scholarly journals Comparisons of Clinical Outcomes in Patients Transferred to Combined Therapy with Peritoneal Dialysis and Hemodialysis over those Directly Transferred to Hemodialysis: A Prospective Multicenter Study in Japan

2021 ◽  
Author(s):  
Yukio Maruyama ◽  
Keitaro Yokoyama ◽  
Chieko Higuchi ◽  
Tsutomu Sanaka ◽  
Yoshihide Tanaka ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Time Course ◽  
Patient Survival ◽  
Fluid Overload ◽  
Combined Therapy ◽  
Volume Overload ◽  
Small Scale ◽  
Control Group ◽  
Before And After

Abstract Background. Combined therapy with peritoneal dialysis (PD) and hemodialysis (HD) represents a treatment option for PD patients who cannot maintain adequacy of dialysis. Although several reports have indicated the clinical utility of combined therapy, most such studies have been small-scale, single-centered, retrospective and before-and-after test investigations lacking a control group. Methods. We conducted a prospective, multicenter, observational cohort study of 176 incident PD patients and compared patient survival and time-course changes in clinical parameters between patients switched from PD alone to combined therapy and patients switched directly to HD. Results. During a median follow-up of 41 months, 47 patients transferred to combined therapy and 35 patients transferred directly to HD. Among patients transferred to combined therapy, 66% transferred because of inadequate dialysis, and/or fluid overload, compared to only 29% among patients directly transferred to HD. Five patients died after transfer to HD alone, whereas 1 patient died after transfer to combined therapy. Although mortality was greater among patients transferred to HD directly than among patients transferred to combined therapy, this difference disappeared after matching for fluid overload and/or inadequate dialysis.Conclusion. This is the first report comparing clinical outcomes for patients on PD alone transferred to combined therapy with those for patients directly transferred to HD. Although comparison of patient survival was difficult because of the small number of deaths, PD patients suffering from inadequate dialysis and/or volume overload could clearly continue PD therapy safely by switching to combined therapy. Further study with a larger number of outcomes is needed.

scholarly journals Bioimpedance Guided Fluid Management in Peritoneal Dialysis

2020 ◽  
Vol 15 (5) ◽  
pp. 685-694 ◽  
Author(s):  
Na Tian ◽  
Xiao Yang ◽  
Qunying Guo ◽  
Qian Zhou ◽  
Chunyan Yi ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Survival ◽  
Fluid Management ◽  
Volume Overload ◽  
Short Term ◽  
Cardiovascular Disease Mortality ◽  
Technique Survival ◽  
Disease Mortality ◽  
Clinical Methods ◽  
And Control

Background and objectivesBioelectrical impedance analysis (BIA) devices can help assess volume overload in patients receiving maintenance peritoneal dialysis. However, the effects of BIA on the short-term hard end points of peritoneal dialysis lack consistency. This study aimed to test whether BIA-guided fluid management could improve short-term outcomes in patients on peritoneal dialysis.Design, setting, participants, & measurementsA single-center, open-labeled, randomized, controlled trial was conducted. Patients on prevalent peritoneal dialysis with volume overload were recruited from July 1, 2013 to March 30, 2014 and followed for 1 year in the initial protocol. All participants with volume overload were 1:1 randomized to the BIA-guided arm (BIA and traditional clinical methods) and control arm (only traditional clinical methods). The primary end point was all-cause mortality and secondary end points were cardiovascular disease mortality and technique survival.ResultsA total of 240 patients (mean age, 49 years; men, 51%; diabetic, 21%, 120 per group) were enrolled. After 1-year follow-up, 11(5%) patients died (three in BIA versus eight in control) and 21 patients were permanently transferred to hemodialysis (eight in BIA versus 13 in control). The rate of extracellular water/total body water decline in the BIA group was significantly higher than that in the control group. The 1-year patient survival rates were 96% and 92% in BIA and control groups, respectively. No significant statistical differences were found between patients randomized to the BIA-guided or control arm in terms of patient survival, cardiovascular disease mortality, and technique survival (P>0.05).ConclusionsAlthough BIA-guided fluid management improved the fluid overload status better than the traditional clinical method, no significant effect was found on 1-year patient survival and technique survival in patients on peritoneal dialysis.

MO704THE PROGNOSTIC IMPACT OF WEIGHT GAIN AFTER PERITONEAL DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Win Hlaing Than ◽  
Jack K C Ng ◽  
Gordon C K Chan ◽  
Winston Fung ◽  
Cheuk Chun Szeto
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Peritoneal Dialysis ◽  
Weight Gain ◽  
Clinical Outcomes ◽  
Patient Survival ◽  
Survival Rates ◽  
Overweight And Obesity ◽  
Technique Survival ◽  
Technique Failure

Abstract Background and Aims The prevalence of obesity has increased over the past decade in patients with End Stage Kidney Disease (ESKD). Obesity at the initiation of peritoneal dialysis (PD) was reported to adversely affect clinical outcomes. However, there are few studies on the prognostic relevance of weight gain after PD. Method We reviewed the change in body weight of 954 consecutive PD patients from the initiation of dialysis to 2 years after they remained on PD. Clinical outcomes including patient survival, technique survival, and peritonitis rate in the subsequent two years were reviewed. Results The mean age was 60.3 ± 12.2 years; 535 patients (56.1%) were men and 504 (52.8%) had diabetes. After the first 2 years on PD, the average change in body weight was 1.2± 5.1 kg; their body weight was 63.0 ± 13.3 kg; body mass index (BMI) 24.4 ± 4.4 kg/m2. The patient survival rates in the subsequent two years were 64.9%, 75.0%, and 78.9% (log rank test, p = 0.008) for patients with weight loss ≥3 kg during the first 2 years of PD weight change between -3 and +3 kg, and weight gain ≥3 kg, respectively. The corresponding technique survival rates in the subsequent two years were 93.1%, 90.1%, 91.3%, respectively (p = 0.110), and the peritonitis rates were 0.7±1.5, 0.6±1.7, and 0.6±1.1 episodes per patient-year, respectively (p = 0.3). When the actual BMI after the first 2 years of PD was categorized into underweight, normal weight, marginal overweight, overweight, and obesity groups, the patient survival rates in the subsequent two years were 77.3%, 75.2%, 73.3%, 74.3%, and 75.9%, respectively (p= 0.005), and technique survival 98.0%, 91.9%, 88.0%, 92.8%, and 81.0%, respectively (p= 0.001). After adjusting for confounding clinical factors by multivariate Cox regression models, weight gain ≥ 3kg during the first 2 years of PD was an independent protective factor for technique failure (adjusted hazard ratio [AHR] 0.049; 95% confidence interval [CI] 0.004-0.554, p = 0.015), but was an adverse predictor of patient survival (AHR 2.338, 95%CI 1.149-4.757, p = 0.019). In contrast, weight loss ≥ 3kg during the first 2 years of PD did not predict subsequent patient or technique survival. Conclusion Weight gain during the first 2 years of PD confers a significant risk of subsequent mortality but appears to be associated with a lower risk of technique failure. The mechanism of this discordant risk prediction deserves further study.

scholarly journals Efficacy of a New Non-drug Acne Therapy: Aloe Vera Gel Combined With Ultrasound and Soft Mask for the Treatment of Mild to Severe Facial Acne

2021 ◽  
Vol 8 ◽  
Author(s):  
Hongyu Zhong ◽  
Xiang Li ◽  
Wanqi Zhang ◽  
Xiaoxiao Shen ◽  
Yuangang Lu ◽  
...  
Keyword(s):  
Treatment Group ◽  
Side Effects ◽  
Combined Therapy ◽  
Aloe Vera ◽  
Physical Method ◽  
Control Group ◽  
Severe Acne ◽  
Aloe Vera Gel ◽  
Before And After ◽  
Acne Therapy

Background: Acne is a chronic disorder that affects almost 80% of adolescents and young adults, causing psychological and emotional distress. However, the current treatments for acne are either ineffective or have many side effects. This study was designed to confirm and objectively quantify the effect of a new non-drug combined therapy on acne.Methods: This study innovatively utilized ultrasound, which enhanced the absorption of aloe vera gel, and soft mask to make a purely physical method without any drugs. In both the treatment group and control group, the number of papules/pustules and the area of hyperpigmented lesions were counted, and a smart mirror intelligent face system was used before and after the combined therapy. Alterations in the skin functional index were recorded and analyzed statistically.Results: In the treatment group, the combined therapy significantly reduced the number of papules and the area of hyperpigmented lesions and improved skin roughness and local blood circulation. In the control group, there was no obvious improvement over 2 months.Conclusion: This study suggests that the new non-drug combined therapy significantly improved acne, which provided experimental evidence and treatment guidance for patients with mild to severe acne, especially patients with moderate acne. This new therapy may possibly be an appropriate method for patients who seek topical treatments with mild side effects and low antibiotic resistance rates.

Effects of Comorbid Alcohol Use Disorder on the Clinical Outcomes of Schizophrenia: A Nationwide Population-based Study

2021 ◽  
Author(s):  
Soojin Ahn ◽  
Youngjae Choi ◽  
Woohyeok Choi ◽  
Young Tak Jo ◽  
Harin Kim ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Clinical Outcomes ◽  
Alcohol Use Disorder ◽  
Medication Possession Ratio ◽  
Small Sample ◽  
Control Group ◽  
Diagnostic Code ◽  
Psychiatric Admissions ◽  
Before And After ◽  
The Impact

Abstract BackgroundAlcohol use disorder (AUD) is a common psychiatric comorbidity in schizophrenia, associated with poor clinical outcomes and medication noncompliance. Most previous studies on the effect of alcohol use in patients with schizophrenia had limitations of small sample size and a cross-sectional design. Therefore, this study aimed to use a nationwide population database to investigate the impact of AUD on clinical outcomes of schizophrenia.MethodsData from the Health Insurance Review Agency database in South Korea from January 1, 2007 to December 31, 2016 was used. Among 64,442 patients with incident schizophrenia, 1,598 with comorbid AUD were selected based on the diagnostic code F10. We performed between- and within-group analyses to compare the rates of psychiatric admissions and emergency room (ER) visits and medication possession ratio (MPR) with control patients having schizophrenia matched for the onset age, sex, and observation period.ResultsThe rates of psychiatric admissions and ER visits decreased after the diagnosis of AUD in both groups; however, the decrease was significantly greater in patients with comorbid AUD compared to the control group. While the case group showed an increase in MPR after the diagnosis of AUD, MPR decreased in the control patients. The rates of psychiatric admissions, ER visits and MPR were worse in the schizophrenia group with comorbid AUD both before and after the diagnosis of AUD.ConclusionsClinical outcomes were worse in the comorbid AUD group than in the control group before and after the diagnosis of AUD. Considering that patients with schizophrenia with comorbid AUD had poorer clinical outcomes even before the diagnosis of AUD, schizophrenia with comorbid AUD could be a distinct subtype of schizophrenia.

Long-Term Clinical Outcomes of Lupus Nephritis Patients Undergoing Peritoneal Dialysis: A Matched, Case-Control Study

2019 ◽  
Vol 39 (6) ◽  
pp. 570-573
Author(s):  
Hongjian Ye ◽  
Peiyi Cao ◽  
Jianxiong Lin ◽  
Xiao Yang ◽  
Qunying Guo ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lupus Nephritis ◽  
Clinical Outcomes ◽  
Case Control Study ◽  
Patient Survival ◽  
Case Control ◽  
Infection Rates ◽  
Technique Failure ◽  
Control Study

The long-term clinical outcomes of peritoneal dialysis (PD) for patients with lupus nephritis (LN) have not been well researched. In the present study, we investigated the long-term prognosis of a Chinese PD cohort. This was a retrospective case-control study that included LN patients receiving PD treatment for more than 90 days from January 2006 to December 2012. Non-diabetic control patients were selected using a ratio of 1:2 for age- and gender-matching. The primary outcome was all-cause mortality. Secondary outcomes included technique failure and hospitalization rate. All patients were followed up to 31 December 2017. A total of 28 LN patients on PD (89.3% female, mean age 42.2±15.8 years) and 56 controls were included. After a median follow-up period of 53.1 months, 11 LN patients died. The cumulative 1-, 3-, and 5-year patient survival rates were 92.4%, 84.7%, and 67.6% in LN patients, and 100%, 93.5%, and 82.9% in the control group, respectively ( p = 0.035). After adjusting for confounders, LN was not significantly associated with mortality (hazard ratio [HR]: 1.39, 95% confidence interval [CI]: 0.45 – 4.26); However, LN was still an independent risk factor of technique failure (HR: 2.87, 95% CI: 1.08 – 7.66). Meanwhile, the LN group had significantly higher hospitalization and infection rates. In conclusion, LN patients undergoing PD had poor patient survival and technique survival, and higher hospitalization and infection rates.

Phosphatidvlcholine and Intraperitoneal Adhesions

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 77-78 ◽  
Author(s):  
Angelos Michael Kappas ◽  
Michael Fatouros ◽  
Kostas Siamopoulos ◽  
Manolis Mylonakis ◽  
Diamantis Cassioumis
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Wistar Rats ◽  
Adhesion Formation ◽  
Control Group ◽  
Intraperitoneal Adhesions ◽  
The Third ◽  
The Past ◽  
Before And After ◽  
The Difference

Phosphatidylcholine (PC), which has successfully been used in the past to increase ultrafiltration in continuous ambulatory peritoneal dialysis (CAPD) patients, has recently been found to prevent experimental adhesion formation after intraperitoneal irrigation with warm saline. The aim of this study was to determine the most effective route(s) of PC administration in the aforementioned model. Eighty Wistar rats underwent laparotomy and intraperitoneal irrigation with saline at 40°C, which in 20 rats was followed by closure of the abdomen (control group, Gc). In another 20 rats PC was given per os before and after irrigation (per os PC group, GoPc). In the third group PC was diluted in the irrigation fluid (intraperitoneal PC group, GIPC), and in the last group PC was given per os and intraperitoneally (combined PC group, Gcpc) Assessment of adhesions was performed 2 weeks after the irrigation. Adhesions were found in 12 rats in the Gc, 5 rats in the Gopc (p=0.05, Fisher's test), 17 rats in the GIPC, and 3 rats in the Gcpc (p=0.007, Fisher's test). The difference between Gopc and Gcpc was not statistically significant. The decreased adhesion formation after PC administration combined with the increased ultrafiltration may be of considerable importance in CAPD patients.

scholarly journals ALPHA–LIPOIC ACID ANTIOXIDANT EFFICIENCY IN TREATMENT OF PERITONEAL DIALYSIS PATIENTS

2015 ◽  
pp. 42-48
Author(s):  
L. Korol ◽  
N. Stepanova ◽  
O. Ablogina ◽  
L. Migal
Keyword(s):  
Peritoneal Dialysis ◽  
Lipoic Acid ◽  
Negative Influence ◽  
Control Group ◽  
Alpha Lipoic Acid ◽  
Antioxidant Efficiency ◽  
Sh Groups ◽  
Before And After ◽  
Total Peroxidase Activity ◽  
Oxidative Processes

The aim of the study was to evaluate the effectiveness of the antioxidant alpha–lipoic acid in peritoneal dialysis (PD) patients taking into account the state of lipid peroxidation (LPO) and antioxidant protection (AOP) before and after treatment. Patients and methods. The research revealed the intensity of oxidative processes in 20 patients treated with continuous ambulatory peritoneal dialysis (CAPD) on the basis of а–lipoic acid applied parenterally in a dose of 600 mg for 2–weeks followed by a transfer to the 6 weeks of oral reception. The intensity of oxidative processes was evaluated before and after treatment through determining the content of MDA in serum (MDAs) and erythrocytes (MDAe). AOP activity was evaluated by the content of the antioxidant enzyme ceruloplasmin (CP), transferrin (Tr), SH–groups and total peroxidase activity (TPA) of red blood cells. The control group consisted of30 individuals comparable on for age and sex. Results. The effects on the study of PD patients (positive decrease of MDAs, increase in CP higher than control group, a significant increase in the content of SH–groups (p=0,04), TPA (p=0,009), Tr (p=0,002) and catalase serum) demonstrated a considerable positive dynamics of LPO /AOP influenced by the use of а–lipoic acid. Conclusions. The research opens up the prospect for further study ofLPO /AOP blood in PD patients and proves the application expediency of alpha–lipoic acid for this group. Use of the latter lowers the activity of oxidative processes significantly and restores AOP indicators substantially, which in turn minimizes the negative influence of oxidative stress on a patient’s body.

scholarly journals Combined treatment of oligoasthenospermia by postoperative Speroton therapy in patients with varicocele

2020 ◽  
Vol 21 (2) ◽  
pp. 64-69
Author(s):  
E. A. Povelitsa ◽  
V. E. Leanovich ◽  
N. I. Dosta ◽  
O. V. Parhomenko ◽  
A. M. Shesternya
Keyword(s):  
Spermatic Cord ◽  
Varicose Veins ◽  
Combined Therapy ◽  
Combined Treatment ◽  
Sperm Concentration ◽  
Study Groups ◽  
Reproductive Age ◽  
Control Group ◽  
Study Objective ◽  
Before And After

The study objective is to evaluate the effectiveness of the Speroton complex therapy in combined treatment of oligoasthenospermia in patients with varicocele after microsurgical phlebectomy of varicose veins of the spermatic cord.Materials and methods. Microsurgical phlebectomy of the spermatic cord was performed in 40 men (mean age 33.0 ± 2.3 years) with oligoasthenospermia and varicocele. The patients were divided into 2 groups: the main group included 20 men who were treated with the Speroton complex for 3 months in the postoperative period, and the control group included 20 men who did not take Speroton. The spermogram parameters were evaluated before and after the operation.Results. Three months after the start of treatment, a statistically significant improvement in spermogram indicators was noted in all study groups. It was determined that combined therapy that included the Speroton complex administration for 3 months, statistically significantly led to the more considerable increase in sperm parameters than in control group: the sperm concentration increased to 38.6 and 28.9 mln/ml, respectively, the percentage of progressive motile sperm – to 49.2 and 39.4 %, the percentage of motile forms – to 72.2 and 43.8 %, viable forms – to 67.8 and 58.1 %, and the percentage of sperm with DNA fragmentation decreased to 12.1 and 17.2 %, respectively, in the main and control groups.Conclusion. Combined treatment with postoperative Speroton therapy for men of reproductive age with infertility and varicocele determines the more significant improvement in the parameters of sperm than performing only surgical correction of varicocele.

Biocompatibility of New Peritoneal Dialysis Solutions: What Can We Hope to Achieve?

2000 ◽  
Vol 20 (5_suppl) ◽  
pp. 57-67 ◽  
Author(s):  
Sung Hee Chung ◽  
Peter Stenvinkel ◽  
Jonas Bergström ◽  
Bengt Lindholm
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Survival ◽  
Fluid Overload ◽  
Systemic Effects ◽  
Peritoneal Membrane ◽  
Local Effects ◽  
Positive Effects ◽  
Baxter Healthcare ◽  
And Function ◽  
Mia Syndrome

Despite the bioincompatibility of the “old”, standard, high glucose, lactate-buffered peritoneal dialysis (PD) solutions, PD is itself a highly successful dialysis modality with patient survival equivalent to that of hemodialysis (HD) during the initial 3 – 5 years of dialysis therapy. Nevertheless, PD technique survival is often limited by infectious complications and alterations in the structure and function of the peritoneal membrane. These local changes also have a negative impact on patient survival owing to systemic effects such as those often seen in patients with high peritoneal transport rate and loss of ultrafiltration (UF) capacity. Patient mortality remains unacceptably high in both HD and PD patients, with most premature deaths being associated with signs of malnutrition, inflammation, and atherosclerotic cardiovascular disease (MIA syndrome). These systemic signs are likely to be influenced by PD solutions both directly and indirectly (via changes in the peritoneal membrane). New, biocompatible PD solutions may have favorable local effects (viability and function of the peritoneal membrane) and systemic effects (for example, on MIA syndrome). Amino acid–based solution [Nutrineal (N): Baxter Healthcare Corporation, Deerfield, IL, U.S.A.] may improve nutritional status as well as peritoneal membrane viability. Bicarbonate/lactate–buffered solution [Physioneal (P): Baxter Healthcare Corporation] may ameliorate local and systemic effects of low pH, high lactate, and high glucose degradation products. Icodextrin-based solution [Extraneal (E): Baxter Healthcare SA, Castlebar, Ireland] may improve hypertension and cardiovascular problems associated with fluid overload and may extend time on therapy in patients with loss of UF capacity. The positive effects of each of these new, biocompatible solutions have been demonstrated in several studies. It is likely that the combined use of N, P, and E solutions will produce favorable synergies in regard to both local effects (peritoneal viability) and systemic effects (less malnutrition, inflammation, and fluid overload). Solution combination is an exciting area for clinical study in the coming years. Furthermore, dialysis fluid additives such as hyaluronan, which protects and improves the function of the peritoneal membrane, may further improve PD solutions. The new, biocompatible PD solutions represent an entirely new era in the evolution of the PD therapy; they are likely to have markedly positive effects on both PD technique and PD patient survival in coming years.

Patient-Doctor Contact Interval and Clinical Outcomes in Continuous Ambulatory Peritoneal Dialysis Patients

2017 ◽  
Vol 45 (4) ◽  
pp. 346-352 ◽  
Author(s):  
Chunyan Yi ◽  
Qunying Guo ◽  
Jianxiong Lin ◽  
Jianying Li ◽  
Xueqing Yu ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
Operating Characteristic ◽  
Patient Survival ◽  
Characteristic Curve ◽  
Survival Rates ◽  
Guangzhou City ◽  
Clinical Events ◽  
The Mean

Background: The optimal patient-doctor contact (PDC) interval remains unknown in peritoneal dialysis (PD) patients. The aim was to investigate the association between PDC interval and clinical outcomes in continuous ambulatory PD (CAPD) patients. Methods: In this retrospective cohort study, CAPD patients who resided in Guangzhou city between January 2006 and December 2012 were included. According to receiver operating characteristic curve analysis, all patients were classified as high (PDC interval ≤2 months) and low (PDC interval >2 months) PDC frequency groups. Biochemical data, clinical events, and clinical outcomes during the follow-up period were compared. Results: Of 433 CAPD patients, the mean age was 51.3 ± 15.7 years, 54.3% of patients were male, and 29.1% with diabetes. The median vintage of PD was 45.8 (26.3-69.1) months. Patients with high PDC frequency (n = 233) had better patient-survival rates (99.6, 87.7, and 76.5% vs. 92.7, 76.5, and 58.7% at 1, 3, and 5 years; p < 0.001), lower peritonitis rate (0.17 vs. 0.23 episodes per patient-year; p < 0.001), and hospitalization rate (0.49 vs. 0.67 episodes per patient-year; p < 0.001) than those in the low PDC frequency group (n = 200). After adjustment for confounders, PDC interval of no more than 2 months was independently associated with better patient survival (hazard ratio 0.60, 95% CI 0.42-0.86, p = 0.006). Conclusion: A PDC interval of 2 months or less was associated with better clinical outcomes in CAPD patients. This indicates that a shorter PDC interval should be encouraged for them to achieve better clinical outcomes.

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