Rationale and design of ELIXIR, a randomized, controlled trial to evaluate efficacy and safety of XyloCore, a glucose-sparing solution for peritoneal dialysis.

Peritoneal dialysis adoption and technique survival is affected by limitations related to peritoneal membrane longevity and metabolic alterations. Indeed, almost all peritoneal dialysis fluids exploit glucose as an osmotic agent that rapidly diffuses across the peritoneal membrane, potentially resulting in metabolic abnormalities such as hyperglycemia, hyperinsulinemia, obesity, and hyperlipidemia. Moreover, glucose-degradation products generated during heat sterilization, other than glucose itself, induce significant morphological and functional changes in the peritoneum leading to ultrafiltration failure.

Rationale and Design of PURE: A Randomized Controlled Trial to Evaluate Peritoneal Ultrafiltration with PolyCore™ in Refractory Congestive Heart Failure.

Introduction: Peritoneal ultrafiltration (PUF) has been proposed as an additional therapeutic option for refractory congestive heart failure (RCHF) patients. Despite promising observational studies and/or case report results, limited clinical trial data exist, and so far, PUF solutions remain only indicated for chronic kidney diseases. In this article, we described a multicenter, randomized, controlled, unblinded, adaptive design clinical trial, about to start, investigating the effects of PolyCore™, an innovative PUF solution, in the treatment of RCHF patients.

Is central venous catheter in haemodialysis still the main factor of mortality after hospitalization?

Background: Haemodialysis is the most frequently prescribed Renal Replacement Therapy modality worldwide. However, patients undergoing this therapy have an unpredictable evolution related to vascular access.

Objective: To determine the factors associated with the mortality and hospitalization rate in haemodialysis patients at a third-level care Centre in the Dominican Republic.

A nephrologist dream of peritoneal dialysis catheter with zero migration: A multicenter prospective study.

Introduction: PD catheter tip migration is a common complication and a significant cause of catheter malfunction. In this perspective, we present our experience with a new catheter and a new technique that involves the use of a new triple cuff PD catheter and a low entry site in an attempt to prevent PD catheter migration.

Methods: A total of 503 incident PD patients have been studied in more than one PD center over a period of 5 years.

Peritoneal catheter insertion: combating barriers through policy change.

Barriers to accessing home dialysis became a matter of life and death for many patients with kidney failure during the coronavirus disease 2019 (COVID-19) pandemic. Peritoneal dialysis (PD) is the more commonly used home therapy option. This article provides a comprehensive analysis of PD catheter insertion procedures as performed around the world today, barriers impacting timely access to the procedure, the impact of COVID-19 and a roadmap of potential policy solutions.

Expanding Utilization of Home Dialysis: An Action Agenda From the First International Home Dialysis Roundtable.

In a groundbreaking meeting, leading global kidney disease organizations came together in the fall of 2020 as an International Home Dialysis Roundtable (IHDR) to address strategies to increase access to and uptake of home dialysis, both peritoneal dialysis and home hemodialysis. This challenge has become urgent in the wake of the coronavirus disease 2019 (COVID-19) pandemic, during which patients with advanced kidney disease, who are more susceptible to viral infections and severe complications, must be able to safely physically distance at home. To boost access to home dialysis on a global scale, IHDR members committed to collaborate, through the COVID-19 public health emergency and beyond, to promote uptake of home dialysis on a broad scale.

How to Improve the Biocompatibility of Peritoneal Dialysis Solutions (without Jeopardizing the Patient's Health).

Peritoneal dialysis (PD) is an important, if underprescribed, modality for the treatment of patients with end-stage kidney disease. Among the barriers to its wider use are the deleterious effects of currently commercially available glucose-based PD solutions on the morphological integrity and function of the peritoneal membrane due to fibrosis. This is primarily driven by hyperglycaemia due to its effects, through multiple cytokine and transcription factor signalling-and their metabolic sequelae-on the synthesis of collagen and other extracellular membrane components.

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.

A COVID-19 pandemic-specific, structured care process for peritoneal dialysis patients facilitated by telemedicine: Therapy continuity, prevention, and complications management.

Coronavirus disease 2019 (COVID-19) has been declared a pandemic. Peritoneal dialysis (PD), being a home therapy, allows for physical distancing measures and movement restrictions. In order to prevent COVID-19 contagioun among the Dominican Republic National Health System PD program patients, a follow-up virtual protocol for this group was developed.

The osmo-metabolic approach: a novel and tantalizing glucose-sparing strategy in peritoneal dialysis.

Peritoneal dialysis (PD) is a viable but under-prescribed treatment for uremic patients. Concerns about its use include the bio-incompatibility of PD fluids, due to their potential for altering the functional and anatomical integrity of the peritoneal membrane. Many of these effects are thought to be due to the high glucose content of these solutions, with attendant issues of products generated during heat treatment of glucose-containing solutions.

Acute peritoneal dialysis in the treatment of COVID-19-related acute kidney injury.

The kidney is not typically the main target of severe acute respiratory syndrome coronavirus 2, but surprisingly, acute kidney injury (AKI) may occur in 4-23% of cases, whereas the dialysis management of AKI from coronavirus 2019 has not gained much attention. The severity of the pandemic has resulted in significant shortages in medical supplies, including respirators, ventilators and personal protective equipment. Peritoneal dialysis (PD) remains available and has been used in clinical practice for AKI for >70 years; however, it has been used on only a limited basis and therefore experience and knowledge of its use has gradually vanished, leaving a considerable gap.

The impact of body mass index (BMI) variation on mortality of incident elderly patients on peritoneal dialysis: a joint model analysis.

Introduction: Data on impact of high body mass index (BMI) on mortality of patients on peritoneal dialysis (PD), especially among elderly, are inconsistent. Objective: To evaluate impact of BMI on cohort of incident elderly PD patients over time.

Methods: Prospective multicenter cohort study (December / 2004-October/2007) with 674 patients.

Incident elderly patients on peritoneal dialysis: Epidemiological characteristics and modality impact on survival time.

Aging of the population and the increased prevalence of diseases such as diabetes and arterial hypertension result in an increasing need of dialysis treatment. Herein we describe a cohort of elderly patients on peritoneal dialysis (PD) and assess the influence of the modality on the long-term survival. Out of a multicenter prospective cohort of 2,144 BRAZPD PD incident patients during a period from December 2004 to October 2007, 762 elderly adults, defined as patients ≥65-year-old, were eligible for the study, 413 started on automated PD (APD) and 349 on continuous ambulatory PD (CAPD).

Type of Referral, Dialysis Start and Choice of Renal Replacement Therapy Modality in an International Integrated Care Setting.

Introduction: Integrated Care Settings (ICS) provide a holistic approach to the transition from chronic kidney disease into renal replacement therapy (RRT), offering at least both types of dialysis.

Objectives: To analyze which factors determine type of referral, modality provision and dialysis start on final RRT in ICS clinics.

Methods: Retrospective analysis of 626 patients starting dialysis in 25 ICS clinics in Poland, Hungary and Romania during 2012.

Icodextrin reduces insulin resistance in non-diabetic patients undergoing automated peritoneal dialysis: results of a randomized controlled trial (STARCH).

Background: Insulin resistance is a common risk factor in chronic kidney disease patients contributing to the high cardiovascular burden, even in the absence of diabetes. Glucose-based peritoneal dialysis (PD) solutions are thought to intensify insulin resistance due to the continuous glucose absorption from the peritoneal cavity. The aim of our study was to analyse the effect of the substitution of glucose for icodextrin on insulin resistance in non-diabetic PD patients in a multicentric randomized clinical trial.

Impact of baseline health-related quality of life scores on survival of incident patients on peritoneal dialysis: a cohort study.

Introduction: In an attempt to decrease mortality in patients with end-stage renal disease, an increase in the lifetime of these patients without much focus on health-related quality of life (HRQOL) was pursued for a long period of time. However, lately, an improvement in the quality of this extended lifetime has focused on both the physical as well as the social and emotional aspects, as these parameters may be associated with clinical outcomes in end-stage renal disease patients.

Aim: To evaluate the impact of self-determined HRQOL at admission on survival of incident peritoneal dialysis (PD) patients.

Metformin in peritoneal dialysis: a pilot experience.

Objective: In a number of patients, the antidiabetic drug metformin has been associated with lactic acidosis. Despite the fact that diabetes mellitus is the most common cause of end-stage renal disease (ESRD) and that peritoneal dialysis (PD) is an expanding modality of treatment, little is known about optimal treatment strategies in the large group of PD patients with diabetes. In patients with ESRD, the use of metformin has been limited because of the perceived risk of lactic acidosis or severe hypoglycemia.

Novel predictors of peritonitis-related outcomes in the BRAZPD cohort.

Introduction: Peritonitis remains the main cause of peritoneal dialysis (PD) technique failure worldwide, despite significant reductions in infection rates observed over the past decades. Several studies have described risk factors for peritonitis, technique failure and mortality. However, there are scarce data regarding predictors of complications during and after a peritonitis episode.

Longitudinal changes in health-related quality of life scores in Brazilian incident peritoneal dialysis patients (BRAZPD): socio-economic status not a barrier.

Background And Objectives: A large proportion of the patients on peritoneal dialysis (PD) in Brazil have low levels of education and family income. The present study assessed whether education level and family income are associated with baseline and longitudinal changes in health-related quality of life (HRQOL) scores during the first year of PD therapy.

Methods: We evaluated 1624 incident patients from the Brazilian Peritoneal Dialysis Multicenter Study (BRAZPD) at baseline, and 486 of them after 12 months.

Prevention of peritoneal dialysis catheter infections in Saudi peritoneal dialysis patients: the emergence of high-level mupirocin resistance.

Purpose: Exit-site infection (ESI) and peritonitis remain the major causes of morbidity and mortality in peritoneal dialysis (PD) patients. This study compared the effectiveness of local mupirocin ointment and gentamicin cream in preventing both gram-positive and gram-negative bacterial infections in PD patients.

Methods: Patients from two centers (n = 203) were assigned to daily mupirocin ointment or gentamicin cream application.

A Brazilian experience in assisted automated peritoneal dialysis: a reliable and effective home care approach.

Introduction: Automated assisted peritoneal dialysis (AAPD) has been shown to be successful as renal replacement therapy for elderly and physically incapable end-stage renal disease (ESRD) patients. In early 2003, a pioneer AAPD program was initiated at GAMEN Renal Clinic in Rio de Janeiro, Brazil. ♢

Objective: We evaluated the results of an AAPD program offered as an option to elderly ESRD patients with physical or cognitive debilities or as last resort to patients with vascular access failure or hemodynamic instability during hemodialysis.

Association of ethnicity and survival in peritoneal dialysis: a cohort study of incident patients in Brazil.

Background: There are no available epidemiologic studies about the impact of ethnicity on outcomes of patients treated with peritoneal dialysis (PD) in South America. This study aims to assess the effect of ethnicity on the mortality of incident PD patients in Brazil.

Study Design: Prospective observational cohort study of incident patients treated with PD.

Body size and longitudinal body weight changes do not increase mortality in incident peritoneal dialysis patients of the Brazilian peritoneal dialysis multicenter study.

Objectives: To determine the roles of body size and longitudinal body weight changes in the survival of incident peritoneal dialysis patients.

Patients And Methods: Patients (n = 1911) older than 18 years of age recruited from 114 dialysis centers (Dec/ 2004-Oct/2007) and participating in the Brazilian Peritoneal Dialysis Multicenter Cohort Study were included. Clinical and laboratory data were collected monthly (except if the patient received a transplant, recovered renal function, was transferred to hemodialysis, or died).

Lack of adequate predialyis care and previous hemodialysis, but not hemoglobin variability, are independent predictors of anemia-associated mortality in incident Brazilian peritoneal dialysis patients: results from the BRAZPD study.

Background/aims: The objective of this study was to analyze the prevalence of anemia and variability of hemoglobin (Hb) values in peritoneal dialysis (PD) patients, to establish its associated factors and their impact on clinical outcomes in a large cohort of patients starting PD treatment.

Methods: Data were collected monthly in incident patients, who were followed until the primary endpoint (death from all causes) or until leaving the study.

Results: 2,156 patients starting PD were included.