Nonclinical Factors Associated with Treatment with Peritoneal Dialysis in Esrd Patients in Taiwan

2010 ◽  
Vol 30 (6) ◽  
pp. 638-643 ◽  
Author(s):  
Hsiu-Chen Huang ◽  
Jiun-Yi Wang ◽  
Chia-Chu Chang ◽  
Ping-Fang Chiu ◽  
Ming-Che Chiang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Family Support ◽  
Univariate Analysis ◽  
Healthcare Providers ◽  
Early Referral ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage ◽  
To Receive ◽  
Esrd Patients

ObjectivesLess than 10% of end-stage renal disease (ESRD) patients in Taiwan receive peritoneal dialysis (PD), which reveals the situation of underutilization of PD. We thus aimed to investigate factors associated with treatment with PD in ESRD patients in Taiwan.PatientsPatients that were 18 years of age or older and had been on dialysis for at least 3 months since 2001 were recruited and interviewed with a structured questionnaire.Results98 hemodialysis (HD) and 102 PD patients were recruited. In univariate analysis, age, sex, level of education, employment status, marital status, traffic time, family support, patient cognition, and receptivity were correlated with treatment with PD. Multivariate analysis showed that patients that were not married ( p = 0.006), that spent more time traveling to the dialysis clinic ( p = 0.006), that were not emergent at the start of dialysis ( p = 0.003), and that had better family support ( p = 0.045), a higher cognition of dialysis ( p = 0.034), and stronger receptivity to dialysis ( p < 0.001) were more likely to receive PD.ConclusionsWe recommend patients follow the standard process to obtain more exhaustive information, consultation, and early referral. In addition, we suggest healthcare providers remind patients to take into account such nonclinical factors as family support and patient receptivity when they choose their dialysis modality.

Characteristics and Clinical Outcomes of End-Stage Renal Disease Patients on Peritoneal Dialysis for over 15 Years: A Single-Center Experience

2017 ◽  
Vol 37 (5) ◽  
pp. 535-541 ◽  
Author(s):  
Youn Kyung Kee ◽  
Jung Tak Park ◽  
Chang-Yun Yoon ◽  
Hyoungnae Kim ◽  
Seohyun Park ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Outcomes ◽  
End Stage Renal Disease ◽  
Short Term ◽  
Factors Associated ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background Maintaining peritoneal dialysis (PD) for a long time is problematic owing to a number of factors. This study aimed to clarify the characteristics and examine the clinical outcomes of patients who received PD as a long-term dialysis modality. Methods All end-stage renal disease (ESRD) patients who initiated PD at Yonsei University Health System between 1987 and 2000 were screened. Patients who maintained PD for over 15 years were classified as the long-term PD group and those who were treated with PD for less than 5 years were included in the short-term PD group. Demographic and biochemical data and clinical outcomes were compared between the groups. Independent factors associated with long-term PD maintenance were ascertained using multivariate logistic regression analysis. Results Among 1,116 study patients, 87 (7.8%) were included in the long-term group and 293 (26.3%) were included in the short-term group. In the long-term group, the mean patient age at PD initiation was 39.6 ± 11.5 years, 35 patients (40.2%) were male, and the mean PD duration was 205.3 ± 32.7 months. Patients were younger, body weight was lower, the proportion of patients with diabetes or cardiovascular diseases was lower, and the proportion of low to low-average transporters was higher in the long-term group than in the short-term group ( p < 0.001). Multiple logistic regression analysis revealed that age, body mass index (BMI), serum creatinine, type of PD solution, and diabetes were significant independent factors associated with long-term PD maintenance. Conclusion Peritoneal dialysis can be considered as a long-term renal replacement therapy option, especially in non-diabetic, not overweight, and young ESRD patients.

Iron Chelation Therapy in CAPD: A New and Effective Treatment of Iron Overload Disease in Esrd Patients

1983 ◽  
Vol 3 (2) ◽  
pp. 99-101 ◽  
Author(s):  
Glen H Stanbaugh ◽  
A. W, Holmes Diane Gillit ◽  
George W. Reichel ◽  
Mark Stranz
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Overload ◽  
End Stage Renal Disease ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelation Therapy ◽  
Peritoneal Dialysate ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

A patient with end-stage renal disease on CAPD, and with massive iron overload is reported. This patient had evidence of myocardial and hepatic damage probably as a result of iron overload. Treatment with desferoxamine resulted in removal of iron in the peritoneal dialysate. On the basis of preliminary studies in this patient it would appear that removal of iron by peritoneal dialysis in conjunction with chelation therapy is safe and effective. This finding should have wide-ranging signficance for patients with ESRD.

MO282EARLY RENAL RECOVERY AFTER A FIRST FLARE OF PAUCI IMMUNE GLOMERULONEPHRITIS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Jeremy Zaworski ◽  
Cyrille Vandenbussche ◽  
Pierre Bataille ◽  
Eric Hachulla ◽  
Francois Glowacki ◽  
...  
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Interstitial Fibrosis ◽  
Univariate Analysis ◽  
Renal Recovery ◽  
Neurological Involvement ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Renal involvement is a severe manifestation of ANCA-associated vasculitis. Patients often progress to end-stage renal disease. The potential for renal recovery after a first flare has seldom been studied. Our objectives were to describe the evolution of the estimated glomerular filtration rate (eGFR) and identify factors associated with the change in eGFR between diagnosis and follow-up at 3 months (ΔeGFRM0–M3) in a cohort of patients with a first flare of pauci-immune glomerulonephritis. Methods This was a retrospective study over the period 2003–2018 of incident patients in the Nord-Pas-de-Calais (France). Patients were recruited if they had a first histologically-proven flare of pauci immune glomerulonephritis with at least 1 year of follow up. Kidney function was estimated with MDRD-equation and analysed at diagnosis, 3rd, 6th and 12th months. The primary outcome was ΔeGFRM0–M3. Factors evaluated were histological (Berden classification, interstitial fibrosis, percentage of crescents), clinical (extra-renal manifestations, sex, age) or biological (severity of acute kidney injury, dialysis, ANCA subtype). Results One hundred and seventy-seven patients were included. The eGFR at 3 months was significantly higher than at diagnosis (mean ± standard deviation, 40 ± 24 vs 28 ± 26 ml/min/1.73 m2, p &lt; 0.001), with a ΔeGFRM0–M3 of 12 ± 19 ml/min/1.73 m2. The eGFR at 12 months was higher than at 3 months (44 ± 13 vs 40 ± 24 ml/min/1.73m2, p = 0.003). The factors significantly associated with ΔeGFRM0–M3 in univariate analysis were: sclerotic class according to Berden classification, percentage of interstitial fibrosis, percentage of cellular crescents, acute tubular necrosis, neurological involvement. The factors associated with ΔeGFRM0–M3 in multivariate analysis were the percentage of cellular crescents and neurological involvement. The mean increase in eGFR was 2.90 ± 0.06 ml/min/1.73m2 for every 10-point gain in the percentage of cellular crescents. ΔeGFRM0–M3 was not associated with the risks of end-stage renal disease or death in long-term follow-up. Conclusions Early renal recovery after a first flare of pauci-immune glomerulonephritis occurred mainly in the first three months of treatment. The percentage of cellular crescents was the main independent predictor of early renal recovery.

The Phantom of Metformin-Induced Lactic Acidosis in End-Stage Renal Disease Patients: Time to Reconsider with Peritoneal Dialysis Treatment

2017 ◽  
Vol 37 (1) ◽  
pp. 56-62 ◽  
Author(s):  
Abdullah K. Al-Hwiesh ◽  
Ibrahiem Saeed Abdul-Rahman ◽  
Abdul-Salam Noor ◽  
Mohammed A. Nasr-El-Deen ◽  
Abdalla Abdelrahman ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Lactic Acidosis ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Diabetic Control ◽  
Plasma Lactate ◽  
Lactate Levels ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

ObjectiveMetformin continues to be the safest and most widely used antidiabetic drug. In spite of its well-known benefits; metformin use in end-stage renal disease (ESRD) patients is still restricted. Little has been reported about the effect of peritoneal dialysis (PD) on metformin clearance and the phantom of lactic acidosis deprives ESRD patients from metformin therapeutic advantages. Peritoneal dialysis is probably a safeguard against lactic acidosis, and it is likely that using this drug would be feasible in this group of patients.Material and methodsThe study was conducted on 83 PD patients with type 2 diabetes mellitus. All patients were on automated PD (APD). Metformin was administered in a dose of 500 - 1,000 mg daily. Patients were monitored for glycemic control. Plasma lactic acid and plasma metformin levels were monitored on a scheduled basis. Peritoneal fluid metformin levels were measured. In addition, the relation between plasma metformin and plasma lactate was studied.ResultsMean fasting blood sugar (FBS) was 10.9 ± 0.5 and 7.8 ± 0.7, and mean hemoglobin A1-C (HgA1C) was 8.2 ± 0.8 and 6.4 ± 1.1 at the beginning and end of the study, respectively (p < 0.001). The mean body mass index (BMI) was 29.1 ± 4.1 and 27.3 ± 4.5 at the beginning and at the end of the study, respectively (p < 0.001). The overall mean plasma lactate level across all blood samples was 1.44 ± 0.6. Plasma levels between 2 and 3 mmol/L were found in 11.8% and levels of 3 - 3.6 mmol/L in 2.4% plasma samples. Hyperlactemia (level > 2 and < 5 mmol/L) was not associated with overt acidemia. None of our patients had lactic acidosis (levels > 5 mmol/L). Age ≥ 60 was a predictor for hyperlactemia. No relationship was found between plasma metformin and lactate levels.ConclusionMetformin may be used with caution in a particular group of ESRD patients who are on APD. Metformin allows better diabetic control with significant reduction of BMI. Information on the relationship between metformin and plasma lactate levels is lacking. Peritoneal dialysis appears to be a safeguard against the development of lactic acidosis in this group of patients.

scholarly journals Lipid status association with 25-hydroxy vitamin D: Cross sectional study of end stage renal disease patients

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Neda Milinković ◽  
Marija Sarić ◽  
Snežana Jovičić ◽  
Duško Mirković ◽  
Višnja Ležaić ◽  
...  
Keyword(s):  
Vitamin D ◽  
Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Density Lipoprotein ◽  
Dialysis Patients ◽  
25 Hydroxy Vitamin D ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Lipid Parameters

SummaryBackgroundSome observational studies indicate an association of 25-hydroxy vitamin D (25(OH)D) insufficiency and atherogenic cholesterol concentrations. The aim of this study was to investigate relationship between 25(OH)D concentrations and lipid parameters in end stage renal disease (ESRD) patients, separately for predialysis, hemodialysis and peritoneal dialysis patients.MethodsWe have adjusted 25(OH)D concentrations for seasonal variability with cosinor analysis, and performed all further analysis using these corrected 25(OH)D concentrations. Concentrations of 25(OH)D and the lipid parameters were determined in 214 ESRD patients and 50 control group participants. The analysis included the measurement of 25(OH)D by HPLC, apolipoprotein (Apo) AI, ApoB and Lp(a) by nephelometry, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) by spectrophotometry and manually calculated ApoB/ApoAI and LDL-C/HDL-C ratio.ResultsESRD patients with adjusted 25(OH)D concentrations of ≤ 50 nmol/L had significantly higher TC (P = 0.005) and ApoAI (P = 0.049). Significantly higher HDL-C (P = 0.011) and ApoAI (P = 0.020) were found in hemodialysis patients with the 25(OH)D concentrations of ≤ 50 nmol/L. The other analyzed lipid parameters differed significantly between predialysis, hemodialysis and peritoneal dialysis patients with 25(OH)D concentrations of < 50 nmol/L.ConclusionsOur study indicate the significant relationship between 25(OH)D repletion and optimal concentrations of lipid parameters in ESRD patients. Further research is necessary to explain whether joint evaluation of vitamin D status and lipid abnormalities could improve cardiovascular outcome in ESRD patients.

scholarly journals Lived Experiences of End Stage Renal Disease Patients Undergoing Continuous Ambulatory Peritoneal Dialysis Therapy

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
M. Hanif Prasetya 'Adhi ◽  
Yanny Trisyani ◽  
Etika Emaliyawati
Keyword(s):  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
End Stage Renal Disease ◽  
Lived Experiences ◽  
Final Diagnosis ◽  
Treatment Modalities ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

End stage renal disease (ESRD) is a serious chronic disease that resulted from complications of chronic renal failure and a final diagnosis that requires treatment modalities such as dialysis or continuous ambulatory peritoneal dialysis (CAPD). However, CAPD is rarely selected as renal replacement therapy by ESRD patients in Indonesia. Therefore, the phenomenon associated with patients undergoing CAPD is unclear, especially in Indonesia. The purpose of this study was to explore the lived experiences of ESRD patients undergoing CAPD therapy. The research method employed qualitative descriptive phenomenology. The participants in this study were 10 ESRD patients with CAPD. Data collection utilized semi-structured interviewed and data was analyzed using the Colaizzi approach. The result of the study was explained through 6 themes. These are: 1) Condition improved with CAPD, 2) Freedom of activity, 3) Between feeling better and bored 4) Health is increased, 5) It is sustained life, 6) Resignation to accept illness. In conclusion, the patients with CAPD felt  significant positive changes in their life and CAPD is considered life-sustaining for the participants, as the majority of the symptoms was decreased significantly. Therefore, the partisipants felt their conditions improved better. The unpleasant sides of CAPD are feeling bored. The support  of the family  is important as it  produced strength and passion for patients in undergoing CAPD.

scholarly journals Trends for and Clinical Factors Associated with Choice of Oral P2Y12 Inhibitors for Patients on Chronic Dialysis

2019 ◽  
Vol 33 (5) ◽  
pp. 511-521 ◽  
Author(s):  
Nishank Jain ◽  
Suzanne L. Hunt ◽  
Huizhong Cui ◽  
Milind A. Phadnis ◽  
Jonathan D. Mahnken ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Esrd Patient ◽  
Chronic Dialysis ◽  
Clinical Factors ◽  
Related Factors ◽  
P2y12 Inhibitors ◽  
Factors Associated ◽  
Prescribing Trends ◽  
To Receive ◽  
Esrd Patients

ABSTRACT Background Trends and clinical factors associated with prescribing choices for oral P2Y12 inhibitors (P2Y12-I) remain unknown for patients on chronic dialysis, i.e., with end-stage renal disease (ESRD). Methods From 2011–2014 U.S. Renal Data System registry, we identified 36,542 ESRD patients who received new prescriptions for P2Y12-I (median age 64.0 years and 54% males). Of the cohort, 93% were receiving hemodialysis and 7% on peritoneal dialysis. We analyzed trends and investigated clinical factors associated with specific P2Y12-I prescribed. Results Clopidogrel was prescribed for 95%, prasugrel for 3%, and ticagrelor for 2%. Clopidogrel was favored for those ≥75 years (18% of cohort). Compared to Caucasians, African Americans (36% of cohort) and Hispanics (19% of cohort) were less likely to receive prasugrel and ticagrelor (P<0.05). Patients receiving hemodialysis versus peritoneal dialysis were less likely to receive prasugrel over clopidogrel, adjusted odds ratio (aOR) 0.67 (0.55-0.82). Each additional year of dialysis decreased the odds of receiving prasugrel over clopidogrel, aOR 0.91 (0.85-0.98). History of atrial fibrillation reduced the odds of receiving ticagrelor or prasugrel over clopidogrel, aOR 0.69 (0.54-0.89) and 0.73 (0.60-0.89), respectively. Concomitant oral anticoagulant use was not associated with choice of P2Y12-I. Occurrence of non-ST segment elevation myocardial infarction or percutaneous coronary intervention within the 6-month period prior to the index date favored ticagrelor over prasugrel, aOR 1.31 (1.06-1.62) and 1.29 (1.01-1.66), respectively. However, prescribing trends favoring ticagrelor over prasugrel were not observed for deployment of drug-eluting, or multiple coronary stents. Conclusion Between 2011 and 2014, clopidogrel remained the most common P2Y12-I whereas ticagrelor and prasugrel remained underutilized in ESRD patients. Prescribing practices for these drugs were based upon clinically approved indication for their use in the general population as well as perceived complexity of an ESRD patient including demographics, dialysis-related factors and comorbidities. Comparative effectiveness studies involving ESRD patients are needed to prove that ticagrelor and prasugrel are just as safe and effective as clopidogrel before clinicians can make informed decisions for choice of P2Y12-I in this patient population.

Sleep Related Respiratory Disorders in End-Stage Renal Disease Patients on Peritoneal Dialysis

1992 ◽  
Vol 12 (1) ◽  
pp. 51-56 ◽  
Author(s):  
Nand K. Wadhwa ◽  
M. Seliger ◽  
Harly E. Greenberg ◽  
Edward Bergofsky ◽  
Wallace B. Mendelson
Keyword(s):  
Peritoneal Dialysis ◽  
Sleep Apnea ◽  
Renal Disease ◽  
Sleep Disturbance ◽  
Peritoneal Cavity ◽  
End Stage Renal Disease ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Chronic Sleep

Study Objective To assess the possible effects of peritoneal dialysis (PD) on sleep-related respiration, which might result from dialysate bulk load in the abdomen and/or alterations in metabolic control of respiration during sleep. Design Subjective and objective measures of sleep were prospectively compared on randomly assigned nights with PD fluid (2.0 L) and without PD fluid in the peritoneal cavity in 11 end-stage renal disease (ESRD) patients on PD. Setting Tertiary-referral university hospital. Patients and Methods Fifteen consecutive patients on peritoneal dialysis who complained of chronic sleep disturbance and requested sedative were selected. Four patients declined polysomnographic studies. Consequently, 11 ESRD patients (8 males and 3 females) with a mean age of 63±4 (SEM) years were studied. Results Eight of the 11 patients reported multiple types of sleep difficulties. Polysomnographic recordings revealed significant primarily obstructive sleep apnea in 6 of 11 patients on at least 1 of 2 nights. Arterial blood pH, paO2, and paC02 did not differ between nights with and without PD fluid in the peritoneal cavity in the group as a whole. In the 6 patients with sleep apnea, Pa02 was significantly lower (p<0.05) during the night with (Pa02=78±7 mmHg) than during the night without PD fluid (Pa02=92±4 mmHg). In the apneic patients, the amount of dialysate drained in the morning was negatively correlated with the minimum arterial oxygen saturation during the night (r=-0.94; p<0.005). Conclusions This study indicates a significant relationship between PD patients with chronic sleep disturbance and sleep apnea syndrome. These data suggest that apneic patients may be susceptible to complications of dialysate bulk effect on oxygen desaturation.

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