Superior patient survival for continuous ambulatory peritoneal dialysis patients treated with a peritoneal dialysis fluid with neutral pH and low glucose degradation product concentration (Balance)

BACKGROUND: In recent years, laboratory and clinical research has suggested the need for peritoneal dialysis fluids (PDFs) that are more biocompatible than the conventional PDFs commonly used today. Bioincompatibility of PDF has been attributed to low pH, lactate, glucose, glucose degradation products (GDPs), and osmolality. PDFs with neutral pH and low GDPs are now available commercially. In vitro and early clinical studies suggest that these solutions are indeed more biocompatible but, as of now, there is no evidence that their use improves patient outcome. METHODS: Using a dedicated database of over 2000 patients treated with PD in Korea, we were able to conduct a retrospective observational study comparing outcomes for incident continuous ambulatory PD patients treated with a standard, conventional, heat-sterilized PDF to the outcomes for patients treated with a novel, low GDP, neutral-pH PDF prepared in a dual-compartment, double-bag PD system (Balance; Fresenius Medical Care, St. Wendel, Germany). In an intention-to-treat analysis, patient and technique survival, peritonitis-free survival, and peritonitis rates were compared in 611 patients treated with Balance for up to 30 months and 551 patients with a standard PDF (stay . safe; Fresenius Medical Care) treated in the same era and with equivalent follow-up. RESULTS: The patients were well matched for most relevant characteristics except older age distribution for the patients treated with the standard PDF. Patients treated with Balance had significantly superior survival compared to those treated with the standard PDF (74% vs 62% at 28 months, p = 0.0032). In a multivariate Cox regression model including age, diabetes, and gender, the survival advantage persisted (relative risk of death for Balance 0.75, 95% confidence interval 0.56 - 0.99, p = 0.0465). Modality technique survival was similarin Kaplan-Meieranalysis for both PDFs. No differences were detected in peritonitis-free survival or in peritonitis rates between the two solutions. CONCLUSION: This study, for the first time, suggests that treatment with a novel biocompatible PDF with low GDP concentration and neutral pH confers a significant survival advantage. The exact mechanisms for such a survival advantage cannot be determined from this study. The usual criticisms of observational studies apply and the results reported here strongly warrant the undertaking of appropriately designed, randomized, controlled clinical trials

The Effects of Statins Unrelated to Cholesterol level on Clinical Outcome of Continuous Ambulatory Peritoneal Dialysis Patients

Patients who are on CAPD (Continuous Ambulatory Peritoneal Dialysis) show higher serum LDL cholesterol and Triglyceride compared to patients who are on hemodialysis. But higher cholesterol level does not seem to effect on raising mortality or cardiovascular morbidity and CAPD failure. On the contrary, lower serum cholesterol level in CAPD patients tends to raise mortality and morbidity due to poor nutritional status. Methods: This study is a retrospective study designed to evaluate the effect of cholesterol level, statin on CAPD outcome and mortality. Patients who were on peritoneal dialysis for at least 6 months since March 1st, 2000 were included. A total of 467 patients were enrolled in this study. Patients' biological parameter, biochemical parameter and morbidity/mortality during CAPD maintenance period were collected. Results: Patients whose initial cholesterol level were above 240 mg/dL shows significantly low CAPD failure rate compared to patients whose initial cholesterol level were below 200 mg/dL (OR=0.469, p=0.049). Patients whose average LDL-cholesterol during CAPD period were over 100mg/dL showed significantly higher mortality compared to patients whose initial LDL-cholesterol level were below 100mg/dL (OR=1.848, p=0.024). Patients whose compliance to statin during CAPD period was over 80% showed significantly low mortality compared to patients who did not take statin during CAPD period (OD=0.556, p=0.020). Patients showed no significant difference in motality due to total cholesterol, HDL cholesterol levels and patients showed no significant difference in CAPD failure due to HDL/LDL cholesterol, statin usage. Conclusions: Usually compared to HD or CKD patients, serum total cholesterol level in CAPD patients was lower significantly. However, triglyceride level in CAPD patients was significantly higher than CKD or HD patient. In this study, the use of statins unrelated to cholesterol level was significantly effective to clinical outcomes in CAPD patients. To verify this results the larger size and prospective study is needed

Higher peritoneal protein clearance as a risk factor for cardiovascular disease in peritoneal dialysis patient.

BACKGROUND AND AIMS: Although a number of studies have been published on peritoneal protein clearance (PrCl) and its association with patient outcomes, the results have been inconsistent. Therefore, the intent of this study was to evaluate the impact of PrCl on cardiovascular disease (CVD) and mortality in peritoneal dialysis (PD) patients. METHODS: This prospective observational study included a total of 540 incident patients who started PD at NHIC Ilsan Hospital, Korea from January 2000 to December 2009. Two different types of analyses such as intention-to-treat and as-treated were used. RESULTS: Correlation analyses revealed that PrCl was positively correlated with diabetes, pulse pressure, C-reactive protein (CRP) level, dialysate/plasma creatinine ratio (D/P cr) at 4 h, and peritoneal Kt/V urea. PrCl was inversely correlated with serum albumin and triglyceride levels. On multivariate analysis, serum albumin, pulse pressure, D/P cr at 4 h, and peritoneal Kt/V urea were found to be independent determinants of PrCl. A total of 129 (23.9%) patients in intention-to-treat analysis and 117 (21.7%) patients in as-treated analysis developed new cardiovascular events. Time to occurrence of cardiovascular event was significantly longer in patients with a value of PrCl below the median (89.4 ml/day). In multivariate analysis, older age, presence of diabetes or previous CVD, and higher PrCl were independent predictors of cardiovascular events. Patients above the median value of PrCl had a significantly lower rate of survival than those below the median. However, a higher PrCl was not associated with increased mortality in multivariate Cox analysis. CONCLUSIONS: A higher PrCl is a risk for occurrence of cardiovascular event, but not mortality in PD patients. Large randomized clinical trials are warranted to confirm this finding

The impact of prophylactic ureteral stenting during kidney transplantation on postoperative surgical outcomes

Background : The aim of this study was to evaluate the safety and feasibility of prophylactic ureteric stenting during kidney transplantation (KT). Methods : The authors retrospectively reviewed patients who underwent KT between June 2016 and June 2019. The prophylactic ureteral stenting group (double-J [DJ]) and no-stent group (no-DJ) were compared with respect to the clinical data and surgical outcomes. Results : A total of 42 patients underwent KT; 17 patients were classified into the DJ group and 25 patients into the no-DJ group. Antithymocyte globulin induction and donor- specific antibody positivity were significantly higher in the DJ group. There were no significant differences between the groups in terms of symptomatic urinary tract infection (UTI). The time to postoperative UTI was significantly shorter in the DJ group than in the no-DJ group (33.5±7.8 vs. 105.3±71.6 days, P=0.013). The development of postoperative BK viremia was significantly higher in the no-DJ group (0.0% vs. 16.0%, P=0.035). Urologic complications were significantly higher in the no-DJ group (0.0% vs. 16.0%, P=0.035). In the no-DJ group, urologic complications occurred in four patients: ureteroneocystostomy stenosis in three patients and ureteroneocystostomy leakage in one patient. Percutaneous ureteral interventions were performed for all patients using percutaneous nephrostomy and reno-uretero-vesical stenting. However, there were no postoperative urologic complications in the DJ group. Conclusions: Prophylactic ureteric stenting during KT may be safe and feasible without significantly increasing the incidence of UTI and BK viremia. Additionally, prophylactic ureteric stenting may reduce urologic complications after KT

Kaplan-Meier plots of the probability of remaining cardiovascular event-free based on the median level (89.4 ml/day) of baseline peritoneal protein.

<p>(A) Intention-to-treat analysis. (B) As-treated analysis.</p

Multivariate Cox regression analysis for cardiovascular events.

<p>HR, hazard ratio; CI, confidence interval; CVD, cardiovascular disease; nPCR, normalized protein catabolic rate; PrCl, peritoneal protein clearance.</p

Chronic kidney disease in nonalcoholic fatty liver disease at primary healthcare centers in Korea.

BackgroundThe prevalence rates of nonalcoholic fatty liver disease (NAFLD) and chronic kidney disease (CKD) are expected to increase with the rising trends in diabetes and obesity associated with aging populations. Considering the impacts of coexistent NAFLD and CKD on morbidity and mortality rates, screening strategies for groups at high-risk of CKD are needed in community-dwelling individuals with NAFLD. The aims of this study were to determine the prevalence and distribution of CKD in NAFLD, as well as the risk factors for CKD and the correlation with liver fibrosis in asymptomatic individuals with NAFLD at primary healthcare centers in Korea.MethodsThis retrospective cross-sectional study used data from 13 health-promotion centers in 10 Korean cities. Liver steatosis and stiffness were assessed using ultrasonography and magnetic resonance elastography (MRE), respectively. CKD was defined as an estimated glomerular filtration rate of ResultsThe prevalence of CKD was 12.4% in NAFLD. Albuminuria (16.2%) and proteinuria (8.0%) were more prevalent in NAFLD. NAFLD (odd ratio = 1.27, 95% CI = 1.09-1.48, P = 0.003) was independently associated with CKD of at least mild stage. However, there was no significant association between CKD of at least moderate stage and NAFLD after adjusting for age and a metabolically unhealthy status. CKD was associated with significant liver fibrosis as measured by MRE in NAFLD.ConclusionThe presence of NAFLD and liver fibrosis were independent risk factors for CKD, but NAFLD was not an independent risk factor for the later stages of CKD

Multivariate Cox regression analysis for mortality.

<p>HR, hazard ratio; CI, confidence interval; CVD, cardiovascular disease; CRP, C-reactive protein; nPCR, normalized protein catabolic rate; GFR, residual glomerular filtration rate; PrCl, peritoneal protein clearance.</p