blockers ◽  
Intraperitoneal Administration ◽  
Diabetic Patients ◽  
Dialysis Therapy ◽  
Converting Enzyme Inhibitors ◽  
Grade Approach ◽  
Ras Inhibitors

Abstract Background This article is a duplicated publication from the Japanese version of “2019 JSDT Guidelines for Peritoneal Dialysis” with permission from the Japanese Society for Dialysis Therapy (JSDT). This clinical practice guideline (CPG) was developed primarily by the Working Group on Revision of Peritoneal Dialysis (PD) Guidelines of the Japanese Society for Dialysis Therapy. Recently, the definition and creation process for CPGs have become far more rigorous; traditional methods and formats no longer adhere to current standards. To improve the reliability of international transmission of our findings, CPGs are created in compliance with the methodologies developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) working group. Part 2 of this PD guideline is the first CPG developed by our society that conforms to the GRADE approach. Methods Detailed processes were created in accordance with the Cochrane handbook and the GRADE approach developed by the GRADE working group. Results Clinical question (CQ)1: Is the use of renin-angiotensin system inhibitors (RAS inhibitors), such as angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB), effective in PD patients? Recommendation: We suggest the usage of RAS inhibitors (ACEI and ARB) in PD patients (GRADE 2C). CQ2: Icodextrin or glucose solution: which is more useful as a dialysate among patients with PD? Recommendation: We suggest using icodextrin when managing body fluids in PD patients (GRADE 2C). CQ3: Is it better to apply or not apply mupirocin/gentamicin ointment to the exit site? Recommendation: We suggest not applying mupirocin/gentamicin ointment to the exit sites of PD patients (GRADE 2C). CQ4: Which surgical approach is more desirable when a PD catheter is placed, open surgery or laparoscopic surgery? No recommendation. CQ5: Which administration route of antibiotics is better in PD patients with peritonitis, intravenous or intraperitoneal? Recommendation: We suggest intraperitoneal administration of antibiotics in PD patients with peritonitis (GRADE 2C). Note: The National Insurance does not currently cover intraperitoneal administration. CQ6: Is peritoneal dialysis or hemodialysis better as the first renal replacement therapy in diabetic patients? No recommendation. Conclusions In the future, we suggest that society members construct their own evidence to answer CQs not brought up in this guideline, and thereby show the achievements of Japan worldwide.

scholarly journals Peritoneal Dialysis Guidelines 2019 Part 1 (Position paper of Japanese Society of Dialysis Therapy)

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yasuhiko Ito ◽  
Munekazu Ryuzaki ◽  
Hitoshi Sugiyama ◽  
Tadashi Tomo ◽  
Akihiro C. Yamashita ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Practice ◽  
Japanese Society ◽  
Enzyme Inhibitors ◽  
Angiotensin Receptor Blockers ◽  
Japanese Version ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Dialysis Therapy ◽  
Converting Enzyme Inhibitors ◽  
New Developments

AbstractApproximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.

Antihypertensive Drugs and Diabetic Retinopathy in Patients with Type 2 Diabetes

2015 ◽  
Vol 235 (2) ◽  
pp. 87-96
Author(s):  
Jen-Chieh Lin ◽  
Mei-Shu Lai
Keyword(s):  
Diabetic Retinopathy ◽  
Antihypertensive Drugs ◽  
Angiotensin Receptor Blockers ◽  
Incidence Rates ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Type 2 Diabetic Patients ◽  
Converting Enzyme Inhibitors ◽  
Type 2 Diabetic

Objective: To evaluate the association between the development of sight-threatening diabetic retinopathy (STDR) and antihypertensive drugs (AHDs) use among type 2 diabetic patients with concomitant hypertension. Methods: Type 2 diabetic patients aged 20-100 years who had at least one prescription for AHDs between 2000 and 2011 were identified from the Longitudinal Health Insurance Database (LHID) 2005. The incidence rates of STDR were followed and Cox proportional hazard models were used to analyze the risk associated with AHDs. Results: Users of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) were associated with a significantly higher risk than users of calcium channel blockers (CCBs), independent of baseline characteristics. After adjusting for time-varying use of concomitant medications for propensity score-matched or -unmatched cohorts, the results showed that patients receiving ACEIs/ARBs and CCBs were associated with a significantly greater risk compared with β-blocker users. Conclusions: Our study did not support a superiority of ACEIs/ARBs and CCBs over β-blockers for lowering the progression of diabetic retinopathy.

scholarly journals Control of blood pressure and cardiovascular outcomes in type 2 diabetes

Open Medicine ◽  
2018 ◽  
Vol 13 (1) ◽  
pp. 304-323 ◽  
Author(s):  
Hernando Vargas-Uricoechea ◽  
Manuel Felipe Cáceres-Acosta
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Events ◽  
Angiotensin Receptor Blockers ◽  
Pharmacological Therapy ◽  
Current Evidence ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Converting Enzyme Inhibitors ◽  
Patients With Diabetes ◽  
The Impact

AbstractHigh blood pressure in patients with diabetes mellitus results in a significant increase in the risk of cardiovascular events and mortality. The current evidence regarding the impact of intervention on blood pressure levels (in accordance with a specific threshold) is not particularly robust. Blood pressure control is more difficult to achieve in patients with diabetes than in non-diabetic patients, and requires using combination therapy in most patients. Different management guidelines recommend initiating pharmacological therapy with values >140/90 mm/Hg; however, an optimal cut point for this population has not been established. Based on the available evidence, it appears that blood pressure targets will probably have to be lower than <140/90mmHg, and that values approaching 130/80mmHg should be recommended. Initial treatment of hypertension in diabetes should include drug classes demonstrated to reduce cardiovascular events; i.e., angiotensin converting-enzyme inhibitors, angiotensin receptor blockers, diuretics, or dihydropyridine calcium channel blockers. The start of therapy must be individualized in accordance with the patient's baseline characteristics, and factors such as associated comorbidities, race, and age, inter alia.

Management of the Diabetic Patients with End Stage Renal Disease

1981 ◽  
Vol 2 (1_suppl) ◽  
pp. 6-10 ◽  
Author(s):  
Pablo Amair ◽  
Ramesh Khanna ◽  
Bernard Leibel ◽  
Andreas Pierratos ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Intraperitoneal Administration ◽  
Good Control ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
One Year ◽  
Stage Renal Disease ◽  
End Stage

Twenty diabetics with end-stage renal disease who had never previously received dialysis treatment were treated with continuous ambulatory peritoneal dialysis for periods of two to 36 months (average, 14.5). Intraperitoneal administration of insulin achieved good control of blood sugar Even though creatinine clearance decreased significantly (P = 0.001), contro of blood urea nitrogen and serum creatinine was adequate. Hemoglobin and serum albumin levels increased significantly (P = 0.005 and 0.04 respectively). Similarly, there was a significant increase in serum triglycerides and alkaline phosphatase (P = 0.02 and 0.05). Blood pressure became normal without medications in all but one of the patients. Retinopathy, neuropathy, and osteodystrophy remained unchanged. Peritonitis developed once in every 20.6 patient-months a rate similar to that observed in nondiabetics. The calculated survival rate was 92 per cent at one year; the calculated rate of continuation on ambulatory peritoneal dialysis was 87 per cent.

Intraperitoneal Administration of Insulin during Peritoneal Dialysis of Diabetics with Terminal Renal Failure

1981 ◽  
Vol 4 (4) ◽  
pp. 162-167
Author(s):  
K.E. Hemmeløff Andersen ◽  
P. Hyltoft Petersen
Keyword(s):  
Peritoneal Dialysis ◽  
Plasma Glucose ◽  
Serum Insulin ◽  
Intraperitoneal Administration ◽  
Significant Rise ◽  
Immunoreactive Insulin ◽  
Diabetic Patients ◽  
Dialysis Fluid ◽  
Terminal Renal Failure ◽  
Control Plasma

The effect on plasma glucose and serum insulin of varying amounts of insulin added to the dialysis fluid was studied in a total of 10 diabetic patients on chronic peritoneal dialysis (PD). The studies were carried out in a 3-day and a 14-day model, using dialysis fluid with two different concentrations of glucose (75 mmol/l (isotonic and 200 mmol/l (hypertonic)) and with addition of either 0, 6, 12 or 24 U/l of immunoreactive insulin (IRI) to the dialysis fluid. Plasma glucose and serum insulin were determined before, during and after dialysis. Dialysate concentrations of glucose and insulin were determined for each cycle. Addition of 12 and 24 U of IRI/I resulted in a significant rise in serum insulin. With the isotonic dialysis fluid no insulin was required to control plasma glucose during PD. With the hypertonic dialysis fluid addition of 12 U of IRl/l was optimal for the control of plasma glucose, while 24 U/l produced post-dialytic hypoglucemia.

Home Before Hospital: A Whole of System Re-Design Project to Improve Rates of Home–Based Dialysis Therapy: Experience and Outcomes Over 8 Years

2021 ◽  
Author(s):  
Omar Tombocon ◽  
Peter Tregaskis ◽  
Catherine Reid ◽  
Daniella Chiappetta ◽  
Kethly Fallon ◽  
...  
Keyword(s):  
Decision Making ◽  
Peritoneal Dialysis ◽  
Change Management ◽  
Working Group ◽  
Multidisciplinary Care ◽  
Cost Effective ◽  
Successful Implementation ◽  
Dialysis Therapy ◽  
Outreach Service ◽  
Home Based

Abstract Background Despite evidence that clinical outcomes for patients treated with peritoneal dialysis or home haemodialysis are better than for patients treated with conventional satellite or hospital-based haemodialysis, rates of home-based dialysis therapies world-wide remain low. Home-based dialysis care is also cost effective and indeed the favoured dialysis option for many patients. Methods Using a lean-thinking framework and established change management methodology, a project embracing a system-wide approach at making a change where a Home before Hospital philosophy underpinned all approaches to dialysis care was undertaken. Three multidisciplinary working groups (Pathway, Outreach and Hybrid) were established for re-design and implementation. The primary aim was to improve home-based dialysis therapy prevalence rates from a baseline of 14.8% % by ≥2.5 %/year to meet a target of 35%, whilst not only maintaining but improving the quality of care provided to patients requiring maintenance dialysis. A future state pathway was developed after review of the current state (Pathway Working Group) and formed the basis on which a nurse-led Outreach service (Outreach Working Group) was established. With the support of the multidisciplinary team, the Outreach Service model focussed on early, consistent, and frequent education, patient support in decision making, and clinician engagement. Results A target prevalence of &gt;30 % for home-based therapies (mainly achieved with peritoneal dialysis) was achieved within 2 years. This prevalence rate reached 35% within 3 years and was maintained at 8 years. In addition, selected patients already on maintenance satellite-based haemodialysis (Hybrid Working Group) were educated to achieve high levels of proficiencies in self-care. Conclusion Having the system-wide approach to a Quality Improvement Process and using established principles and change management processes, the successful implementation of a new sustainable model of care focused on home-based dialysis therapy was achieved. A key feature of the model (through Outreach) was early nurse-led education and support of patients in decision making and ongoing support through multidisciplinary care.

Abstract 137: Comparing Blood Pressure Control in Diabetic Versis Nondiabetic Veterans Following Percutaneous Coronary Intervention

2012 ◽  
Vol 32 (suppl_1) ◽  
Author(s):  
Karthik Challa ◽  
Amit Ladani ◽  
Sloane McGraw ◽  
Anupama Shivaraju ◽  
Adhir Shroff
Keyword(s):  
Lifestyle Modification ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Coronary Intervention ◽  
National Committee ◽  
Diabetic Patients ◽  
Channel Blockers ◽  
Antihypertensive Medications ◽  
Converting Enzyme Inhibitors ◽  
The Mean

Background: As per the US Joint National Committee VII (JNC-7) recommendations, patients with known underlying coronary artery disease and diabetes should have goal blood pressures (BP) of systolic (SBP) <130 and diastolic (DBP) <80 to decrease morbidity and mortality associated with cardiovascular disease. In addition to lifestyle modification, these goals can be attained by use of multiple classes of drugs including beta-blockers (BB), angiotensin-converting-enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB), calcium channel blockers (CCB), diuretics and nitrates. Methods: We conducted a retrospective cohort study focusing on the attainment of the JNC-7 guidelines, comparing outcomes between 355 diabetic to 580 non-diabetic patients undergoing PCI between September 2004 and January 2011 at the Jesse Brown Veterans Affairs Hospital in Chicago, IL. BP measurements and antihypertensive medications pre and post PCI at 6-month follow-up were documented. Results: Among the diabetic population, the mean SBP decreased from 136 to 131 mmHg (p = 0.0007) and mean DBP decreased from 73 to 70 mmHg (p = 0.0005). In the non-diabetics, the mean SBP decreased from 133 to 127 mmHg (p < 0.0001) and the mean DBP decreased from 73 to 70 mmHg (p < 0.0001). With regards to JNC-7 guidelines, the percent of diabetics at SBP goal increased from 39% to 49% (p = 0.0053) and percent at DBP goal increased from 73% to 82% (p = 0.0098). In non-diabetics, percent at goal for SBP increased from 45% to 57% (p < 0.0001) and percent at DBP goal increased from 68% to 76% (p = 0.0009). Among diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 79% to 92%. In non-diabetics, there was a statistically significant (p <0.0001) increase in use of BB from 66% to 87% and ACE-I/ARB from 51% to 70%. Conclusions: In both groups undergoing PCI, SBP and DBP improved with more patients achieving JNC-7 targets. Among diabetics, there was a significant increase in utilization of BB. Among non-diabetics, there was a significant increase in utilization of BB and ACE-I/ARB.

scholarly journals Use of inhibitors of the renin angiotensin system and COVID-19 prognosis: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Jessica Barochiner ◽  
Rocio Martinez
Keyword(s):  
Angiotensin Receptor Blockers ◽  
Meta Analysis ◽  
Random Effect ◽  
Renin Angiotensin System ◽  
Cochrane Library ◽  
Composite Outcome ◽  
Converting Enzyme Inhibitors ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Ras Inhibitors

Background: controversy has arisen in the scientific community on whether the use of renin angiotensin system (RAS) inhibitors in the context of COVID-19 would be of benefit or harmful. A meta-analysis of eligible studies comparing the occurrence of severe and fatal COVID-19 in infected patients who were under treatment with angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) vs no treatment or other antihypertensives was conducted. Methods: PubMed, Google Scholar, the Cochrane Library, MedRxiv and BioRxiv were searched for relevant studies. Fixed-effect models or random-effect models were used depending on the heterogeneity between estimates. Results: a total of fifteen studies with 21,614 patients were included. The use of RAS inhibitors was associated with a non-significant 20% decreased risk of the composite outcome (death, admission to intensive care unit, mechanical ventilation requirement or progression to severe or critical pneumonia): RR 0.81 (95%CI: 0.63-1.04), p=0.10, I2=82%. In a subgroup analysis that included hypertensive subjects only, ACEI/ARB were associated with a 27% significant decrease in the risk of the composite outcome (RR 0.73 (95%CI: 0.56-0.96), p=0.02, I2=65%). Conclusion: the results of this pooled analysis suggest that the use of ACEI/ARB does not worsen the prognosis, and could even be protective in hypertensive subjects. Patients should continue these drugs during their COVID-19 illness.

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