Peritoneal Dialysis after Nonrenal Solid Organ Transplantation: Clinical Outcomes and Practical Considerations

2010 ◽  
Vol 30 (1) ◽  
pp. 7-12 ◽  
Author(s):  
Jeffrey Perl ◽  
Joanne M. Bargman ◽  
Sarbjit V. Jassal

The incidence of end-stage renal disease following nonrenal solid organ transplantation (NRSOT) is increasing and is associated with a poor prognosis. The etiology of end-stage renal disease is multifactorial, with calcineurin inhibitor (CNI) nephrotoxicity being primarily responsible. The impact of dialysis modality on the survival of these patients remains unclear. Peritoneal dialysis appears to be a feasible and safe option for renal replacement therapy in NRSOT patients. Concerns that NRSOT patients are at a higher risk of infectious and noninfectious complications necessitate practical considerations when prescribing and planning for peritoneal dialysis in these patients. While nephrotoxicity is a well-recognized complication of long-term CNI use, “peritoneotoxic” effects with significant alterations in peritoneal membrane structure and function have recently been described. Further study including the role of CNI-free immunotherapy protocols to optimize the outcomes of NRSOT recipients is needed.

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Damir Rebić ◽  
Senija Rašić ◽  
Velma Rebić

Diabetes mellitus (DM) is the leading cause of the end-stage renal disease (ESRD). Vascular diseases are the most common cause of morbidity and mortality in the chronic kidney disease. The aim of this study was to analyze the impact of peritoneal dialysis (PD) treatment on morphologic and hemodynamic vascular parameters of carotid arteries in diabetic type 2 and nondiabetic patients with ESRD during the period of one year after the start of PD treatment using ultrasonography of carotid arteries and their relation on uremia and PD inherent factors. Mean intima-media thickness, plaque score, peak systolic velocity, end-diastolic velocity, and carotid diameter significantly decreased 12 months after PD treatment start in both groups. Significant reduction in median serum endothelin-1 concentration after 12 months on PD treatment was observed in the group of patients with DM (7.6–5.9 pg/mL) and also in group of patients without DM (3.6–3.3 pg/mL). Also median nitric oxide concentration significantly increased after 12 months on PD compared to baseline levels both in patients with DM (25.0–34.3 μmol/L) as was observed in patients without DM (49.6–56.5 μmol/L). PD treatment, with the regulation of these vasoactive molecules and other vascular risk factors, significantly contributes to vascular remodeling, especially in DM patients.


2020 ◽  
Author(s):  
Min Yan Zhang ◽  
Miao He ◽  
Sheng Wan ◽  
Qiong Yan Ding ◽  
Lei Liu ◽  
...  

Abstract Background With the increasing incidence of end stage renal disease(ESRD),peritoneal dialysis(PD) has become the preferred method of kidney replacement therapy for an increasing number of patients with end stage renal disease due to its many advantages.The intent of this study was to explore the correlations between sex, age and risk of withdrawal from peritoneal dialysis.Methods All patients who underwent PD catheterization and initiated PD at Wuhan No.1 Hospital between 2013 and 2018 were screened.Clinical information of these patients was collected and compared according to gender and age,then was applied to the Cox proportional hazards model to determine the impact of factors of withdrawal from peritoneal dialysis.Results ①Hazard ratios(HRs) of withdrawal of PD associate with gender and age at initiation were 0.736(P = 0.289)、1.151༈P = 0.489༉respectively.Nonetheless,male patients under 60 years old had a 1.58-fold higher risk of withdrawal than others(HR 0.63,P = 0.031).②The withdrawal risk of patients with total Creatinine clearance rate (Ccr) above 60L/W was 82.4% higher than that of patients who did not meet the standard (HR 1.82,P = 0.005).③The withdrawal risk of patients with high D/P Creatinine༈Cr༉value which was calculated from peritoneal equilibration test(PET) were 2.06 times higher than low-average and high-average transport patients(HR2.06,P = 0.008).④Patients with serum albumin above 35 g/L were intended to withdraw from PD than those below 35 g/L (HR 0.56,P = 0.006).Conclusions There were significant differences in total KT/V, total Ccr,serum creatinine(Scr) and blood Urea nitrogen(BUN)among patients with PD of different gender and age.The analysis showed that male patients under 60 years old, Ccr, value of D/Pcr and serum albumin had a high correlation with the technical survival rates.While gender or age at PD initiation were not associated with technique survival,male patients under 60 years old had a 1.58-fold higher risk of withdrawal from PD than others.The outcome that the withdrawal risk of patients with Ccr above 60L/W was 82.4% higher than other patients who did not meet the standard suggested that Ccr was not suitable as an index for evaluating the adequacy of PD,especially for men under 60 years old.And patients with high D/Pcr value or with serum albumin under 35 g/L were related risk factors for technique survival.


2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Samah W. Al-Jabi ◽  
Ansam Sous ◽  
Fatimah Jorf ◽  
Mahmoud Taqatqa ◽  
Mahdi Allan ◽  
...  

Abstract Background The impact of end-stage renal disease on the patient’s psychological status necessitates the value of increasing depression awareness. The current study aimed to assess the depression prevalence among Palestinian hemodialyzed patients and its association with patients’ characteristics. Methods A convenience clustered sampling technique was followed. Sample was collected from ten hemodialysis centers in the West Bank, Palestine, during 3 months in 2015. We used the Beck Depression Inventory-II scale (BDI-II) to evaluate depression among participants. All data were analyzed using Statistical Package for the Social Sciences version 16.0. Results Two hundred and eighty-six hemodialyzed patients were interviewed. The mean age (± standard deviation) of the patients was 52.0 ± 14.3 years, and most participants were males 172 (60.1%). Regarding the dialysis characteristics, the median of years of dialysis was 2 years (1–4). The prevalence of depression was 73.1%. Elderly patients (p = 0.001), female (p = 0.036), living in rural areas or camp (p = 0.032), low income (p = 0.041), unemployment (p = 0.001), not doing regular exercise (p = 0.001), and having multi comorbidities (p = 0.001) were significantly associated with more depression scores. The results of binary logistic regression showed that only patients who were living in camps, patients who were previously employed, and patients who were not practicing exercise remained significantly associated with a higher depression score. Conclusions This study is the first one confirmed about depression and its prevalence among hemodialyzed patients in the West Bank, Palestine. Compared to other communities, the study found a higher depression prevalence rate. There is a need to offer psychological interviews and non-pharmacological and pharmacological interventions.


2009 ◽  
Vol 24 (10) ◽  
pp. 2035-2039 ◽  
Author(s):  
Michelle N. Rheault ◽  
Jurat Rajpal ◽  
Blanche Chavers ◽  
Thomas E. Nevins

2019 ◽  
Vol 10 (02) ◽  
pp. 324-326 ◽  
Author(s):  
Ching Soong Khoo ◽  
Tze Yuan Tee ◽  
Hui Jan Tan ◽  
Raymond Azman Ali

ABSTRACTWe report a patient with end-stage renal disease on peritoneal dialysis, who developed encephalopathy after receiving a few doses of cefepime. He recovered clinically and electroencephalographically after having discontinued the culprit agent and undergone hemodialysis. This case highlights the importance of promptly recognizing this reversible encephalopathy, which can lead to the avoidance of unnecessary workup, reduce the length of hospital stay, and thereby improve the patients’ outcome.


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