Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease

BACKGROUND: Studies comparing patient survival of hemodialysis (HD) and peritoneal dialysis (PD) have yielded conflicting results and no such study was from South-East Asia. This study aimed to compare the survival outcomes of patients with end-stage renal disease (ESRD) who started dialysis with HD and PD in Singapore.METHODS: Survival data for a maximum of 5 years from a single-center cohort of 871 ESRD patients starting dialysis with HD (n = 641) or PD (n = 230) from 2005-2010 was analyzed using the flexible Royston-Parmar (RP) model. The model was also applied to a subsample of 225 propensity-score-matched patient pairs and subgroups defined by age, diabetes mellitus, and cardiovascular disease.RESULTS: After adjusting for the effect of socio-demographic and clinical characteristics, the risk of death was higher in patients initiating dialysis with PD than those initiating dialysis with HD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.67-2.59; p&lt;0.001), although there was no significant difference in mortality between the two modalities in the first 12 months of treatment. Consistently, in the matched subsample, patients starting PD had a higher risk of death than those starting HD (HR: 1.73, 95% CI: 1.30-2.28, p&lt;0.001). Subgroup analysis showed that PD may be similar to or better than HD in survival outcomes among young patients (≤65 years old) without diabetes or cardiovascular disease.CONCLUSION: ESRD patients who initiated dialysis with HD experienced better survival outcomes than those who initiated dialysis with PD in Singapore, although survival outcomes may not differ between the two dialysis modalities in young and healthier patients. These findings are potentially confounded by selection bias, as patients were not randomized to the two dialysis modalities in this cohort study.</p

Evaluation of fractionally distilled Picea abies TMP-turpentine on wood-decaying fungi : in vitro, microcosm and field experiments

Synthetic and heavy metal antifungals are frequently used as wood preservatives. However, they exhibit relatively inert biodegradation and toxic properties when leached; this makes their replacement with environmentally degradable yet functional alternatives a key target in the wood protection industry. In this context, distilled fractions of raw thermomechanical pulp turpentine (TMP-T) from Picea abies were assessed for their wood protecting capabilities against wood-decaying fungi. Antifungal bioactivity of fractions and some of their combinations were screened on agar-plates against the brown-rot fungus Coniophora puteana. Addition of TMP-T fractions showed a significant fungal growth rate reduction, while mixtures indicated the presence of synergistic and antagonistic effects. One fraction, obtained after distilling 1 L TMP-T at 111–177 °C at 0.5 mbar, showed complete growth inhibition of Antrodia sinuosa, Serpula lacrymans, Serpula himantioides and significant inhibition of Antrodia serialis, Antrodia xantha, Gloeophyllum sepiarium, Heterobasidion parviporum at a concentration of 1000 ppm. This fraction was further examined for long- and medium-term effects on wood decay in microcosm soil-jar and field experiment, respectively. The known antifungal compounds benzisothiazolinone, 2-octyl-4-isothiazolin-3-one, 3-iodo-2-propynyl N-butylcarbamate and two commercial wood preservatives were used as reference treatments. Commercial preservatives instilled long-term efficacy against C. puteana wood decay in a soil-jar microcosm experiment, but no noticeable protection with antifungal compounds or the present treatments was found. However, a moderate effect by the TMP-T fraction from the in vitro assay was observed and the TMP-turpentine distillation residue showed a similar fungal inhibition effect to the most potent commercial treatment after 29 months in the field