scholarly journals Reduced Erythrocyte Survival in Uremic Patients Under Hemodialysis or Peritoneal Dialysis

2016 ◽  
Vol 41 (6) ◽  
pp. 966-977 ◽  
Author(s):  
Rosi Bissinger ◽  
Ferruh Artunc ◽  
Syed M. Qadri ◽  
Florian Lang
Keyword(s):  
Peritoneal Dialysis ◽  
Erythrocyte Survival ◽  
Uremic Patients

A Comparison of Bone Scans in Uremic Patients Treated with Intermittent Peritoneal Dialysis Or Hemodialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 312-317
Author(s):  
Hanna Plotast ◽  
Alicja E. Grzegorzewska ◽  
Roman Junik ◽  
Jerzy Sowinski ◽  
Maciej Gernbicki
Keyword(s):  
Peritoneal Dialysis ◽  
Normal Limit ◽  
Cranial Vault ◽  
Entire Group ◽  
Similar Frequency ◽  
Dialysis Treatment ◽  
Younger Age ◽  
Uremic Patients ◽  
Bone Scans ◽  
Sacral Bone

The aim of the study was a comparative analysis of bone scans in uremic patients treated with intermittent peritoneal dialysis (IPD) or hemodialysis (HD). Bone scintigraphy was performed using technetium Tc 99m etidronate (EHDP) in 28 uremics (age 46.0±13.5 years, x±SD) on IPD for 3.1±3.0 months and 28 uremics (age 43.5±11.6 years) on HD for 47.3±33.9 months. Serum c terminal parathormone (cPTH) exceeded 5.3±3.3 and 6.8±3.5 times the upper normal limit of 1.4 ng/mL in IPD and HD patients, respectively. Despite significant differences in dialysis treatment duration in IPD and HD patients, an increased Tc 99m EHDP uptake in bones was shown with similar frequency, when all the groups were compared. However, in the group of patients with serum cPTH exceeding four times the upper normal limit (n = 30) or in the age group less than 45 years old (n = 26), a greater marker uptake was observed in HD patients. Significant differences (p < 0.05) were shown in the cranial vault: 33% of HD patients (n = 18) with higher cPTH and 47% of those less than 45 years old (n = 15) revealed an increased marker uptake, whereas it was not observed in any IPD patient. When scans of HD patients dialyzed less than (n = 11) and more than (n = 17) 30 months were compared, a significantly higher appearance of increased marker uptake was shown in cranial vault (41% vs 0%, p < 0.02) and in sacral bone (82% vs 36%, p < 0.02) in patients with longer dialysis. The latter group of HD patients also showed an increased marker uptake in cranial vault compared to the entire group of PD patients (41% vs 7%, p < 0.01). Our studies suggest that bone scan changes, indicating secondary hyperparathyroidism, progress significantly with prolongation of dialysis treatment, especially in patients with higher cPTH levels of younger age.

Histologic Change of Peritoneal Membrane in Relation to Adequacy of Dialysis in Continuous Ambulatory Peritoneal Dialysis Patients

2003 ◽  
Vol 23 (2_suppl) ◽  
pp. 26-30 ◽  
Author(s):  
Irini Savidaki ◽  
Dionisios Karavias ◽  
Florentia Sotsiou ◽  
Sotiria Alexandri ◽  
Pantelitsa Kalliakmani ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Structural Changes ◽  
Mesothelial Cells ◽  
Peritoneal Membrane ◽  
Histologic Change ◽  
Significant Difference ◽  
Uremic Patients ◽  
Group B ◽  
Histologic Changes

Background Long-term exposure of peritoneal membrane to bioincompatible dialysis solutions leads to structural changes and loss of ultrafiltration capability. Objective We studied the possible relationship between histologic change and the transport characteristics of peritoneal membrane and adequacy of dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients. Patients and Methods The study included 18 CAPD patients (11 men, 7 women) who underwent a peritoneal biopsy either at initiation of treatment (group A, n = 9) or after a mean of 4 years on CAPD (group B, n = 9). The morphologic changes in the mesothelial cells and the vascular compartment and the thickness of the submesothelial collagenous zone were estimated and compared with observations from 6 patients with normal renal function who underwent biopsy of the parietal peritoneum during abdominal surgery. The relationship of the observed changes in CAPD patients to results from a peritoneal equilibration test (PET) and to adequacy of dialysis [total weekly creatinine clearance (CCr) and Kt/V urea] were also investigated. Results The main histologic changes in both groups of patients were loss of mesothelial cells and decrease in the normal mesothelial surface, thickening of the submesothelial collagenous zone, and presence of vascular hyalinosis. The thickness of the submesothelial collagenous zone in both groups of patients was significantly greater than that found in controls (410 μm and 580 μm vs 50 μm, p < 0.05). Although no significant difference was found between morphologic change in the peritoneal membrane of uremic patients starting on CAPD and those who had been on peritoneal dialysis (PD) for a mean period of 4 years, a trend was observed toward more severe lesions in the latter patients. The PET, CCr, and Kt/V urea were not significantly different in the two groups of patients. Those parameters also showed no significant changes when examined at initiation of CAPD and after a mean of 4 years of PD in the same patients (group B). No significant correlations were observed between the histologic changes and the PET, CCr, or Kt/V in both groups of patients. Conclusions Significant structural changes are observed in the peritoneal membrane of uremic patients, and those changes become worse with CAPD treatment. Structural changes are not followed by functional changes during the first 4 years on CAPD.

scholarly journals P1145ADEQUACY AND SURVIVAL IN PERITONEAL DIALYSIS: TEN YEARS EXPERIENCE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Vincenzo Terlizzi ◽  
Elena Pezzini ◽  
Roberta Cortinovis ◽  
Diana Bertoni ◽  
Alessandra Pola ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peritoneal Dialysis ◽  
Protective Factor ◽  
Residual Renal Function ◽  
Dialysis Modality ◽  
Dialysis Adequacy ◽  
Dialysis Treatment ◽  
Increased Risk ◽  
Uremic Patients

Figure: Background and Aims in Italy only a minority of uremic patients perform peritoneal dialysis (PD). In dialysis centers where PD is practiced and proposed the prevalence is no more than 23%. Proposed advantages of PD over HD are a more preserved Residual renal function (RRF), that has been associated with better survival, and better Quality of life (Qol) due to possible more preservation of previous lifestyle, independence, possibility of traveling, and flexibility. Incremental peritoneal dialysis is a promising way to further improve Qol and to preserve RRF. Lastly, PD is less expensive than HD. Aim of this study has been to retrospectively evaluate our ten-years experience of PD treatment on survival, dialysis adequacy, preservation of RRF and nutrition in uremic patients followed at our Dialysis Center. Method We retrospectively evaluated all the incident patients that started PD treatment due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. The exclusion criteria were time of dialysis treatment less than 3 months and absence of previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded. Data on dialysis adequacy, nutrition, RRF and PD dialysis modality performed were also recorded. Results During the observation period 329 patients started PD. 60 were excluded due to follow-up of less than 3 months. Therefore, 269 patients (males 160, 59%) were studied. The average age was 65±16 years, BMI 24±4 kg/m2. Comorbidities were: hypertension (87%), diabetes mellitus (32%), cerebral vascular disease (26%) and ischemic heart disease (25%). The mean duration of dialysis treatment was 2.1±1.5 years. At the end of ten-years follow-up 24% of patients have had a kidney transplant, 18% were on PD treatment, 17% have had a shift towards HD, 39% had died. The main causes of death were: infection (39%) and cardiovascular disease (31%). The most common dialysis modality performed was APD (61%); CAPD was performed in 39% of pts. Dialysis modality (CAPD; APD), nutrition parameters (PNA; BMI), as well as RRF, expressed as an average value during follow-up, are shown in Figure 1. 81 patients (30%) were treated with incremental PD; 85% of them with manual exchanges. The comparison of dialysis parameters between incremental PD and standard PD are shown in Figure 2. Multivariate analysis with survival as dependent variable (Figure 3), showed that age, diabetes mellitus, and low wKt/V were independently associated with an increased risk of mortality. Diuresis volume and male gender were protective factors. No independent influence on mortality of the dialysis treatment modality was found. Conclusion In this ten-years experience of patients undergoing PD at our Center, incremental PD seems to be a protective factor for the maintenance of a preserved diuresis and better dialysis adequacy, and these factors are associated with better survival of the patients.

Dislipemia in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Pharmacological Therapy (Simvastatin) versus Hemodialysis

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 431-433 ◽  
Author(s):  
Roberto Marangoni ◽  
Fernando Civardi ◽  
Franceso Masi ◽  
Roberto Cimino ◽  
Luca Maltagliati ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Total Cholesterol ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Pharmacological Therapy ◽  
Apolipoprotein A ◽  
Previously Treated ◽  
Uremic Patients ◽  
Significant Change ◽  
Therapeutic Possibilities

Peritoneal dialysis can worsen disllpemia, which is frequent in chronically uremic patients. In order to verify the therapeutic possibilities, we retrospectively studied 20 chronically uremic patients who had been previously treated with continuous ambulatory peritoneal dialysis (CAPO) and who had developed an IV-type dislipemia. Twelve have continued CAPO treatment and have been simultaneously treated with simvastatin; 8 have withdrawn from CAPO and have begun HO, without any antidislipemic pharmacological support. The results, after 3, 6, 12, and 18 months of treatment, showed the following: In patients treated with CAPO and simvastatin, highly significant decreases were noted in total cholesterol (T-cho) and triglycerides (TG) (p<0.001), and highly significant increases were noted in HOL-cholesterol (HOL-cho) (p<0.005) and apolipoprotein-A 1 (Apo-A 1) (p<0.01). In patients treated with HO, only slightly significant decreases were noted in T-cho (p<0.01) and TG (p<0.02), a slightly significant increase in Apo-A1 (p<0.05), and no significant change in HOL-cho. Apollpoprotein-B showed no change in the two groups. Therefore, patients undergoing CAPO, with dislipemia only, can continue the treatment, because simvastatin is capable of correcting dislipemia, while those patients who have displemia as well as other complications strictly due to CAPO must abandon treatment and must be transferred to extracorporeal methods.

Rate of Synthetic Oligosaccharide Degradation as a Novel Measure of Amylase Activity in Peritoneal Dialysis Patients

2008 ◽  
Vol 28 (3) ◽  
pp. 296-304 ◽  
Author(s):  
Elvia García–López ◽  
Andrzej Werynski ◽  
Olof Heimbürger ◽  
José C. Divino Filho ◽  
Bengt Lindholm ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Amylase Activity ◽  
Ex Vivo ◽  
Total Activity ◽  
Activity Level ◽  
Dialysis Patients ◽  
Ex Vivo Model ◽  
Patient Groups ◽  
Uremic Patients ◽  
The Relationship

Background Plasma α–amylase activity is elevated in uremic patients but lower in peritoneal dialysis (PD) patients using icodextrin in comparison to healthy controls. We studied the rate by which an exogenous oligosaccharide (maltoheptaose; G7) is degraded ex vivo by amylase in plasma from PD patients treated with glucose or icodextrin PD solutions. Methods Plasma amylase (pancreatic and total) activity and concentration were measured in 11 controls and in PD patients treated with glucose ( n = 11) and icodextrin ( n = 19). The plasma was spiked with G7 and/or synthetic amylase and the metabolites formed were measured by HPLC following incubation at 37°C for 4 hours. Results The relationship between amylase activity and amylase concentration was similar in all patients and controls. The G7 degradation rate was slower in plasma from icodextrin patients but it was also reduced in patients using glucose compared with the controls, in spite of the higher amylase activity in the glucose group. Normalization (by spiking) of patient plasma with porcine amylase increased but did not normalize the speed of G7 degradation. At a given endogenous amylase activity level, the efficiency of G7 degradation was similar for both patient groups. Conclusions An ex vivo model to study the relationship between amylase activity and the actual rate of carbohydrate (represented by G7) breakdown was developed and showed that PD patients using glucose and icodextrin degrade G7 at a slower speed than controls. This suggests that amylase-mediated carbohydrate metabolism is reduced in PD patients. Further clinical studies are needed to confirm if these findings hold true also in other groups of uremic patients with varying degrees of kidney failure, as well as in patients undergoing hemodialysis.

scholarly journals Management of Uremic Patients With Heparin-Induced Thrombocytopenia Requiring Hemodialysis

2007 ◽  
Vol 14 (4) ◽  
pp. 459-464 ◽  
Author(s):  
Takefumi Matsuo ◽  
Keiko Wanaka
Keyword(s):  
Peritoneal Dialysis ◽  
Extracorporeal Circulation ◽  
Medical Records ◽  
Nafamostat Mesilate ◽  
Heparin Induced Thrombocytopenia ◽  
Surgical Interventions ◽  
Uremic Patients

Medical records of 122 patients with suspected heparin-induced thrombocytopenia on dialysis were reviewed. Method of dialysis in heparin-induced thrombocytopenia patients with bleeding from various causes (including surgical interventions) and how to cope with blood access occlusion induced by heparin-induced thrombocytopenia were studied. Of 122 patients, 17 who met the criteria of >30% thrombocytopenia, clots in the extracorporeal circulation, positive for heparin/PF4 complex antibodies, and improvement from heparin-induced thrombocytopenia with the use of an alternative anticoagulant or another strategy for heparin-induced thrombocytopenia were chosen. Argatroban was uneventfully introduced in 12 patients having neither bleeding nor blood access failure. In all, 2 of 5 patients were treated with peritoneal dialysis. The others requiring a regional anticoagulant were given nafamostat mesilate. Argatroban as an alternative provides effectively anticoagulation in patients with heparin-induced thrombocytopenia on dialysis. In patients with heparin-induced thrombocytopenia with bleeding and its associated risk, nafamostat mesilate was an alternative. Peritoneal dialysis also was applied in cases of blood access failure due to heparin-induced thrombocytopenia.

scholarly journals Evaluating Hyponatremia in Non-Diabetic Uremic Patients on Peritoneal Dialysis

2016 ◽  
Vol 36 (2) ◽  
pp. 196-204 ◽  
Author(s):  
Ming-Tso Yan ◽  
Chih-Jen Cheng ◽  
Hsiu-Yuan Wang ◽  
Chwei-Shiun Yang ◽  
Sheng-Jeng Peng ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Body Fluid ◽  
Extracellular Volume ◽  
Bioelectrical Impedance ◽  
High Water ◽  
Plasma Sodium ◽  
Fluid Composition ◽  
Dialysis Adequacy ◽  
Hand Grip ◽  
Uremic Patients

BackgroundAn approach to hyponatremia in uremic patients on peritoneal dialysis (PD) necessitates the assessment of intra-cellular fluid volume (ICV) and extracellular volume (ECV). The aim of the study was to evaluate the association of plasma sodium (Na+) concentration and body fluid composition and identify the causes of hyponatremia in non-diabetic PD patients.MethodsSixty non-diabetic uremic patients on PD were enrolled. Baseline body fluid composition, biochemistry, hand-grip test, peritoneal membrane characteristics, dialysis adequacy, Na+and water balance, and residual renal function (RRF) were measured. These parameters were reevaluated for those who developed hyponatremia, defined as serum Na+concentration < 132 mmol/L and a decline in serum Na+> 7 mmol/L, during monthly visits for 1 year. Body fluid composition was determined by multi-frequency bioelectrical impedance (BIA).ResultsThere was no significant correlation between serum Na+concentrations and any other parameters except a negative correction with overnight ultrafiltration (UF) amount ( p = 0.02). The ICV/ECV ratio was positively correlated with serum albumin ( p < 0.005) and hand grip strength ( p < 0.05). Over 1 year, 9 patients (M:F = 3:6, aged 35 – 77) with 4 different etiologies of hyponatremia were identified. Hyponatremic patients with a body weight (BW) loss had either an increased ICV/ECV ratio associated with primarily a negative Na+balance ( n = 2) or a reduced ratio of ICV/ECV associated with malnutrition ( n = 2). In contrast, hyponatremic patients with a BW gain had either a reduced ICV/ECV ratio associated with a rapid loss of RRF and a higher peritoneal permeability ( n = 2) or a normal to increased ICV/ECV ratio associated with high water intake ( n = 3).ConclusionBesides BW change and ultrafiltration rate, the assessment of ICV/ECV ratio is valuable in identifying the etiologies of hyponatremia in PD and provides a guide for optimal therapy.

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