Excessive Weight Gain during the First Year of Peritoneal Dialysis Is Associated with Inflammation, Diabetes Mellitus, and a Rapid Decrease in Residual Renal Function

The authors carried out a retrospective chart review in 114 patients treated for at least two years at the Toronto Western Hospital Peritoneal Dialysis Unit and identified eight, who gained an “excessive” amount of weight equal to or greater than 10 kg of their initial weight. These patients had gained an average of 13.1 kg over the preceding two years. They are mostly males and their average age is 51 years. They are well-nourished normotenseive nondiabetics with mostly normal cardiac function. They are adequately dialyzed (per KT/V urea), have little residual renal function and typically have peritoneal membranes characterized by high average transport. According to BIA analysis, this weight gain was likely due to an increase in fat mass accompanied by a trend toward decreasing body-cell mass. This weight gain may be due to increased caloric intake secondary to dialysate glucose absorption in the setting of high average (peritoneal membrane) transport. Such excessive weight gain also may occur if these patients have polymorphism of the UCP-2 gene, which can alter metabolic rate.

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Predictors of Faster Decline of Residual Renal Function in Taiwanese Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080802803s35 ◽

2008 ◽

Vol 28 (3_suppl) ◽

pp. 191-195 ◽

Cited By ~ 3

Author(s):

Chia-Te Liao ◽

Chih-Chung Shiao ◽

Jenq-Wen Huang ◽

Kuan-Yu Hung ◽

Hsueh-Fang Chuang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Function ◽

Peritoneal Dialysis ◽

Clinical Laboratory ◽

Statistical Significance ◽

Univariate Analysis ◽

Residual Renal Function ◽

Measure Data ◽

Chi Square ◽

Artery Disease

⋄ Objective Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan. ⋄ Methods The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR. ⋄ Results All patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis. ⋄ Conclusions Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

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Rate of Decline of Residual Renal Function in Patients on Continuous Peritoneal Dialysis and Factors Affecting It

Peritoneal Dialysis International ◽

10.1177/089686080002000410 ◽

2000 ◽

Vol 20 (4) ◽

pp. 429-438 ◽

Cited By ~ 91

Author(s):

Manoj K. Singhal ◽

Shaunmukhum Bhaskaran ◽

Edward Vidgen ◽

Joanne M. Bargman ◽

Stephen I. Vas ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Multivariate Analysis ◽

Peritoneal Dialysis ◽

Creatinine Clearance ◽

Outcome Measure ◽

Residual Renal Function ◽

Left Ventricular ◽

Male Gender

Objective We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. Study Design Single-center, prospective cohort study. Setting Home PD unit of a tertiary care University Hospital. Patients The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. Measurement All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. Outcome Measure The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. Results There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate ( p = 0.0001), higher rate of peritonitis ( p = 0.0005), higher use of AG ( p = 0.0006), presence of diabetes mellitus ( p = 0.005), larger body mass index (BMI) ( p = 0.01), and no use of antihypertensive medications ( p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. Conclusion Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.

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P1207ANALYSIS OF OUTCOME AND FACTORS ASSOCIATED WITH MAINTENANCE OF PERITONEAL DIALYSIS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1207 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Merita Rroji (Molla) ◽

Saimir Seferi ◽

Larisa Shehaj ◽

Myftar Barbullushi

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

Good Survival ◽

First Year ◽

Technical Failure ◽

Technique Survival ◽

Ultrafiltration Failure ◽

Comorbidity Index ◽

Short Time

Abstract Background and Aims Peritoneal dialysis (PD) is generally associated with a good survival rate and with great preservation of residual renal function (RRF). The various causes of technique failure are responsible for the relative short time staying in PD. Objectives: This study aimed to analyze the outcome and factors correlated with maintenance peritoneal dialysis (PD) to guide for improving prognosis. Method In a retrospective way we examined our PD-cohort concerning mortality, technique survival, peritonitis rate, and other complications. Results From 2005 to 2019 the number of PD patients who have been treated in PD program for more than 3 months was around 199 patient, 29.1% diabetics, mean age 53.3±15.03 years old and meantime in therapy 32.39± 27.34 months. The PD was seen as an alternative for younger patients in the transplant list and elderly patients with comorbidity. Around 7.5% of the PD patients were transplanted and 8.5 % of patients were transferred from HD due to vascular access failure. Around 88.9% of patients were on PD for more than 1 year, 37.7% from 3 up to 5 years and 19.8% percent of the patients have stayed on PD for more than 5 years. Cardiovascular mortality was the main cause of mortality with 53% of the cases. Higher comorbidity index, lower albumin levels, and lower residual renal function were the main risk factors for lower survival. The technical survival of patients was 92.3% during the first year, 79.5% and 69.6% in the second and the fifth year, respectively. There was not found a difference in technical survival between diabetics and nondiabetics patients. Ultrafiltration failure followed by peritonitis was the main reason for transfer patients with more than 24 months in therapy in hemodialysis probably linked with the no availability of icodextrin. Peritonitis rate was 1:41 patient months. Conclusion PD program in our center is organized based in the concept of integrated care in RRT. The outcome of our patients was at least comparable to those reported by larger registries Although we have done good progress in the prevention of infection the nonavailability of icodextrin is an important factor for a technical failure. RRF is an important factor and we need to be more focused to maintain it longer in the future.

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Influence of excessive weight gain in infants of the first year of life on the risk of obesity in schoolchildren

Voprosy praktičeskoj pediatrii ◽

10.20953/1817-7646-2017-5-7-11 ◽

2017 ◽

Vol 12 (5) ◽

pp. 5-11

Author(s):

R.N. Trefilov ◽

◽

L.V. Sofronova ◽

R.M. Akhmedova ◽

◽

...

Keyword(s):

Weight Gain ◽

First Year ◽

Excessive Weight Gain ◽

Excessive Weight ◽

First Year Of Life

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Dietary salt restriction during conservative therapy may prevent declines in residual renal function for the first year after starting peritoneal dialysis in patients with end-stage renal diseases

Integrative Food Nutrition and Metabolism ◽

10.15761/ifnm.1000276 ◽

2020 ◽

Vol 7 (1) ◽

Author(s):

Tetsuaki Hiramatsu ◽

Masashi Mizuno ◽

Yasuhiro Suzuki ◽

Sumiyo Nomori ◽

Yoshiko Shiga ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Conservative Therapy ◽

Residual Renal Function ◽

Renal Diseases ◽

First Year ◽

Dietary Salt ◽

Salt Restriction ◽

Dietary Salt Restriction ◽

End Stage

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A Fast Decline of Residual Renal Function in the First Year is a Predictor for Early Withdrawal from Peritoneal Dialysis in Non-Diabetic Patients

Kidney & Blood Pressure Research ◽

10.1159/000497807 ◽

2019 ◽

Vol 44 (1) ◽

pp. 12-21

Author(s):

Junni Wang ◽

Xishao Xie ◽

Xingqun Yan ◽

Xin Yang ◽

Xiaohui Zhang ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Residual Renal Function ◽

First Year ◽

Diabetic Patients ◽

Early Withdrawal ◽

Fast Decline

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Factors Associated with Sudden Death in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080902900109 ◽

2009 ◽

Vol 29 (1) ◽

pp. 58-63 ◽

Cited By ~ 4

Author(s):

Kai Ming Chow ◽

Cheuk Chun Szeto ◽

Bonnie Ching-Ha Kwan ◽

Kwok Yi Chung ◽

Chi Bon Leung ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Function ◽

Peritoneal Dialysis ◽

Blood Transfusion ◽

Sudden Death ◽

Mineral Metabolism ◽

Residual Renal Function ◽

Alphabetical Order ◽

Dialysis Adequacy ◽

Dialysis Unit

Background Relatively little is known of the epidemiology and predictors of sudden death in peritoneal dialysis (PD) populations. We aimed to identify the risk factors of sudden death among PD subjects. Methods To explore clinical correlates of sudden death in PD patients, we conducted a population-based case-control study using data from a single dialysis unit. Cases ( n = 24) were defined as all PD patients that met the criteria for sudden death during January 2003 through December 2006. We also selected 48 control subjects that were selected from the prevalent PD patient name list compiled in alphabetical order. Data on the hemoglobin, potassium, and calcium levels, residual renal function, dialysis adequacy, cardiovascular risks, comorbid conditions, concurrent use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and erythropoietin, electrocardiographic and echocardiographic findings were extracted from case notes and computer records. Confounders were controlled by logistic regression. Results Over a period of 4 years, 24 PD patients (mean age 61.4 ± 9.5 years, median duration of dialysis 3.1 years) experienced sudden death. Univariate analyses showed that patients that died suddenly were more likely to be male and to have diabetes mellitus, a history of smoking, and a lower small solute clearance as measured by Kt/V. Cases of sudden death were also more likely to have received blood transfusion within the previous 1 year. There were no significant differences between patients and controls for residual renal function, serum potassium levels, control of blood pressure and mineral metabolism, or hemoglobin levels. Multivariate regression analysis confirmed independent association between recent blood transfusion and increased odds of sudden death [adjusted odds ratio (OR) 5.18, 95% confidence interval (CI) 1.44 – 18.6]. Two other factors significantly associated with risk of sudden death were male gender (adjusted OR 4.16, 95% CI 1.14 – 15.2) and diabetes mellitus (adjusted OR 5.33, 95% CI 1.53 – 18.6). Conclusion This study shows that recent blood transfusion is associated with an increased likelihood of sudden death in PD patients. The mechanisms that underlie this observation are unclear.

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