Effect of Cold Dialysis Solution on the Sexual Dysfunction of Patients with Chronic Renal Failure Undergoing Hemodialysis: A Randomized Clinical Trial

Background: The present study aimed to evaluate the effect of cold dialysis solution on the sexual dysfunction of patients with chronic renal failure undergoing hemodialysis. Methods: This randomized clinical trial was conducted with a before and after parallel design among 60 hemodialysis patients diagnosed with sexual dysfunction. The selected subjects were randomly allocated to the two groups of experimental and control (30 per each). Patients in the experimental and control groups underwent hemodialysis for one month using 35.5°C and 37°C dialysis solutions, respectively. Following the procedure, male and female sexual function was assessed in the study groups. Data were collected using the International Index of Erectile Functions, the female sexual function index (FSFI), and a demographic questionnaire. Data analysis was performed using Chi-square, Fisher's exact test, Mann-Whitney U test, t-test, paired t-test, and Wilcoxon test at 95% confidence interval. Results: No significant difference was observed between the experimental and control groups regarding male sexual function before and after the intervention (P > 0.05). However, the Mann-Whitney U test indicated a significant difference in the female subjects’ arousal in the experimental group before (3.68 ± 0.38) and after the intervention (3.98 ± 0.46; z = 2.216; P = 0.027). Conclusions: Cold dialysis solution could only increase the sexual arousal of the women in the experimental group, and no changes were observed in other sexual function domains of the male and female patients. Given the short duration of our intervention, it is recommended that further longitudinal studies be performed on larger cohorts of patients in different geographical regions.

Control system for glucose level regulation in peritoneal dialysis

Kidney failure leads to the serious health issues associated with abnormal water-salt balance. In this case, peritoneal dialysis therapy is often prescribed: 1-2 liters of dialysis solution is administered in peritoneal cavity for 3-4 hours. During this time, due to diffusion and osmosis, toxins and excess water are transferred from blood to solution. One of the method’s downsides is the transition of glucose (osmotic agent) into the bloodstream, which leads to a gradual decrease in the fluid removal rate. To mitigate this problem, one must use the system, which will measure current glucose concentration and inject glucose into solution to compensate absorption. The paper proposes such a control system for automatic regulation of the glucose concentration in peritoneal dialysate solution. Its structure, elements, their functions and characteristics are discussed. Proposed system is capable to work autonomously or can be incorporated into wearable “artificial kidney” device.

Amelioration of fatigue in chronic dialysis patients with dialysis solution employing electrolyzed water containing molecular hydrogen (H2) and its association with autonomic function balance

Background Enhanced oxidative stress is involved with fatigue in hemodialysis (HD) patients. Molecular hydrogen (H2) could improve the redox status. Thus, the study examines whether HD solution rendered by electrolyzed water containing H2 (E-HD) could impact the fatigue and autonomic balance of patients. Methods This single-arm, prospective observational study examined 95 patients on chronic HD (54 males; mean age and HD duration; 71.4 years and 10.6 years). Fatigue status on HD and HD-free days was compared between control HD (CHD) and 8 weeks after commencement of E-HD, using a visual analog scale (VAS) and an original scale. Autonomic balance was analyzed with the degree of activities of the sympathetic and parasympathetic nervous system via frequency analysis of a continuous beat interval. Results Patients were classified into three groups according to the presence of subjective fatigue during the period of CHD: Group A (40.0%), fatigue only on HD days; Group B (11.6%), presence of fatigue on both HD and HD-free days; and Group C (48.4%), freedom from fatigue. During the 8-week observation period of E-HD, VAS scores were significantly decreased on HD days in Group A, while Group B showed no significant changes in VAS on HD days, but significant decreases on HD-free days. No consistent changes were found in Group C. Significant increases in percentages of patients who reported absence of fatigue were seen in Group A on HD days and in Group B on HD-free days in week 8. Regarding changes in autonomic balance parameters after E-HD commencement, a positive correlation was identified between changes in VAS and autonomic balance in Group A. Conclusion E-HD may ameliorate fatigue in patients with subjective symptoms on HD and HD-free days. The influence of autonomic balance by E-HD and its impact on fatigue needs to be elucidated.

Clinical and paraclinical characteristics of patients undergoing hemodialysis

Introduction: End-stage renal disease (ESRD) is an irreversible decrease in kidney function with severe consequences. Objectives: The aim of this study was to investigate clinical and paraclinical characteristics of hemodialysis patients. Patients and Methods: This study was a descriptive-analytical performed on 105 patients undergoing hemodialysis referred to Bou Ali and Velayat hospitals in Qazvin. The data were included age, gender, duration of dialysis, kind of vascular access, kind of catheter, site of catheters, weight, height, systolic and diastolic blood pressure, kind of flux, use of midodrine, kind of dialysis solution, number of dialysis per week, calcium (Ca), iron, total iron binding capacity (TIBC), ferritin, parathyroid hormone (PTH), Kt/V, blood urea nitrogen (BUN) and creatinine (Cr). The data were analyzed using SPSS version 21. Results: The mean age of the patients was 60.97±15.13 years and 44.8% of the patients were females. The mean number of dialysis per week was 2.84 times with a mean duration of 3.90 years. The mean Cr level was 8.89±3.14 mg/dL. Males had higher level of BUN (55.91±16.06 mg/dL versus 65.24±17.53 mg/ dL, P=0.006) and Cr (8.09±2.43 mg/dL versus 9.59±3.47 mg/dL, P=0.010). Arteriovenous fistula/AVF was the most common vascular access (76.2% of cases). With increasing BUN, number of dialysis per week and weight, the level of Cr increases significantly (P<0.05). In the younger patients, Cr showed low level compared to the older patients. Conclusion: The number of dialysis per week, weight and BUN level is factors to predict the level of Cr and with increasing these factors, the level of Cr increases. The mean Cr level was high which showed inadequacy of hemodialysis in these patients. The level of Cr and BUN is higher in men.

MO718ROLE OF CT-PERITONEOGRAPHY IN THE PATIENT WITH GENITAL EDEMA AND PERITONEAL DIALYSIS

Background and Aims Genital edema is a frequent complication in those patients who are on peritoneal dialysis, generally secondary to the increase in intra-abdominal pressure that it entails. It occurs late after the implantation of the peritoneal catheter (after 30 days of implantation). The typical clinical manifestation of this condition is basically subcutaneous edema in the genital area, accompanied by pain and UF failure. The diagnosis must be made by using an imaging test, mainly CT-peritoneography. Method A series of clinical cases of PD patients who consulted for genital edema is reviewed, analyzing the role of peritoneography Results CASE 1 A 76-year-old male, 15 days after the start of the technique, consulted for right scrotal edema. It was decided to suspend CAPD and start hospital intermittent IPD with low volumes. A CT-peritoneography was requested, which revealed a right peritoneal-vaginal duct and a left inguino-scrotal leak. Surgical correction of the anatomical defect was performed without incident, with subsequent return of the patient to CAPD. CASE 2 A 78-year-old man, 15 days after the start of the technique, consulted for bilateral scrotal edema. A CT-peritoneography was performed, which showed that the leak of peritoneal fluid to the scrotum was due to bilateral inguinal hernia. Subsequently, inguinal hernioplasty of the surgical defect was performed without complications. Conclusion Genital edema, as a complication of patients with CAPD, appears in approximately 4-10% of them. CT-peritoneography is the diagnostic technique of choice. To do this, 150 ml of nonionic iodinated contrast, with a concentration of 300 mg/ml, are diluted in approximately 2 liters of dialysis solution, which are introduced into the peritoneal cavity of the patient 2 h before performing the CT. Subsequently, a CT scan of the abdomen and pelvis including the perineum is performed, in the supine position and craniocaudal direction.

The Effect of Dialysis Solution Temperature and Stepwise Ultrafiltration Profile on Dialysis Adequacy and Pruritus in Hemodialysis Patients: A Quasi-experimental Study

Background: Patients with renal insufficiency who receive hemodialysis should be continuously monitored to avoid possible complications, as they are at increased risk of several problems, including pruritus, as one of the most annoying problems. It seems that dialysis adequacy affects the pruritus of hemodialysis patients. Objective: The current study aimed to investigate the effect of dialysis solution temperature and stepwise ultrafiltration profile on dialysis adequacy and pruritus of hemodialysis patients. Methods: Following a single group quasi-experimental design, 34 eligible hemodialysis patients admitted to the hemodialysis ward of Zahedan Medical Center (Iran) in 2020 were recruited using the convenience sampling technique. All patients attended three standard dialysis sessions (at a temperature of 37°C) and three cold dialysis sessions (36°C) with a stepwise dialysis ultrafiltration profile. Dialysis adequacy was measured at the end of each session, and Yosipovitch’s Pruritus Severity Scale (PSS) was filled before and after each dialysis session. Data were summarized using descriptive statistics (i.e., frequency, mean, and standard deviation). Mean scores before and after dialysis were paired by t-test using SPSS version 22. Statistical significance was considered when P-value < 0.05. Results: The mean and standard deviation of dialysis adequacy in both standard dialysis and cold dialysis techniques with stepwise ultrafiltration profile were 1.18 ± 0.36 and 1.44 ± 0.48, respectively, indicating that dialysis adequacy of the cold dialysis method with stepwise ultrafiltration profile was significantly higher (P = 0.001). Besides, the mean pruritus scores in the standard dialysis and cold dialysis methods with stepwise ultrafiltration profile were -0.73 ± 0.80 and -1.73 ± 1.16, respectively, showing a significant difference (P = 0.001). Conclusions: Cold hemodialysis with a stepwise ultrafiltration profile can be used as a simple and low-cost technique to improve both dialysis adequacy and relieve pruritus in hemodialysis patients.

Delayed bowel perforation after instilling over warmed peritoneal dialysate

Background Peritoneal dialysis (PD) is a safe and home-based treatment for end-stage renal disease (ESRD) patients. The direct thermal damage of abdominal organs is very rare. Case presentation We report a peritoneal dialysis patient presented abdominal pain and feculent effluent 3 weeks after he instilled hot dialysis solution. In spite of emergency exploratory laparotomy and active treatment, the patient died of septic shock. Biopsy revealed necrosis and perforation of the intestines. Conclusions Delayed bowel perforation by hot fluid is very rare. Standardized performance is of the first importance for peritoneal dialysis patients.

A New Peritoneal Dialysis Solution Containing L-Carnitine and Xylitol for Patients on Continuous Ambulatory Peritoneal Dialysis: First Clinical Experience

Peritoneal dialysis (PD) is a feasible and effective renal replacement therapy (RRT) thanks to the dialytic properties of the peritoneal membrane (PM). Preservation of PM integrity and transport function is the key to the success of PD therapy, particularly in the long term, since the prolonged exposure to unphysiological hypertonic glucose-based PD solutions in current use is detrimental to the PM, with progressive loss of peritoneal ultrafiltration capacity causing technique failure. Moreover, absorbing too much glucose intraperitoneally from the dialysate may give rise to a number of systemic metabolic effects. Here we report the preliminary results of the first clinical experience based on the use in continuous ambulatory PD (CAPD) patients of novel PD solutions obtained through partly replacing the glucose load with other osmotically active metabolites, such as L-carnitine and xylitol. Ten CAPD patients were treated for four weeks with the new solutions. There was good tolerance to the experimental PD solutions, and no adverse safety signals were observed. Parameters of dialysis efficiency including creatinine clearance and urea Kt/V proved to be stable as well as fluid status, diuresis, and total peritoneal ultrafiltration. The promising tolerance and local/systemic advantages of using L-carnitine and xylitol in the PD solution merit further research.

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics)

Peritoneal dialysis (PD) for acute kidney injury (AKI) in children has a long track record and shows similar outcomes when compared to extracorporeal therapies. It is still used extensively in low resource settings as well as in some high resource regions especially in Europe. In these regions, there is particular interest in the use of PD for AKI in post cardiac surgery neonates and low birthweight neonates. Here, we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI in paediatrics. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis. Summary of recommendations 1.1 Peritoneal dialysis is a suitable renal replacement therapy modality for treatment of acute kidney injury in children. (1C) 2. Access and fluid delivery for acute PD in children. 2.1 We recommend a Tenckhoff catheter inserted by a surgeon in the operating theatre as the optimal choice for PD access. (1B) (optimal) 2.2 Insertion of a PD catheter with an insertion kit and using Seldinger technique is an acceptable alternative. (1C) (optimal) 2.3 Interventional radiological placement of PD catheters combining ultrasound and fluoroscopy is an acceptable alternative. (1D) (optimal) 2.4 Rigid catheters placed using a stylet should only be used when soft Seldinger catheters are not available, with the duration of use limited to <3 days to minimize the risk of complications. (1C) (minimum standard) 2.5 Improvised PD catheters should only be used when no standard PD access is available. (practice point) (minimum standard) 2.6 We recommend the use of prophylactic antibiotics prior to PD catheter insertion. (1B) (optimal) 2.7 A closed delivery system with a Y connection should be used. (1A) (optimal) A system utilizing buretrols to measure fill and drainage volumes should be used when performing manual PD in small children. (practice point) (optimal) 2.8 In resource limited settings, an open system with spiking of bags may be used; however, this should be designed to limit the number of potential sites for contamination and ensure precise measurement of fill and drainage volumes. (practice point) (minimum standard) 2.9 Automated peritoneal dialysis is suitable for the management of paediatric AKI, except in neonates for whom fill volumes are too small for currently available machines. (1D) 3. Peritoneal dialysis solutions for acute PD in children 3.1 The composition of the acute peritoneal dialysis solution should include dextrose in a concentration designed to achieve the target ultrafiltration. (practice point) 3.2 Once potassium levels in the serum fall below 4 mmol/l, potassium should be added to dialysate using sterile technique. (practice point) (optimal) If no facilities exist to measure the serum potassium, consideration should be given for the empiric addition of potassium to the dialysis solution after 12 h of continuous PD to achieve a dialysate concentration of 3–4 mmol/l. (practice point) (minimum standard) 3.3 Serum concentrations of electrolytes should be measured 12 hourly for the first 24 h and daily once stable. (practice point) (optimal) In resource poor settings, sodium and potassium should be measured daily, if practical. (practice point) (minimum standard) 3.4 In the setting of hepatic dysfunction, hemodynamic instability and persistent/worsening metabolic acidosis, it is preferable to use bicarbonate containing solutions. (1D) (optimal) Where these solutions are not available, the use of lactate containing solutions is an alternative. (2D) (minimum standard) 3.5 Commercially prepared dialysis solutions should be used. (1C) (optimal) However, where resources do not permit this, locally prepared fluids may be used with careful observation of sterile preparation procedures and patient outcomes (e.g. rate of peritonitis). (1C) (minimum standard) 4. Prescription of acute PD in paediatric patients 4.1 The initial fill volume should be limited to 10–20 ml/kg to minimize the risk of dialysate leakage; a gradual increase in the volume to approximately 30–40 ml/kg (800–1100 ml/m2) may occur as tolerated by the patient. (practice point) 4.2 The initial exchange duration, including inflow, dwell and drain times, should generally be every 60–90 min; gradual prolongation of the dwell time can occur as fluid and solute removal targets are achieved. In neonates and small infants, the cycle duration may need to be reduced to achieve adequate ultrafiltration. (practice point) 4.3 Close monitoring of total fluid intake and output is mandatory with a goal to achieve and maintain normotension and euvolemia. (1B) 4.4 Acute PD should be continuous throughout the full 24-h period for the initial 1–3 days of therapy. (1C) 4.5 Close monitoring of drug dosages and levels, where available, should be conducted when providing acute PD. (practice point) 5. Continuous flow peritoneal dialysis (CFPD) 5.1 Continuous flow peritoneal dialysis can be considered as a PD treatment option when an increase in solute clearance and ultrafiltration is desired but cannot be achieved with standard acute PD. Therapy with this technique should be considered experimental since experience with the therapy is limited. (practice point) 5.2 Continuous flow peritoneal dialysis can be considered for dialysis therapy in children with AKI when the use of only very small fill volumes is preferred (e.g. children with high ventilator pressures). (practice point)

A Double-Walled Assistive Holder Used in Peritoneal Dialysis Connection

When compared with conventional kidney hemodialysis, peritoneal dialysis (PD) has advantages such as maintaining stable physiological blood status and blood pressure, alleviating anemia, and improving mobility, which make it an ideal method for at-home (even on the road) dialysis treatment. However, a serious drawback of PD is the potential for infection of the abdominal lining (peritonitis), which can discourage people from using PD. Since PD can involve up to 4–5 fluid exchanges per day that require connection and disconnection of a tube to a catheter, there can be a substantial risk of infection. This infection risk creates a barrier to the use of PD and prevents people from enjoying the benefits of convenience and portability that PD can provide. This study proposes an assistive holder for PD patients that helps reduce the possibility of contamination during connection and disconnection of dialysis solution exchange bags. This PD assistive holder is low-cost, lightweight, and disposable. The holder is compatible with existing PD procedures and it can be used by touch only, for people with impaired vision. The PD assistive holder enables patients to care for themselves at home and improves the functionality and portability of standard PD systems.