Holistic nursing approach to improve outcome in diabetic patients on peritoneal dialysis

2017 ◽  
Author(s):  
Krisztina Budai
Keyword(s):  
Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Holistic Nursing ◽  
Improve Outcome

scholarly journals Insulin Resistance as a Predictor of Cardiovascular Disease in Patients on peritoneal dialysis

2013 ◽  
Vol 33 (4) ◽  
pp. 411-418 ◽  
Author(s):  
Yun Li ◽  
Lihua Zhang ◽  
Yong Gu ◽  
Chuanming Hao ◽  
Tongying Zhu
Keyword(s):  
Insulin Resistance ◽  
Peritoneal Dialysis ◽  
Independent Predictor ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Model Assessment ◽  
Mortality Hazard ◽  
Cv Disease ◽  
The Impact ◽  
Mortality Hazard Ratio

BackgroundInsulin resistance is associated with multiple risk factors for cardiovascular (CV) disease in the general population. Patients on peritoneal dialysis (PD) are more likely to develop insulin resistance. However, no evaluation of the impact of insulin resistance on CV disease morbidity or mortality in patients on PD has been performed.MethodsOur prospective cohort study included all non-diabetic patients on PD at our center ( n = 66). Insulin resistance was evaluated at baseline by the homeostasis model assessment method (HOMA-IR) using fasting glucose and insulin levels. The cohort was followed for up to 58 months (median: 41.3 months; interquartile range: 34.3 months). A multivariate Cox model was used to analyze the impact of insulin resistance on CV disease mortality.ResultsFourteen CV events occurred in the higher HOMA-IR group [IR-H (HOMA-IR values in the range 2.85 – 19.5), n = 33], but only one event occurred in the lower HOMA-IR group (IR-L (HOMA-IR values in the range 0.83 – 2.71), n = 33) during the follow-up period. Level of HOMA-IR was a significant predictor of CV events [risk ratio: 17.7; 95% confidence interval (CI): 2.10 to 149.5; p = 0.008]. In the IR-H group, 10 patients died (8 CV events), but in the IR-L group, only 4 patients died (1 CV event). Patients in the IR-H group experienced significantly higher CV mortality (hazard ratio: 9.02; 95% CI: 1.13 to 72.2; p = 0.04). Even after adjustments for age, systolic blood pressure, body mass index, C-reactive protein, triglycerides, resistin, and leptin, HOMA-IR remained an independent predictor of CV mortality (hazard ratio: 14.8; 95% CI: 1.22 to 179.1; p = 0.03).ConclusionsInsulin resistance assessed using HOMA-IR was an independent predictor of CV morbidity and mortality in a cohort of nondiabetic patients on PD. Insulin resistance is a modifiable risk factor; the reduction of insulin resistance may reduce CV risk and improve survival in this group of patients.

Acid–Base Disturbances

2014 ◽  
pp. 594-602
Author(s):  
Julian L. Seifter
Keyword(s):  
United States ◽  
Cardiovascular Disease ◽  
Peritoneal Dialysis ◽  
Renal Transplantation ◽  
End Stage Renal Disease ◽  
The United States ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Stage Renal Disease ◽  
End Stage

According to projections from the United States Renal Data Service (USRDS), 〉600,000 individuals in the United States will have end-stage renal disease (ESRD) by 2010. The leading cause of ESRD in the United State is diabetes, followed by hypertension. As the care of diabetic patients has improved, particularly in the area of cardiovascular disease, they are living through their cardiovascular complications long enough to develop ESRD. As a consequence, since the inception of the Medicare ESRD program. the dialysis population has gradually become older with increasing numbers of comorbid conditions. Renal replacement therapy in the form of hemodialysis or peritoneal dialysis may serve as a bridge to the best form of renal replacement, renal transplantation. The demand for suitable kidneys for transplantation far exceeds the supply, leaving many patients on dialysis for extended periods of time.

Experience with Continuous Ambulatory Peritoneal Dialysis in Belgium

1980 ◽  
Vol 1 (5) ◽  
pp. 54-58 ◽  
Author(s):  
Norbert H. Lameire ◽  
Marc De Paepe ◽  
Raymond Vanholder ◽  
Johan Verbanck ◽  
Severin Ringoir
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Average Rate ◽  
Sodium Concentration ◽  
Risk Category ◽  
Diabetic Patients ◽  
Serum Triglycerides ◽  
Number Of Patients ◽  
Stage Renal Disease ◽  
End Stage

This paper has reviewed experience in Belgium with 99 patients on CAPD. They represent 6-7% of all dialysis patients in this country. The principle reasons for selecting CAPD were old age, problems with vascular access and major cardiovas cular complications. Hemoglobin and hematrocrit values increased in all patients but preliminary measurements of red cell volume in some of them showed no change. Most patients showed moderate increases in serum triglycerides. In three non-diabetic patients with marked elevation in triglyceride levels, insulin, given intraperitoneally, prevented further increases. The frequency of peritonitis was still high; the average rate was one episode every 7.6 patient months. Other major complications included hypotension, which improved after the substitution of dialysate with a higher sodium concentration, severe respiratory disease and gangrene of the legs. After a mean follow-up of seven months, the death rate was 18% and the rate of technical success was 70%. The fact that most of our patients were in the high-risk category should be kept in mind when comparing these results with those obtained with other modes of treatment. At the end of 1978, a total of 1195 patients with end-stage renal disease (ESRD) were treated on either home or hospital dialysis in Belgium. There were 50 dialysis centers for a total population of 9.8 million. Of these 1195 patients, only seven were treated with either continuous ambulatory peritoneal dialysis (2-4) or intermittent peritoneal dialysis. Since then and until July 1, 1980 the number of patients treated with CAPD in Belgium has increased to 99 and this paper describes our experience with these patients.

Risk Factors Responsible for Ultrafiltration Failure in Early Stages of Peritoneal Dialysis

2000 ◽  
Vol 20 (6) ◽  
pp. 631-636 ◽  
Author(s):  
Rafael Selgas ◽  
M.-Auxiliadora Bajo ◽  
M.-José Castro ◽  
Gloria Del Peso ◽  
Abelardo Aguilera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Control Group ◽  
Diabetic Patients ◽  
Rapid Loss ◽  
The Third ◽  
Early Stages ◽  
Ultrafiltration Failure ◽  
Peritoneal Function ◽  
Over Time

Objective To define risk factors for ultrafiltration failure (UFF) during early stages of peritoneal dialysis (PD). Design Retrospective analysis of a group of patients whose peritoneal function was prospectively followed. Setting A tertiary-care public university hospital. Patients Nineteen of 90 long-term PD patients required a peritoneal resting period to recover UF capacity: 8 had this requirement before the third year on PD (early, EUFF group) and 11 had a late requirement (LUFF group). The remaining 71 patients, those with stable peritoneal function over time, constituted the control group. Main Outcome Measures Peritoneal UF capacity under standard conditions (monthly) and small solute peritoneal transport (yearly). Results None of the conditions appearing at the start of PD or during the observation period could be definitely identified as the cause of UFF. There were no differences in characteristics between the EUFF group and the other two groups, except for the higher prevalence of diabetes in the EUFF group. Residual renal function (RRF) declined in all three groups during the first 2 years, with rapid loss during the third year in the EUFF group. This rapid loss in RRF was coincident with UFF. Peritoneal solute and water transport at baseline was similar in the three groups. After 2 years on PD, individuals in the EUFF group showed a significantly lower UF and higher creatinine mass transfer coefficient values than those in the LUFF group. Diabetic patients in the control group showed remarkable stability in UF capacity over time. During the second year on PD, requirement for increases in dialysate glucose concentration was 3.4 ± 0.5% in the LUFF group, but as high as 25.5 ± 24.2% in the EUFF group. The accumulated days of active peritonitis (APID, days with cloudy effluent) were similar for the three groups after 1, 2, and 3 years on PD. Interestingly, diabetic patients in the control group showed an APID index significantly lower than the overall EUFF group. Diabetics in the control group also had significantly lower APID versus nondiabetics in the control group ( p = 0.016). Conclusions Our findings suggest that certain patients develop early UFF type I. Diabetic state and a higher glucose requirement to obtain adequate UF suggest that glucose on both sides of the peritoneal membrane could be responsible. The mechanisms for this higher requirement remain to be elucidated. The identification of a larger cohort of these early UFF patients should lead to a better exploration of the primary pathogenic mechanisms.

The Diabetic Patient on Continuous Ambulatory Peritoneal Dialysis

1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 16-20 ◽  
Author(s):  
C.T. Flynn
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Diabetic Patients ◽  
Term Survival ◽  
Basic Issue ◽  
Insulin Dependent ◽  
Intraperitoneal Insulin ◽  
Insulin Dependent Diabetic

Insulin-dependent diabetics with renal failure have a relatively poor long-term survival. The basic issue, therefore, is quality of life. CAPD allows the patient to be independent. The procedure can be performed as well by the blind as by a sighted patient and thus is available to blind diabetics. Intraperitoneal insulin offers a safe, consistent and convenient control of the blood sugar. Our experience suggests that continuous ambulatory peritoneal dialysis is the dialytic treatment of choice for the majority of insulin-dependent diabetic patients.

Chiropody May Prevent Amputations in Diabetic Patients on Peritoneal Dialysis

2003 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Jennifer Lipscombe ◽  
Sarbjit V. Jassal ◽  
Susan Bailey ◽  
Joanne M. Bargman ◽  
Stephen Vas ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Disease ◽  
Peripheral Vascular Disease ◽  
Tertiary Care ◽  
Diabetic Patients ◽  
Care Hospital ◽  
Peripheral Vascular ◽  
Foot Care ◽  
Care Assessment ◽  
Patients With Diabetes

← Background A multidisciplinary approach has been shown to be of benefit in the prevention of lower limb ulceration and amputation in patients with diabetes, but there is less information on the role of such an approach in patients receiving dialysis treatment. ← Objective The purpose of the present study was to determine whether the institution of a chiropody program would result in fewer amputations in diabetic patients on peritoneal dialysis (PD). ← Design Retrospective chart review. ← Setting The PD program at a tertiary-care hospital. ← Patients Patients with diabetes that were enrolled in the PD program between January 1997 and December 1999, inclusive, that were offered the opportunity to see a chiropodist, and that agreed to be seen. A total of 132 patients were included. ← Intervention Education about foot care, assessment, and, in some instances, treatment by a chiropodist. ← Results Patients with an amputation were more likely to be male ( p < 0.01) and have peripheral vascular disease ( p < 0.001) compared to those without an amputation. They also had a lower average mean arterial pressure ( p < 0.05), lower weekly creatinine clearance ( p < 0.01), higher mean erythropoietin dose ( p < 0.05), and longer duration of end-stage renal disease ( p < 0.001). Factors that were predictive of shorter time to death or amputation were older age [hazard ratio (HR) = 1.03, p < 0.05], peripheral vascular disease (HR = 2.66, p < 0.01), and cerebrovascular disease (HR = 2.70, p < 0.01). Being seen by a chiropodist was protective (HR = 0.39, p < 0.01). ← Conclusion The current study suggests that a chiropody program may help to prevent amputation in patients with diabetes on PD.

Hepatic Subcapsular Steatosis as a Complication Associated with Intraperitoneal Insulin Treatment in Diabetic Peritoneal Dialysis Patients

2005 ◽  
Vol 25 (6) ◽  
pp. 596-600 ◽  
Author(s):  
Dilek Torun ◽  
Levent Oguzkurt ◽  
Siren Sezer ◽  
Aysegul Zumrutdal ◽  
Metin Singan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Insulin Treatment ◽  
Tertiary Care ◽  
Serum Triglyceride ◽  
Insulin Dosage ◽  
Diabetic Patients ◽  
Serum Triglyceride Level ◽  
Glucose Levels ◽  
Daily Insulin

Objectives The aim of this study was to evaluate hepatic subcapsular steatosis (HSS) and its association with clinical parameters in nondiabetic continuous ambulatory peritoneal dialysis (CAPD) patients and in diabetic CAPD patients receiving intraperitoneal (IP) or subcutaneous (SC) insulin. Design Cross-sectional study. Setting A tertiary-care university hospital. Patients 28 CAPD patients (17 males and 11 females; mean age 53.5 ± 14 years; mean CAPD duration 22.8 ± 9 months) were included in the study. 14 patients had type II diabetes mellitus and 14 were nondiabetics. In the diabetic group, 8 patients were receiving IP insulin and 6 were receiving SC insulin. Outcome Measures HSS was diagnosed on computed tomography without contrast administration. Other data collected were body mass index (BMI), weekly Kt/V, peritoneal equilibration test (PET) results, daily insulin dosage, duration of diabetes mellitus, duration of insulin treatment, dialysate glucose load, and serum findings for alanine aminotransferase, aspartate aminotransferase, albumin, and lipid profiles. Results HSS was detected in 5 of the 8 diabetics who were receiving IP insulin. None of the diabetics receiving SC insulin and none of the nondiabetic patients exhibited HSS. Daily insulin dosage [108 (95 – 108.5) vs 54 (36 – 72) U/day, p = 0.02], BMI [31 (30.5 – 36) vs 26.6 (26 – 30) kg/m2, p = 0.02], serum triglyceride level [194 (184 – 505) vs 69 (61 – 82) mg/dL, p = 0.04], and PET creatinine levels [D/P2 creat: 0.67 (0.54 – 0.74) vs 0.50 (0.50 – 0.56), p = 0.05; D/P4 creat: 0.75 (0.64 – 0.86) vs 0.60 (0.59 – 0.62), p = 0.02] were higher in diabetic patients receiving IP insulin who had HSS than in those who did not have HSS. PET glucose levels [D0/D2 glu: 0.40 (0.37 – 0.45) vs 0.50 (0.48 – 0.51), p = 0.03; D0/D4 glu: 0.36 (0.26 – 0.38) vs 0.44 (0.38 – 0.48), p = 0.04] were lower in diabetic patients receiving IP insulin who had HSS than in those who did not have HSS. Conclusions Our results suggest that IP insulin plays a more important role in the pathogenesis of HSS than glucose levels in diabetic CAPD patients. They also indicate that HSS is associated with higher daily insulin requirement, obesity, hypertriglyceridemia, and high peritoneal transport rate in diabetic CAPD patients receiving IP insulin.

scholarly journals SO070THE SPECTRUM OF RENAL OSTEODYSTROPHY IN PREVALENT PERITONEAL DIALYSIS PATIENTS IN 21ST CENTURY - A HISTOMORPHOMETRIC ANALYSIS OF BONE BIOPSIES

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Luciano Pereira ◽  
Juliana Magalhães ◽  
Luís Mendonça ◽  
Hugo Diniz ◽  
Maria João Sousa ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Vascular Calcification ◽  
Renal Osteodystrophy ◽  
Frequent Pattern ◽  
Diabetic Patients ◽  
Histomorphometric Analysis ◽  
Bone Formation Rate ◽  
Susceptible Population ◽  
X Ray ◽  
Bone Biopsies

Abstract Background and Aims The spectrum of renal osteodystrophy (ROD) in peritoneal dialysis (PD) patients remains to be clarified. Most studies are old and the results inconsistent. Also there were changes in clinical practice that may have influenced the bone histology in PD patients. Method In order to characterize ROD in prevalent PD population, we performed tetracycline-labelled bone biopsies in 49 PD patients with histomorphometric analysis according KDIGO guidelines. Exclusion criteria: history of kidney transplant, hemodialysis, treatment with agents interfering in bone metabolism (for example bisphosphonates). Hands and pelvis x-ray were performed to evaluate vascular calcification (VC) and to calculate the Adragão score. All patients were treated with biocompatible PD solutions, with calcium concentration of 1.25 mmol/L. Results Forty-nine patients participated in the study, with 32 biopsies analyzed so far. Mean age was 52.4±10.9 years, 16 male, 6 with diabetes mellitus, 23 on manual PD, median time on PD was 22.1 (3-61) months. Mean calcium, phosphate and PTH were 9.2±0.5 mg/dL, 4.9±1.0 mg/dL and 489.87±227.8 pg/mL, respectively. Vascular calcification was detected in 29% of patients and mean Adragão score was 1.13. Essential histomorphometric and selected data is represented in table 1: Bone volume (BV) tended to be lower in diabetics - 17.1% (10.1-23.1) compared with non-diabetics – 22.6% (12.7-41.4) (p=0.07). Median bone formation rate (BFR) tended to be lower - 21.39 µm3/µm2/y (8.2-53.2) in diabetic patients than in non-diabetics - 28.63 µm3/µm2/y (3.5-89.77) (p=0.80). PTH levels also tended to be lower in diabetics – 384.8 pg/mL compared to non-diabetics – 514.1 pg/mL (p=0.14). BV tended to be lower in patients with VC – 19.1% (10.1-27) compared with patients without VC - 22.6% (12.7-41.4) (p=0.23). VC was detected on x-ray in all 6 patients with diabetes and only in 11.5% (3 in 26) of non-diabetic patients. Conclusion Similar to previous reports, the most frequent ROD pattern was ABD. However, PD patients with ABD had mean PTH of 405 pg/mL, a value well within the recommended KDIGO targets. This reinforces PTH as a far from ideal marker of bone turnover and suggests different targets for PTH levels in this seemingly highly susceptible population to ABD even when treated with low calcium dialysate. The proportion of patients with normal bone was higher than previously published. This finding can be explained by differences in the classification of ROD and prescription of biocompatible PD solutions in all patients. Diabetic patients tended to have lower BV and BFR. This finding is not surprising considering osteoblastic toxicity caused by advanced glycation end products. Also diabetic patients have a state of relative hypoparathyroidism. In conclusion, the most frequent pattern was ABD. Diabetic patients on PD may be a different subgroup.

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