Periodontal disease in chronic kidney disease and end-stage renal disease patients: a review.

Periodontal disease is a chronic inflammatory disorder and being so it has been associated with accelerated atherosclerosis and malnutrition. Cardiovascular diseases are the leading cause of mortality in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients [National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases: Annual Data Report, 2010]. A recent scientific statement released by the American Heart Association [Lockhart et al.

Predictors of hospitalization in patients on peritoneal dialysis: the Missouri experience.

Background: We analyzed a large number of demographic and biochemical variables to identify predictors of hospitalization in subjects on peritoneal dialysis (PD).

Methods: All patients initiated on PD at our center from January 1990 through December 1999 were included. The following variables at the initiation of PD were included: demographics, clinical data, nutritional and adequacy parameters, transport characteristics, and various co-morbidities.

Peritoneal dialysis or hemodialysis? A dilemma for the nephrologist.

Selection of the initial dialysis modality is crucial in the treatment of end-stage renal disease (ESRD) patients. Several patient- and physician-related factors play important roles in the decision between peritoneal dialysis (PD) and hemodialysis (HD). Although HD is the most common dialysis modality in the United States, in some studies PD has shown a survival advantage over HD, at least in the first 2 years of dialysis treatment, especially in non-diabetic patients and in young patients with diabetes.

Automated peritoneal dialysis - indications and management.

Automated peritoneal dialysis (APD) use has increased considerably in the last decade, and its growth has been mainly driven by patient preference and development of new, simpler cyclers. Careful management of the APD prescription can result in adequate solute and fluid removal in vast majority of patients, even anuric and large patients. So far, there are no convincing data that peritonitis rates, decline in residual renal function, protein losses, patient and technique survival, are different for APD and continuous ambulatory peritoneal dialysis (CAPD).

MIA syndrome in peritoneal dialysis: prevention and treatment.

Malnutrition, inflammation and atherosclerosis are prevalent in end stage renal disease and constitute the Malnutrition-Inflammation-Atherosclerosis Syndrome. The syndrome is associated with high cardiovascular mortality and accounts for most of the premature deaths in peritoneal dialysis patients. Presence of elevated C-reactive protein levels correlates with malnutrition, decreased fluid removal and mortality in these patients.

Rates of continuous ambulatory peritoneal dialysis-associated peritonitis at the University of Missouri.

Peritoneal dialysis (PD)-associated peritonitis contributes significantly to morbidity and modalityfailure. The number of patients on PD is declining in Western countries, and peritonitis is a potential deterrent to the therapy. Here, we present a clinically significant decline in the rate of peritonitis at a single center over a 28-year period, with current rates significantly lower than the national average, and we review several factors that have contributed to those outcomes.

National Kidney Foundation Council on Renal Nutrition survey: past-present clinical practices and future strategic planning.

Early nutritional intervention is thought to play a major role in the preservation of renal function and the overall wellbeing in the renal patient. In preparation for renal replacement therapy (RRT), a consultation with the renal nutritionist to establish a diet consistent with the existing diagnosis may increase the likelihood of reducing cardiovascular risk factors, preventing malnutrition and anemia, and slowing the progression of renal disease, all of which can contribute to positive patient outcomes. In a 1999 United States Renal Data System survey of 3,468 new dialysis patients, 46% indicated that they had not consulted with a dietitian before the initiation of dialysis.

Retrospective evaluation of renal kt/V(urea) at the initiation of long-term peritoneal dialysis at the University of Missouri: relationships to longitudinal nutritional status on peritoneal dialysis.

The purpose of this study was to examine the impact of low levels of residual renal function (RRF) on nutritional status in end-stage renal disease patients starting peritoneal dialysis (PD) at baseline and after a year on dialysis. We conducted a single center retrospective analysis of 116 patients who started long-term PD in a university teaching hospital from 1989 to 1998 and were followed for 1 year. Patients were divided into four equal groups according to their initial renal Kt/V(urea) (L/week) levels at the start of PD and followed for 1 year.

1975 to 1984--an important decade for peritoneal dialysis: memories with personal anecdotes.

That decade, 1975 to 1984, saw many important events in the history of PD, including (1) the beginnings of CAPD; (2) the performance in Canada of CAPD with solutions in bags; (3) the First International Peritoneal Dialysis Symposium, in Mexico, preceding all the symposia and congresses to follow; (4) the approval of solutions in bags and CAPD Medicare reimbursement in the USA; (5) the start of the NIH CAPD Registry, probably setting the groundwork for the USRDS; (6) the First Annual CAPD Conference, beginning 23 years of consecutive conferences; (7) the start of the Peritoneal Dialysis Bulletin, which later became Peritoneal Dialysis International; and (8) the formation of the ISPD. One hopes those caring for patients on chronic PD will remember the ideas and hopes of this period and build on them into the distant future. In my opinion, the new ideas, the clinical and laboratory studies, and the experiences shared during this exciting time not only advanced PD and its results, but also had a positive impact on our understanding of uremia and improved the quality of care and results obtained with all renal replacement therapies.

Utilization of PD modalities: evolution.

In the early 1960s, peritoneal dialysis (PD) was introduced as a form of long-term maintenance therapy in patients with end-stage renal disease (ESRD). We have come a long way since. Increasing understanding of peritoneal kinetic behavior, its innovative manipulation to meet patient needs, critical monitoring of clinical outcomes, and parallel development in technology have all contributed to the worldwide success of the therapy over the past four decades.

High peritoneal transport: a blessing or curse?

High transporters are defined based on the peritoneal equilibration test. Peritoneal transport rate changes over time, inflammation and angiogenesis affecting the total pore area. Factors influencing the neovascularization process are described.

An analysis of dialysis training in the United States and Canada.

Background: Because the prevalence of end-stage renal disease (ESRD) has progressively increased in both the United States and Canada, patients with ESRD are likely to constitute progressively larger proportions of nephrology practices.

Methods: We mailed a questionnaire to US and Canadian nephrology program directors to determine methods used in dialysis training; 53% of US and 73% of Canadian programs responded.

Results: Training programs in the United States enrolled a larger median number of fellows and had a lower median faculty-fellow ratio compared with programs in Canada.

The relationship between urine osmolality and specific gravity.

Background: In general, there is a good correlation between the specific gravity and osmolality of a urine sample. In certain clinical conditions, such as uncontrolled diabetes mellitus, nephrotic syndrome, after the administration of intravenous radiocontrast material or saline diuresis, dependence upon specific gravity for determining the concentrating ability will result in over- or underestimation.

Methods: We studied the relationship between specific gravity and osmolality in vitro with simulated urines of varying composition.