Risk Factors for Peritoneal Dialysis–Associated Peritonitis: The Role of Oral Active Vitamin D

2010 ◽  
Vol 30 (5) ◽  
pp. 541-548 ◽  
Author(s):  
Michael Rudnicki ◽  
Julia Kerschbaum ◽  
Johann Hausdorfer ◽  
Gert Mayer ◽  
Paul König
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Lower Risk ◽  
Concomitant Medication ◽  
Mortality Data ◽  
Active Vitamin ◽  
Baseline Serum ◽  
Laboratory Parameters ◽  
Active Vitamin D

BackgroundPeritonitis is a major complication of peritoneal dialysis (PD), being associated with hospitalization, catheter loss, technique failure, and increased mortality. Data on various risk factors for peritonitis are inconsistent, and no association with concomitant therapy has been shown.MethodsWe performed a retrospective analysis of all incident and prevalent PD patients ( n = 55) treated in Innsbruck, Austria, between 2000 and 2007. Data consisted of 1291 patient–months and 55 episodes of peritonitis. Patient demographic data, comorbidities, concomitant medication, laboratory parameters, and microbiology results were obtained from the medical records and from the hospital's electronic database.ResultsThe mean peritonitis incidence rate was 0.51 episodes/patient–year (range: 0.24 – 0.73 episodes/patient–year) or 1 episode every 23.5 months (range: 16 – 50 months). In a primary analysis including demographic characteristics, comorbidities, laboratory parameters, and concomitant medication, only treatment with oral active vitamin D was associated with a significantly lower risk of peritonitis. Adjusted for time on PD and baseline serum albumin, oral active vitamin D therapy was associated with an 80% reduced relative risk of peritonitis [hazard ratio (HR): 0.20; 95% confidence interval (CI): 0.06 to 0.64; p = 0.007)]. The risk reduction was comparable in patients who received 0.25 μg or more of vitamin D daily (HR: 0.18; 95% CI: 0.05 to 0.65; p = 0.008) and in those who received less than 0.25 μg vitamin D daily (HR: 0.21; 95% CI: 0.06 to 0.77; p = 0.018).ConclusionsTreatment with oral active vitamin D might be associated with a lower risk of peritonitis in PD patients.

scholarly journals Serum 25-Hydroxyvitamin D Level Could Predict the Risk for Peritoneal Dialysis-Associated Peritonitis

2015 ◽  
Vol 35 (7) ◽  
pp. 729-735 ◽  
Author(s):  
Hai-Chen Pi ◽  
Ye-Ping Ren ◽  
Qin Wang ◽  
Rong Xu ◽  
Jie Dong
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Vitamin D Deficiency ◽  
Vitamin D Supplementation ◽  
Active Vitamin ◽  
Baseline Serum ◽  
Hydroxyvitamin D ◽  
Active Vitamin D ◽  
25 Hydroxyvitamin D ◽  
The Mean

BackgroundAs an immune system regulator, vitamin D is commonly deficient among patients on peritoneal dialysis (PD), which may contribute to their impaired immune function and increased risk for PD-related peritonitis. In this study, we aimed to investigate whether vitamin D deficiency could predict the risk of peritonitis in a prospective cohort of patients on PD.MethodsWe collected 346 prevalent and incident PD patients from 2 hospitals. Baseline demographic data and clinical characteristics were recorded. Serum 25-hydroxyvitamin D (25[OH]D) was measured at baseline and prior to peritonitis. The mean doses of oral active vitamin D used during the study period were also recorded. The outcome was the occurrence of peritonitis.ResultsThe mean age of patients and duration of PD were 58.95 ± 13.67 years and 28.45 (15.04 – 53.37) months, respectively. Baseline 25(OH)D level was 16.15 (12.13 – 21.16) nmol/L, which was closely associated with diabetic status, longer PD duration, malnutrition, and inflammation. Baseline serum 25(OH)D predicted the occurrence of peritonitis independently of active vitamin D supplementation with a hazard ratio (HR) of 0.94 (95% confidence interval [CI] 0.90 – 0.98) after adjusting for recognized confounders (age, gender, dialysis duration, diabetes, albumin, residual renal function, and history of peritonitis). Compared to the low tertile, middle and high 25(OH)D level tertiles were associated with a decreased risk for peritonitis with HRs of 0.54 (95% CI 0.31 – 0.94) and 0.39 (95% CI 0.20 – 0.75), respectively.ConclusionsVitamin D deficiency evaluated by serum 25(OH)D rather than active vitamin D supplementation is closely associated with a higher risk of peritonitis.

scholarly journals Dynamic changes in calcium and phosphate plasma concentrations in the patients on peritoneal dialysis

2006 ◽  
Vol 63 (1) ◽  
pp. 27-30
Author(s):  
Natasa Jovanovic ◽  
Mirjana Lausevic ◽  
Biljana Stojimirovic
Keyword(s):  
Vitamin D ◽  
Renal Failure ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Calcium Concentration ◽  
Phosphate Binders ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Stage Renal Disease ◽  
End Stage

Background/Aim. The disturbances of active forms of vitamin D synthesis and disturbances in calcium and posphate metabolism develop early in chronic renal failure, when creatinine clearance is about 30 ml/min. Chronic hemodialysis and peritoneal dialysis only partially correct the biochemical environment of patients on chronic renal replacement therapy because of end-stage renal disease. These dialysis modalities can?t significantly affect the endocrine disturbances of chronic renal failure and they have minimal modulatory effect. The management of disturbed calcium (Ca) and phosphate (P) metabolism and the maintainance of Ca ? P product below 4.4 mmol/l thanks to the use of dialysate solutions with the appropriate calcium concentration and the careful dosage of phosphate binders, calcium and active vitamin D metabolits, are extremely important for the prevention of renal osteodystrophy, secondary hyperparathyroidism as well as low-bone turnover disease. The aim of the study was to analyze the plasma levels of calcium, phosphate, albumin, alkaline phosphatase and parathormon (PTH) in 58 patients who were treated with continuous ambulatory peritoneal dialysis (CAPD) from March to August 2003. The use of phosphate binders and the substitution with active vitamin D metabolits were also analyzed. Methods. We examined 58 patients, 30 males and 28 female, mean-age 52 years (range, 26-78 years), affected by end-stage renal disease of the different leading cause. The average time on peritoneal dialysis program was 20 months (2-66 months). Most of the patients were treated by CAPD, while only few of them performed automatic, cyclic or intermittent peritoneal dialysis. Most of the patients used a dialysate with 1.75 mmol/l calcium concentration. Results. The study showed that our patients on chronic CAPD program during several months had normal calcemia, phosphatemia and the level of alkaline phosphatase, and that they had Ca ? P product in the recommended range. PTH serum level ranged from 16 to 490 pg/l in our patients. Conclusion. The study showed that a balanced diet and a correct dosage of phosphate binders, as well as a careful substitution with active vitamin D metabolits render a good control of calcium and phosphate serum balance, as well as an effective prevention of renal osteodystrophy development in the patients on chronic peritoneal dialysis treatment.

scholarly journals The impact of cinacalcet in the mineral metabolism markers of patients on dialysis with severe secondary hyperparathyroidism

2019 ◽  
Vol 41 (3) ◽  
pp. 336-344
Author(s):  
Sérgio Gardano Elias Bucharles ◽  
Fellype Carvalho Barreto ◽  
Miguel Carlos Riella
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Secondary Hyperparathyroidism ◽  
Mineral Metabolism ◽  
Phosphate Binders ◽  
Dialysis Patients ◽  
Active Vitamin ◽  
Ipth Level ◽  
Active Vitamin D ◽  
The Impact

Abstract Introduction: Treating secondary hyperparathyroidism (SHPT), a common condition associated with death in patients with chronic kidney disease, is a challenge for nephrologists. Calcimimetics have allowed the introduction of drug therapies no longer based on phosphate binders and active vitamin D. This study aimed to assess the safety and effectiveness of cinacalcet in managing chronic dialysis patients with severe SHPT. Methods: This retrospective study included 26 patients [age: 52 ± 12 years; 55% females; time on dialysis: 54 (4-236) months] on hemodialysis (N = 18) or peritoneal dialysis (N = 8) with severe SHPT (intact parathyroid hormone (iPTH) level > 600 pg/mL) and hyperphosphatemia and/or persistent hypercalcemia treated with cinacalcet. The patients were followed for 12 months. Their serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and iPTH levels were measured at baseline and on days 30, 60, 90, 180, and 365. Results: Patients with hyperphosphatemia (57.7%), hypercalcemia (23%), or both (19.3%) with iPTH > 600 pg/mL were prescribed cinacalcet. At the end of the study, decreases were observed in iPTH (1348 ± 422 vs. 440 ± 210 pg/mL; p < 0.001), Ca (9.5 ± 1.0 vs. 9.1 ± 0.6 mg/dl; p = 0.004), P (6.0 ± 1.3 vs. 4.9 ± 1.1 mg/dl; p < 0.001), and ALP (202 ± 135 vs. 155 ± 109 IU/L; p = 0.006) levels. Adverse events included hypocalcemia (26%) and digestive problems (23%). At the end of the study, 73% of the patients were on active vitamin D and cinacalcet. Three (11.5%) patients on peritoneal dialysis did not respond to therapy with cinacalcet, and their iPTH levels were never below 800 pg/mL. Conclusion: Cinacalcet combined with traditional therapy proved safe and effective and helped manage the mineral metabolism of patients with severe SHPT.

Effects of Oral Paricalcitol and Calcitriol Treatment on Peritoneal Membrane Characteristics of Peritoneal Dialysis Patients — A Pilot Study

2018 ◽  
Vol 38 (3) ◽  
pp. 220-228 ◽  
Author(s):  
Karima Farhat ◽  
Andrea W.D. Stavenuiter ◽  
Marc G. Vervloet ◽  
Pieter M. ter Wee ◽  
Robert H.J. Beelen ◽  
...  
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Parathyroid Hormone ◽  
Pilot Study ◽  
Peritoneal Membrane ◽  
Transport Parameters ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Markers Of Inflammation ◽  
Peritoneal Transport

BackgroundLong-term peritoneal dialysis (PD) is frequently complicated by technique failure preceded by peritoneal remodeling. Vitamin D has potent immunomodulatory characteristics: anti-inflammatory, anti-angiogenic, anti-fibrotic properties, and influences on the macrophage phenotype. Little is known about the relation between pleiotropic effects attributed to vitamin D3and the peritoneal membrane and what is the most appropriate vitamin D sterol in prevention of peritoneal remodeling in PD patients. Animal studies have suggested that paricalcitol has advantageous effects: decrease in plasma markers of inflammation, less peritoneal fibrosis, less pronounced PD-induced omental angiogenesis, and prevention of loss of ultrafiltration. We investigated whether paricalcitol is advantageous over calcitriol in PD patients.MethodA multicenter open-label 1:1 randomized non-blinded clinical pilot study enrolled prevalent continous ambulatory PD (CAPD) patients for a period of 6 months comparing paricalcitol with calcitriol. All patients were treated with biocompatible PD fluids. The primary endpoint was peritoneal transport parameters, exploratory endpoints were biomarkers of peritoneal damage and cell analysis (including M1/M2 macrophages), and safety endpoints were metabolic parameters.ResultsTwenty-seven patients were included. Fourteen were randomized to treatment with paricalcitol. There was no difference in peritoneal transport parameters between the groups. We found similar Kt/V, D/P creatinine, D/D0 glucose, ultrafiltration, residual renal function and 24-h urine volume during the study. There was no difference in biomarker concentrations in peritoneal effluents, and no difference in leucocyte differentiation or mesothelial cells between the groups at any time point. Parathyroid hormone (PTH) levels decreased after administration of calcitriol after 12 and 24 weeks compared with baseline ( p = 0.001; p = 0.025). Parathyroid hormone levels in the paricalcitol group did not change significantly.ConclusionIn this pilot study we investigated the effect of active vitamin D in PD patients. We found no specific benefit of active vitamin D3in vitamin D3-sufficient PD patients. Additional studies in preferably incident patients, with an adequate PTH suppression in the intervention groups and during a longer period, are required to test the beneficial effects of active vitamin D3over no treatment and to investigate whether in 25(OH)D3-deficient PD patients the type of active vitamin D3matters.

scholarly journals Intraperitoneal Calcitriol for Treatment of Severe Hyperparathyroidism in Children with Chronic Kidney Disease: A Therapy Forgotten

2016 ◽  
Vol 36 (6) ◽  
pp. 688-690 ◽  
Author(s):  
Rahul Chanchlani ◽  
Susan Ackerman ◽  
Elizabeth Piva ◽  
Elizabeth Harvey
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
Oral Formulations ◽  
Active Vitamin D Sterols ◽  
Intravenous Formulation

Active Vitamin D sterols such as calcitriol and alfacalcidol are quite effective in the treatment of mineral bone disease secondary to chronic kidney disease. However, some children on peritoneal dialysis (PD) are resistant to oral formulations of active Vitamin D, and use of an intravenous formulation in such patients is inconvenient. In these children, intraperitoneal (IP) calcitriol has been shown to be effective in the treatment of secondary hyperparathyroidism. However, its use has declined. We report 2 children, aged 1 and 9.5 years, on chronic cycler PD with severe secondary hyperparathyroidism refractory to oral active Vitamin D who were successfully treated with IP calcitriol for a period of 12 and 4 months, respectively. We also discuss the published literature on the efficacy of IP calcitriol for treatment of secondary hyperparathyroidism and specific considerations for its use in PD patients.

MO1020EFFICACY OF CALCITRIOL COMPARING TO ALFACALCIDOL FOR THE TREATMENT OF SECONDARY HYPERPARATHYROIDISM IN CHILDREN ON PERITONEAL DIALYSIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina Khvan ◽  
Samat Issakov ◽  
Nazym Nigmatullina ◽  
Saltanat Rakhimzhanova ◽  
Venera Altynova
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Secondary Hyperparathyroidism ◽  
Initial Dose ◽  
Plasma Calcium ◽  
T Test ◽  
Active Vitamin ◽  
Active Vitamin D ◽  
The Mean ◽  
Pth Level

Abstract Background and Aims Active vitamin D analogues are used routinely for the treatment of secondary hyperparathyroidism in children with end-stage renal disease (ESRD) on peritoneal dialysis (PD). Calcitriol is preferred active form of vitamin D, while data on efficacy of alfacalcidol in children on PD are limited. The aim of this study was to compare the efficacy of these two active vitamin D analogues for the treatment of secondary hyperparathyroidism in children on PD. Method This retrospective cohort study included data from 26 pediatric patients under 18 years of age with ESRD on PD who were treated at the National Research Center for Maternal and Child Health, Astana, Kazakhstan. Patients were allocated by initial treatment into two groups: oral alfacalcidol (n=21) and oral calcitriol (n=5). The first step of the study was to compare the efficacy of treatment between this two groups 3 and 6 months after. The second step was to compare the efficacy of calcitriol in subgroup of patients from alfacalcidol group who were switched to calcitriol later (n=12). The following characteristics were analyzed: parathyroid hormone (PTH), total plasma calcium, ionized plasma calcium, plasma phosphorus, initial dose of active vitamin D and corrected dose of vitamin D after 3 months. Independent t-test and repeated measures Anova were used for comparison between alfacalcidol and calcitriol groups. To compare data in subgroup between baseline and 3 months after conversion from alfacalcidol to calcitriol we used paired Student t-test. Results The mean age and baseline characteristics were no different between alfacalcidol and calcitriol groups (Table 1). The initial dose of alfacalcidol was 2.42±1.03 µg/week (0.157±0.097 µg/kg/week) and 2.09±0.74 µg/week (0.105±0.039 µg/kg/week) for calcitriol were not significantly different (P=0.5 and P=0.25 respectively). After 3 months of treatment there was statistically significant decrease of PTH level in calcitriol group 180±168 pmol/L comparing to alfacalcidol group 869±670 pmol/L (P=0.006). After 6 months, there was statistically significant decrease of PTH level in calcitriol group 261±259 pmol/L in contrast with alfacalcidol group 1080±716 pmol/L (P=0.047) and rise in total calcium in calcitriol group 2.46±0.17 mmol/L compared with alfacalcidol group 2.09±0.25mmol/L (P=0.035). The mean dose of calcitriol was also significantly lower as opposed to alfacalcidol dose: 0.04±0.039 µg/kg/week and 0.17±0.076 µg/kg/week respectively (P=0.002). The median age of children who were switched from alfacalcidol to calcitriol were significantly younger comparing with those who continued alfacalcidol (5±4.6 and 10±4.3 years of age respectively (P=0.022)). 3 months after conversion there was significant increase in ionized calcium level and decrease in PTH level comparing with baseline (Table 2). The dose of alfacalcidol before and dose of calcitriol after switch were differed (0.18±0.1 µg/kg/week and 0.13±0.05 µg/kg/week respectively, P=0.025) Conclusion Calcitriol showed superior efficacy for the treatment of secondary hyperparathyroidism in children on PD with the dose 4.25 times lower that of alfacalcidol. Alfacalcidol had limited efficacy for the treatment of secondary hyperparathyroidism in younger children when prescribed in recommended doses.

MO944BONE DISEASE AFTER KIDNEY TRANSPLANTATION - (SUBTOTAL) PARATHYROIDECTOMY REDUCES FRACTURE RISK

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ulrich Jehn ◽  
Anja Kortenhorn ◽  
Katharina Schütte-Nütgen ◽  
Markus Strauss ◽  
Hermann Josef Pavenstädt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Vitamin D ◽  
Fracture Risk ◽  
Protective Factor ◽  
Active Vitamin ◽  
Pathological Fractures ◽  
Subtotal Parathyroidectomy ◽  
Active Vitamin D ◽  
Mineral Bone Disorder ◽  
Bone Disorder

Abstract Background and Aims Kidney transplant recipients can be considered as high-risk collective for pathological fractures, since diverse risk factors leading to mineral bone disorder (MBD) and osteoporosis accumulate in this setting. (Subtotal) parathyroidectomy (PTX) is indicated for ESRD patients with secondary hyperparathyroidism (sHPT) who do not respond to drug therapy adequately. This study aims to identify influencable factors that are associated with pathological fractures and bone disease in KTX recipients. Method We conducted a retrospective study involving 722 adult patients with a total of 4686 patient-years who were transplanted at our center between January 2007 and June 2015. The clinical patient data was extracted from the patients’ electronic files. Different laboratory and clinical parameters for mineral bone disorder and osteoporosis including medication were evaluated. As primary endpoint we chose fracture events that were not related to malignancies or adequate trauma. Results 47 (6,5%) of the patients suffered from pathologic fracture events during the follow-up period. 124 of the patients (17.2%) underwent PTX. In 112 of these patients (90.3%), PTX was performed prior to kidney transplantation (KTx), in 12 patients PTX took place after KTx. Median time for PTX in relation to KTx was 3.7 years prior to KTx (IQR 5.43). Only 1 (2,2%) of the patients with fracture events has received PTX beforehand compared to 124 (19,2%) of the patients without fractures. Adjusted for the well-known fracture risk factors for mineral bone disease and osteoporosis which include female sex, age and dialysis vintage, PTX remains a significant protective factor against fractures after KTx in multivariable Cox regression analysis (HR 0.124, p=0.041) and in Kaplan-Meier analysis (Figure 1). Serum calcium levels were significantly lower in patients after PTX (p&lt;0.001). Active Vitamin D was applicated in patients after PTX more frequently (40.0% vs. 22.7%, p&lt;0.001) Conclusion Our study reveals PTX as a protective factor regarding pathological fractures after KTx. As these patients show lower serum calcium levels, one explanation for this finding could be a more generous supplementation of these patients with active vitamin D, which is known to increase bone mineral density and to reduce fracture risk. Therefore, considering that hypoprathyroidism following PTX after KTx and low plasma-PTH levels correlate with significant decrease of renal function, patients on conservative sHPT therapy should be treated with active vitamin D preparations more generously and special attention should be paid on bone metabolism.

scholarly journals Treatment with Oral Active Vitamin D Is Associated with Decreased Risk of Peritonitis and Improved Survival in Patients on Peritoneal Dialysis

PLoS ONE ◽  
2013 ◽  
Vol 8 (7) ◽  
pp. e67836 ◽  
Author(s):  
Julia Kerschbaum ◽  
Andreas Vychytil ◽  
Karl Lhotta ◽  
Friedrich C. Prischl ◽  
Martin Wiesholzer ◽  
...  
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
Active Vitamin ◽  
Active Vitamin D
Sign in / Sign up

Export Citation Format

Share Document