scholarly journals Association of blood pressure after peritoneal dialysis initiation with the decline rate of residual kidney function in newly-initiated peritoneal dialysis patients

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254169
Author(s):  
Yusuke Kuroki ◽  
Kei Hori ◽  
Kazuhiko Tsuruya ◽  
Dai Matsuo ◽  
Koji Mitsuiki ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
European Society ◽  
Regression Line ◽  
Logarithmic Scale ◽  
Residual Kidney Function ◽  
Decline Rate ◽  
European Society Of Cardiology ◽  
Annual Decline

Background Lower blood pressure (BP) levels are linked to a slower decline of kidney function in patients with chronic kidney disease (CKD) without kidney replacement therapy. However, there are limited data on this relation in peritoneal dialysis (PD) patients. Here we evaluated the association of BP levels with the decline of residual kidney function (RKF) in a retrospective cohort study. Methods We enrolled 228 patients whose PD was initiated between 1998 and 2014. RKF was measured as the average of creatinine and urea clearance in 24-hr urine collections. We calculated the annual decline rate of RKF by determining the regression line for individual patients. RKF is thought to decline exponentially, and thus we also calculated the annual decline rate of logarithmic scale of RKF (log RKF). We categorized the patients’ BP levels at 3 months after PD initiation (BP3M) into four groups (Optimal, Normal & High normal, Grade 1 hypertension, Grade 2 & 3 hypertension) according to the 2018 European Society of Cardiology and European Society of Hypertension Guidelines for the management of arterial hypertension. Results The unadjusted, age- and sex-adjusted, and multivariable-adjusted decline rate of RKF and log RKF decreased significantly with higher BP3M levels (P for trend <0.01). Compared to those of the Optimal group, the multivariable-adjusted odds ratios (95% confidence interval) for the faster side of the median decline rate of RKF and log RKF were 4.04 (1.24–13.2) and 5.50 (1.58–19.2) in the Grade 2 and 3 hypertension group, respectively (p<0.05). Conclusions Higher BP levels after PD initiation are associated with a faster decline in RKF among PD patients.

Volume management as a key dimension of a high-quality PD prescription

2020 ◽  
Vol 40 (3) ◽  
pp. 282-292 ◽  
Author(s):  
Angela Yee-Moon Wang ◽  
Jie Dong ◽  
Xiao Xu ◽  
Simon Davies
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Clinical Care ◽  
Small Sample ◽  
Volume Status ◽  
Volume Control ◽  
High Quality ◽  
Volume Management ◽  
Residual Kidney Function

Background: Appropriate volume control is one of the key goals in a peritoneal dialysis (PD) prescription. As such it is an important component of the International Society of Peritoneal Dialysis (ISPD) guideline for “High-quality PD prescription” necessitating a review of the literature on volume management. The workgroup recognized the importance of including within its scope measures of volume status and blood pressure in prescribing high-quality PD therapy. Methods: A Medline and PubMed search for publications addressing volume status and its management in PD since the publication of the 2015 ISPD Adult Cardiovascular and Metabolic Guidelines, from October 2014 through to July 2019, was conducted. Results: There were no randomized controlled trials on blood pressure intervention and six randomized trials of bioimpedance-guided volume management. Generally, all studies were of small sample size, short duration, and used surrogate markers as primary outcomes. As a consequence, only “practice points” were drawn. High-quality goal-directed PD prescription should aim to achieve and maintain clinical euvolemia taking residual kidney function and its preservation into account, so that both fluid removal from peritoneal ultrafiltration and urine output are considered and residual kidney function is not compromised. Blood pressure should be included as a key objective parameter in assessing the quality of PD prescription but there is currently no evidence for a specific target in PD. Clinical examination remains the keystone of routine clinical care. Conclusions: High-quality goal-directed PD prescription should include volume management as one of the key dimensions.

scholarly journals Individualized Hemodialysis Treatment: A Perspective on Residual Kidney Function and Precision Medicine in Nephrology

2018 ◽  
Vol 9 (2) ◽  
pp. 69-82 ◽  
Author(s):  
Inkyong Hur ◽  
Yong Kyu Lee ◽  
Kamyar Kalantar-Zadeh ◽  
Yoshitsugu Obi
Keyword(s):  
Blood Pressure ◽  
Precision Medicine ◽  
Kidney Function ◽  
Hemodialysis Patients ◽  
Maintenance Hemodialysis ◽  
Clinical Aspects ◽  
Patient Centeredness ◽  
Mineral And Bone Disorder ◽  
Term Survival ◽  
Residual Kidney Function

Background: Residual kidney function (RKF) is often expected to inevitably and rapidly decline among hemodialysis patients and, hence, has been inadvertently ignored in clinical practice. The importance of RKF has been revisited in some recent studies. Given that patients with end-stage renal disease now tend to initiate maintenance hemodialysis therapy with higher RKF levels, there seem to be important opportunities for incremental hemo­dialysis by individualizing the dose and frequency according to their RKF levels. This approach is realigned with precision medicine and patient-centeredness. Summary: In this article, we first review the available methods to estimate RKF among hemodialysis patients. We then discuss the importance of maintaining and monitoring RKF levels based on a variety of clinical aspects, including volume overload, blood pressure control, mineral and bone metabolism, nutrition, and patient survival. We also review several potential measures to protect RKF: the use of high-flux and biocompatible membranes, the use of ultrapure dialysate, the incorporation of hemodiafiltration, incremental hemodialysis, and a low-protein diet, as well as general care such as avoiding nephrotoxic events, maintaining appropriate blood pressure, and better control of mineral and bone disorder parameters. Key Message: Individualized hemodialysis regimens may maintain RKF, lead to a better quality of life without compromising long-term survival, and ensure precision medicine and patient-centeredness in nephrology practice.

Association of B-Type Natriuretic Peptide Level with Residual Kidney Function in Incident Peritoneal Dialysis Patients

2019 ◽  
Vol 39 (2) ◽  
pp. 147-154 ◽  
Author(s):  
Yasuhiro Kawai ◽  
Shigeru Tanaka ◽  
Hisako Yoshida ◽  
Masatoshi Hara ◽  
Hiroaki Tsujikawa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Natriuretic Peptide ◽  
Subgroup Analysis ◽  
Proportional Hazards Model ◽  
Urine Volume ◽  
Cox Proportional Hazards Model ◽  
University Hospital ◽  
Residual Kidney Function ◽  
Increased Risk

Background Residual kidney function (RKF) is an important factor influencing both technique and patient survival in peritoneal dialysis (PD) patients. B-type natriuretic peptide (BNP) is considered a marker of cardio-renal syndrome. The relationship between BNP and RKF in PD patients remains unclear. Methods We conducted a prospective study of 89 patients who had started and continued PD for 6 months or more in Kyushu University Hospital between June 2006 and September 2015. Participants were divided into low BNP (≤ 102.1 ng/L) and high BNP (> 102.1 ng/L) groups according to median plasma BNP level at PD initiation. The primary outcome was RKF loss, defined as 24-hour urine volume less than 100 mL. We estimated the association between BNP and RKF loss using a Kaplan-Meier method and Cox proportional hazards model and compared the rate of RKF decline between the 2 groups. To evaluate the consistency of the association, we performed subgroup analysis stratified by baseline characteristics. Results During the median follow-up of 30 months, 30 patients lost RKF. Participants in the high BNP group had a 5.87-fold increased risk for RKF loss compared with the low BNP group after adjustment for clinical and cardiac parameters. A high plasma BNP level was more clearly associated with RKF loss in younger participants compared with older participants in subgroup analysis. Conclusions B-type natriuretic peptide may be a useful risk marker for RKF loss in PD patients. The clinical importance of plasma BNP level as a marker of RKF loss might be affected by age.

scholarly journals High rates of protein intake are associated with an accelerated rate of decline of residual kidney function in incident peritoneal dialysis patients

2019 ◽  
Vol 34 (8) ◽  
pp. 1394-1400 ◽  
Author(s):  
Pablo Otero Alonso ◽  
Miguel Pérez Fontán ◽  
Antía López Iglesias ◽  
Teresa García Falcón ◽  
Ana Rodríguez-Carmona
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Odds Ratio ◽  
Protein Intake ◽  
First Year ◽  
Main Study ◽  
Study Variable ◽  
Residual Kidney Function ◽  
Rate Of Decline

AbstractBackgroundPreservation of residual kidney function (RKF) is a relevant objective in peritoneal dialysis (PD) patients. The influence of dietary protein intake (PI) on this variable has not been adequately investigated.MethodsFollowing an observational design, we studied 336 patients incident on PD, with a minimum follow-up of 6 months. The main study variable was the mean PI [normalized rate of protein nitrogen appearance (nPNA)] during the first 4 months on PD. The main outcome variables were the absolute rate of decline of RKF and the proportion of patients presenting a >50% decay of their RKF during the first year of follow-up. We applied univariate and multivariate strategies of analysis, taking into consideration the main control variables bearing a correlation with nPNA and/or RKF.ResultsMean nPNA (first 4 months) was 1.23 ± 0.33 g/kg/day, while the overall rate of decline of RKF was −0.13 ± 0.29 mL/min/month; 69 patients (25.1%) had lost >50% of their initial RKF by the end of the first year. Univariate analysis disclosed consistent associations between the main study variable on one hand and baseline RKF (r = 0.32, P < 0.0005) and its rate of decline (r = −0.23, P < 0.0005) on the other. The latter two variables were also significantly correlated (r = −0.36, P < 0.0005). Multivariate analysis identified mean nPNA as an independent predictor of the rate of decline of RKF [odds ratio 1.09 per 0.10 g/kg/day, 95% confidence interval (CI) 0.99–1.19, P = 0.058] and, in particular, of the probability of losing >50% of the baseline RKF during the first year of treatment (odds ratio 1.15 per 0.10 g/kg/day, 95% CI 1.04–1.27, P = 0.006).ConclusionHigher rates of PI during the first months of therapy are associated with a faster decline of RKF among patients incident on PD. Our results underline the convenience of keeping an adequate balance between sufficient protein ingestion, to prevent malnutrition and wasting, and sensible restriction in stable, adequately nourished individuals with rates of intake in the higher range or above-recommended allowances.

scholarly journals Intermittent Peritoneal Dialysis: Urea Kinetic Modeling and Implications of Residual Kidney Function

2012 ◽  
Vol 32 (2) ◽  
pp. 142-148 ◽  
Author(s):  
Steven Guest ◽  
Alp Akonur ◽  
Arshia Ghaffari ◽  
James Sloand ◽  
John K. Leypoldt
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Function ◽  
Low Dose ◽  
High Dose ◽  
Urea Clearance ◽  
Home Setting ◽  
Residual Kidney Function ◽  
Baxter Healthcare ◽  
Fill Volume ◽  
Treatment Adequacy

♦BackgroundIntermittent peritoneal dialysis (IPD) is an old strategy that has generally been eclipsed, in the home setting, by daily peritoneal therapies. However, for a select group of patients with exhausted vascular access or inability to receive PD at home, in-center IPD may remain an option or may serve as an incremental strategy before initiation of full-dose PD. We investigated the residual kidney clearance requirements necessary to allow thrice-weekly IPD regimens to meet current adequacy targets.♦MethodsThe 3-pore model of peritoneal transport was used to examine 2 thrice-weekly IPD dialysis modalities: 5 – 6 dwells with 10 – 12 L total volume (low-dose IPD), and 50% tidal with 20 – 24 L total volume (high-dose IPD). We assumed an 8-hour dialysis duration and 1.5% dextrose solution, with a 2-L fill volume, except in tidal mode. The PD Adequest application (version 2.0: Baxter Healthcare Corporation, Deerfield, IL, USA) and typical patient kinetic parameters derived from a large dataset [data on file from Treatment Adequacy Review for Gaining Enhanced Therapy (Baxter Healthcare Corporation)] were used to model urea clearances. The minimum glomerular filtration rate (GFR) required to achieve a total weekly urea Kt/V of 1.7 was calculated.♦ResultsIn the absence of any dialysis, the minimum residual GFR necessary to achieve a weekly urea Kt/V of 1.7 was 9.7 mL/min/1.73 m2. Depending on membrane transport type, the low-dose IPD modality met urea clearance targets for patients with a GFR between 6.0 mL/min/1.73 m2and 7.6 mL/min/1.73 m2. Similarly, the high-dose IPD modality met the urea clearance target for patients with a GFR between 4.7 mL/min/1.73 m2and 6.5 mL/min/1.73 m2.♦ConclusionsIn patients with residual GFR of at least 7.6 mL/min/1.73 m2, thrice-weekly low-dose IPD (10 L) achieved a Kt/V urea of 1.7 across all transport types. Increasing the IPD volume resulted in a decreased residual GFR requirement of 4.7 mL/min/1.73 m2(24 L, 50% tidal). In patients with residual kidney function and dietary compliance, IPD may be a viable strategy in certain clinical situations.

scholarly journals New АСС/AHA and ESC/ESH arterial hypertension guidelines

2018 ◽  
Vol 17 (5) ◽  
pp. 99-119 ◽  
Author(s):  
E. V. Reznik ◽  
I. G. Nikitin
Keyword(s):  
Blood Pressure ◽  
Arterial Hypertension ◽  
European Society ◽  
American Heart Association ◽  
American Heart ◽  
Heart Association ◽  
National Guidelines ◽  
Hypertension Guidelines ◽  
European Society Of Cardiology ◽  
Detection Evaluation

The American College of Cardiology and the American Heart Association updated the guideline for the prevention, detection, evaluation and management of high blood pressure in adults in 2017 The European Society of Cardiology and the European Society оf Hypertension updated guidelines for the management of arterial hypertension in 2018. This article reviews new positions of these documents, compares approaches to current issues of managing of the patients with arterial hypertension, pro and contra with previous versions of similar documents. It is necessary to update the National guidelines for management of patients with arterial hypertension, which should include the dignity of both European and American approaches.

scholarly journals Approaches to the Diagnosis and Treatment of Arterial Hypertension in the Light of European Recommendations

Kardiologiia ◽  
2019 ◽  
Vol 59 (9) ◽  
pp. 64-70
Author(s):  
V. N. Larina ◽  
B. Ya. Bart ◽  
E. A. Vartanian ◽  
E. V. Fedorova ◽  
M. P. Mikhailusova ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Drug Treatment ◽  
Arterial Hypertension ◽  
European Society ◽  
Initial Therapy ◽  
Ambulatory Bp Monitoring ◽  
Single Pill ◽  
European Society Of Cardiology

In this review we present analysis the European recommendations on hypertension – what’s new and what has changed in the tactics of managing patients with arterial hypertension (AH). We compared recommendations on hypertension of the European Society of Cardiology (ESC) and the European Society of hypertension (ESH) 2018 with European recommendations of previous years. In the updated version of guidelines, it is still recommended to determine AH as blood pressure (BP) ≥140 and / or ≥90 mm Hg; to subdivide BP levels into optimal, normal, and high normal, to classify severity of AH as 3 degrees, and to distinguish separately its isolated systolic form. Values for out-of-office BP remained unchanged, but recommendations emerged concerning wider use of ambulatory BP monitoring and self-measurement of BP. For initial therapy, it was recommended to use two drugs combinations preferably as single pill combinations. An increase of the role of nurses and pharmacists in teaching, supporting patients and controlling hypertension has been noted. This can improve the achievement of target BP and, as a result, reduce the cardiovascular risk. New European recommendations highlight the modern aspects of classification and diagnosis of AH, main stages of screening, and algorithm of drug treatment of AH.

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