The Trio Trial - A Randomized Controlled Clinical Trial Evaluating the Effect of a Biocompatible Peritoneal Dialysis Solution on Residual Renal Function.

Unlabelled: ♦

Background And Objective: Residual renal function (RRF) correlates with mortality and morbidity rates in patients receiving peritoneal dialysis (PD). We examined the effect of a biocompatible PD solution (Gambrosol Trio; Gambro Lundia AB, Lund, Sweden) with lower concentrations of glucose degradation products on rates of decline in RRF. ♦

Design, Setting, Participants, And Measurements: Incident patients at 2 centers in Canada and 1 in Hong Kong were randomized (by minimization) in an open-label parallel group trial to receive Gambrosol Trio or standard PD solution (Dianeal; Baxter Healthcare, Mississauga, Canada) for 2 years.

Magnesium retards the progress of the arterial calcifications in hemodialysis patients: a pilot study.

Background: The aim of the study was to evaluate the impact of magnesium (Mg) on the evolution of arterial calcifications in hemodialysis patients.

Patients And Methods: Seventy-two stable hemodialysis patients were randomly allocated to two groups: 36 administered a regimen containing magnesium carbonate plus calcium acetate as a phosphate binder (Mg group), while the rest 36 received calcium acetate alone (Ca group). The presence and the progression of arterial calcifications were evaluated in plain X-rays using a simple vascular calcification score.

Peritoneal dialysis outcomes in a modern cohort of overweight patients.

Background: The incidence of obesity is increasing both in the general population and in incident dialysis patients. While there is evidence that being overweight is associated with good outcomes in hemodialysis, the evidence in peritoneal dialysis (PD) patients is not very clear. We studied a modern cohort of PD patients to examine outcomes in large patients.

Vitamin D status in patients with recurrent kidney stones.

Data regarding the prevalence of 25-hydroxyvitamin D (25(OH)D) insufficiency in patients with nephrolithiasis, and the effects of vitamin D supplementation on parathyroid hormone (PTH) are few and conflicting. In this article, we examined the prevalence of vitamin D insufficiency and deficiency in 236 recurrent kidney stone formers and the correlation of vitamin D levels with other parameters of stone formation. The prevalent stone composition was calcium oxalate (80.

Hyponatremia in peritoneal dialysis: epidemiology in a single center and correlation with clinical and biochemical parameters.

Background: Hyponatremia in peritoneal dialysis (PD) patients has previously been associated with water overload and weight gain, or with malnutrition and intracellular potassium depletion. Although there is a sizable literature about transmembrane sodium and water removal in PD, there are few reports about the incidence and characteristics of hyponatremia in the clinical setting.

Aim: We evaluated the incidence and factors associated with hyponatremia in PD patients in a single PD unit.

Glycemic control and survival in peritoneal dialysis patients with diabetes mellitus.

Purpose: The optimal target for glycated hemoglobin (HbA1c) has not been well defined in peritoneal dialysis (PD) patients with diabetes mellitus.

Methods: The objective of our study was to examine the predictive value of predialysis and time-averaged follow-up HbA1c values on technique and patient survival in diabetic PD patients treated in the Toronto General Hospital Home Peritoneal Dialysis Unit, between January 1, 2003 and December 31, 2008 with a median follow-up period of 30±23 months.

Results: Ninety-one patients (mean age 64±13 years-old) were included in this retrospective study.

Normocalcemic hyperparathyroidism in patients with recurrent kidney stones: a disease entity or vitamin D deficiency?

This retrospective data analysis was undertaken to examine the biochemical differences between renal stone formers with normocalcemic hyperparathyroidism (NHPT) and those with normal parathyroid hormone (PTH) levels. Our goal was to ascertain whether 25-hydroxyvitamin D (25(OH)D) status related to PTH levels in this patient cohort. Our findings among 74 patients with NHPT indicate that stone formers with NHPT had significantly lower 25(OH)D levels compared to 192 controls (p = 0.

Aging and physiological changes of the kidneys including changes in glomerular filtration rate.

In addition to the structural changes in the kidney associated with aging, physiological changes in renal function are also found in older adults, such as decreased glomerular filtration rate, vascular dysautonomia, altered tubular handling of creatinine, reduction in sodium reabsorption and potassium secretion, and diminished renal reserve. These alterations make aged individuals susceptible to the development of clinical conditions in response to usual stimuli that would otherwise be compensated for in younger individuals, including acute kidney injury, volume depletion and overload, disorders of serum sodium and potassium concentration, and toxic reactions to water-soluble drugs excreted by the kidneys. Additionally, the preservation with aging of a normal urinalysis, normal serum urea and creatinine values, erythropoietin synthesis, and normal phosphorus, calcium and magnesium tubular handling distinguishes decreased GFR due to normal aging from that due to chronic kidney disease.

Home dialysis first: a new paradigm for new ESRD patients.

Patients with end-stage renal disease (ESRD) were treated with either in-center hemodialysis (ICH) or one of the modes of home-based dialysis (HBD)-- peritoneal dialysis (PD) or home hemodialysis (HHD). Home-based dialysis modes showed better outcomes than ICH (PD for the first 2-3 years and HHD for the long-term). Home PD has become more attractive with overnight cyclers for PD and the use of home helpers.

Variability in CKD stage in outpatients followed in two large renal clinics.

Objective: Chronic kidney disease (CKD) is staged by glomerular filtration rate (GFR). CKD stages sometimes vary between routine office visits, and it is unknown if this impacts renal and patient survival separately from a cross-sectional CKD stage value. We quantified and categorized CKD stage variability in a large group of outpatients and correlated this with clinical and demographic features and with renal and patient survival.

Two icodextrin exchanges per day in peritoneal dialysis patients with ultrafiltration failure: one center's experience and review of the literature.

Background: At present, only one exchange of an icodextrin-based solution is recommended to increase peritoneal ultrafiltration (UF) during long-dwell exchanges in peritoneal dialysis (PD) patients with impaired UF.

Aim: To review our experience with two icodextrin exchanges per day on net UF and body weight in PD patients with poor UF.

Methods: Data were analyzed on nine patients with poor UF on chronic PD who were given two icodextrin exchanges per day for 6 months and had various clinical and biochemical parameters assessed monthly.

Encapsulating peritoneal sclerosis: a single-center experience and review of the literature.

Encapsulating peritoneal sclerosis (EPS) is a serious and often fatal complication of long-term PD with severe malnutrition and poor prognosis. It causes progressive obstruction and encapsulation of the bowel. This retrospective study reviews our experience and that reviewed in the literature concerning EPS.

Dialysis modality choices among chronic kidney disease patients: identifying the gaps to support patients on home-based therapies.

Background: Home dialysis is a cost-effective renal replacement strategy, which provides improved quality of life compared to conventional in-center hemodialysis (CHD). To date, most studies support the use of multidisciplinary chronic kidney disease (CKD) clinics to facilitate timely initiation of dialysis. This is an observational cohort study examining 486 patients with CKD over the period of 2001-2007 to ascertain potential demographic differences among patients transitioned to in-center versus home dialysis.

Discordant PD catheter and effluent culture results. The limited clinical relevance of culturing PD catheters.

Objectives: To determine if discordance in culture results between the effluent and the tip of the peritoneal catheter had an effect on outcome in patients whose peritoneal dialysis (PD) catheter was removed mostly for nonresolving peritonitis. Reasons for and outcomes of PD catheter removal were also analyzed.

Methods: We retrospectively reviewed the charts of all PD patients with recent peritonitis for which the PD catheter was removed between 1 January 2003 and 30 April 2009.

Diabetic patients on peritoneal dialysis.

During the past two decades, a number of studies have tried to evaluate the clinical status of dialyzed diabetic patients and the factors that may affect their outcomes. However, only a small number of diabetic patients on peritoneal dialysis (PD) have been followed for over 5 years, which is largely because of the presence of various comorbid conditions at the start of dialysis, the coexisting, far-advanced, target-organ damage that may gradually progress during the course of dialysis and limit the long-term survival on PD. On the contrary, among renal replacement therapies, survival of diabetic patients undergoing either PD or hemodialysis (HD) is probably similar, while diabetic patients on PD and HD have a lower actuarial survival than nondiabetic counterparts.

Update on potential medical treatments for encapsulating peritoneal sclerosis; human and experimental data.

Encapsulating peritoneal sclerosis (EPS) is an infrequent but serious complication of peritoneal dialysis (PD). The pathogenesis is unknown but speculation is ongoing. The current management of EPS focuses on prevention and treatment of the inflammatory and fibrotic changes at the level of the peritoneal membrane with immunosuppressive and antifibrotic agents, respectively.

Glucoregulatory hormones and choice of osmotic agent in peritoneal dialysis.

Objective: The present study was performed to explore the range of effects of amino acid-based peritoneal dialysis (PD) solutions on glucoregulatory hormones in comparison with an osmotically equivalent glucose-based solution. ♢

Methods: 13 adult nondiabetic patients on PD underwent 2 peritoneal dwells of 2 hours' duration with either 1.5% dextrose solution or 1.

Glomerular filtration rate (GFR) estimated from serum creatinine predicts total (urine and peritoneal) creatinine clearance in patients on peritoneal dialysis.

Objectives: The aim of this study was to examine the accuracy of the Modification of Diet in Renal Disease (MDRD) equation and the Cockcroft and Gault formula (CCrCG) in predicting total creatinine clearance achieved by residual renal function plus peritoneal dialysis in patients on chronic peritoneal dialysis.

Methods: Total creatinine clearance was defined as peritoneal creatinine clearance (PCcr) plus the average of urine urea and creatinine clearances (cGFR). Correlation analysis and Bland-Altman plot were used to establish the degree of correlation and agreement between the estimations of creatinine clearance achieved by PCcr and the average of cGFR and estimated creatinine clearance based on serum creatinine by using either MDRD equation or the Cockcroft and Gault formula.

Peritoneal dialysis in the nursing home.

Unlabelled: The mean age of patients with end-stage renal disease increases steadily. The elderly on dialysis have significant comorbidity and require extra attention to meet their dialysis, dietary, and social needs, and some may need to be treated at a long-term care facility such as a nursing home (NH). Providing dialysis and caring for elderly patients in a nursing home (NH) presents a number of challenges.

Management of elderly patients with end-stage kidney disease.

The number of elderly patients requiring renal replacement therapy will continue to increase in the future. Previously, these patients were believed to have a poor prognosis on renal replacement therapy and therefore they were treated with conservative measures. Although there are no controlled randomized studies, an increasing amount of literature indicates that elderly persons with end-stage kidney disease are a heterogeneous population and that, in many of them, dialysis provides a good quality of life and survival.

Assisted peritoneal dialysis: what is it and who does it involve?

Together with the obvious increase of elderly patients with end-stage renal disease (ESRD), utilization of peritoneal dialysis (PD) has declined since the mid-1990s in a number of countries--a decline that is particularly marked in this elderly ESRD population. A major obstacle that affects any dialysis modality in elderly patients is the greater disease burden than is seen in younger patients. However; this factor may be overcome if patients start PD with assistance provided by visiting helpers (nurses or others) or people at home, mostly family members.

Elderly diabetic patients on peritoneal dialysis.

Diabetes mellitus is the fastest-growing cause of end-stage renal disease (ESRD) among patients requiring renal replacement therapy (RRT). While diabetes mellitus has become the leading cause of ESRD, the number of elderly patients who need dialysis has grown almost exponentially. Most elderly patients with diabetes are treated with hemodialysis; only a small percentage are treated with peritoneal dialysis (PD).