China
Africa
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Mathematical Modeling of Dialysis
Published in Sirshendu De, Anirban Roy, Hemodialysis Membranes, 2017
Another parameter used to understand dialysis adequacy is urea reduction ratio (URR). It is defined asCt/C0 is known as urea reduction fraction, denoted by R. Combining Equations 7.28 and 7.29, we haveIt is recommended that for dialysis adequacy, URR ~ 6529; hence, Kt/V ~ 1.2. This explains the reason behind maintaining Kt/V at 1.2, as discussed in Chapter 2.
Nutritional Strategies for the Patient with Diabetic Nephropathy
Published in Jeffrey I. Mechanick, Elise M. Brett, Nutritional Strategies for the Diabetic & Prediabetic Patient, 2006
In patients with diabetic nephropathy treated with continuous ambulatory peritoneal dialysis (CAPD), in whom PEM and nitrogen balance remains impaired despite attempts to improve oral intake, one option is to add amino acids to one of the usual four daily peritoneal dialysis fluid (PDF) exchanges. Several studies, with treatment duration for at least 3 months, have demonstrated the beneficial effect of a 1.1% amino acid dialysis solution (e.g., Nutrineal®) on nitrogen balance, serum albumin, and serum amino acid concentrations, but at the expense of increased acidosis, need for antacid treatment, and decreased dialysis adequacy (evidence levels 2 and 3) [82–84]. In a PRCT involving 60 malnourished Chinese CAPD patients, there was no demonstrable benefit of amino acid-containing PDF [85]. There was no evidence of increased mortality or incidence of peritonitis with amino acid-containing PDF. Ohter effects of amino acid-containing PDF are improved peritoneal mesothelial cell physicology [86,87] and impairment of endothelial function [88]. Overall, there is insufficient conclusive evidence, especially in patients with diabetes, supporting the routine use of amino acid-containing PDF with respect to nutritional benefit (grade D). However, since this intervnetion is generally well-tolerated, it does offer the potential advantage to adult and pediatric patients with diabetes of introducing a lower glucose load, lower insulin requirement, improved glycemic control, and reduction in amino acid losses in the peritoneal effluent (evidence level 2) [89,90].
Outcomes and Economics of ESRF
Published in Meguid El Nahas, Kidney Diseases in the Developing World and Ethnic Minorities, 2005
Eduardo Lacson Jr, Martin K. Kuhlmann, Nathan W. Levin, Kunal Shah, Maki Yoshino
Among surrogate outcomes such as dialysis adequacy, the DOPPS had spKt/V of 1.3 among all continents, thus negating any comparisons (54). When the data were pooled, it raised some concern about the potential need for higher dialysis dose for women (55), consistent with the findings from the recently concluded HEMO study (56). For developing countries like India, for example, Kt/V is often not measured or if done, results show that many patients have spKt/V <1.0 (3). Again, the main concern in developing countries is the provision of HD, sometimes to alleviate emergent fluid or electrolyte problems and with less emphasis on laboratory-based adequacy measurements. There was a large variation between the DOPPS countries when considering anemia management (57). However, there is little to add to currently existing clinical practice guidelines except perhaps to encourage judicious iron replacement (35–40% had transferring saturation <10%) and maintenance of a high index of clinical suspicion for other sources of blood loss or covert infection/inflammation. The findings confirmed that the wide standard deviations of the hemoglobin values made it very difficult to keep hemoglobin within the narrow 11–12 mg/dL range recommended by the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines for anemia management (58), consistent with data from Ref. 59. The relevance of this finding to the developing world rests mostly in the lack of funds for the procurement of erythropoietin. The potential need for erythropoietin can be exponentially grown if the access to RRT continues to grow. However, as in the case of India, the cost of erythropoietin may be twice that of the HD treatment itself (3). Medications are often not reimbursed in developing countries and these become out-of-pocket expenses. Therefore, given the choice, most patients would rather save any spare funds to pay for future HD therapy rather than pay for a single dose of erythropoietin, with uncertainty as to when they can get funds for the next dose.
Kt/V reach rate is associated with clinical outcome in incident peritoneal dialysis patients
Published in Renal Failure, 2022
Shuang Liu, Lijie Zhang, Shuang Ma, Jing Xiao, Dong Liu, Rui Ding, Zhengyan Li, Zhanzheng Zhao
The relationship between Kt/V and prognosis remains controversial [5], including studies from China. Szeto et al. [13] found that Kt/V was an independent predictor of clinical outcome only for new CAPD cases, not for prevalent cases. Lo et al. [14] showed that Kt/V had no effect on clinical outcome, but clinical problems and severe anemia were significantly increased in patients with total Kt/V below 1.70. While, another large multicenter study from China [15] confirmed that Kt/V was independently associated with one-year mortality in a prognostic model. Similar result was observed in a recent study from Taiwan [9] that lower Kt/V was a risk factor for mortality among PD patients. Differences in the study population, study design, methods, length of follow-up, outcome definitions, and level of baseline RRF can partially account for the inconsistent results. In this study, we used Kt/V reach rate as the grouping variable to analyze the relationship between Kt/V and prognosis. Our study is consistent with the finding by Szeto et al. [13] that patients in the dialysis adequacy group had better clinical outcomes than those in the dialysis inadequacy group. Furthermore, the Kt/V reach rate was associated with prognosis.
Effect of clinical factors on trajectory of functional performance in patients undergoing hemodialysis
Published in Renal Failure, 2021
Jin-Bor Chen, Lung-Chih Li, Wen-Chin Lee, Sin- Hua Moi, Cheng-Hong Yang
We attempted to determine the association between uremic toxins and trajectory of functional performance in patients undergoing HD. We analyzed this association with the indicators of small uremic solutes and middle molecules in circulation. Our result did not exhibit a positive association between uremic toxins and trajectory of KPS scales in patients undergoing HD, except with BUN and beta-2-microglobulin. In our previous study, we found that BUN was one of the major determinants of functional performance in patients undergoing HD by the classification and regression tree approach [8]. It is well known that HD patients have high beta-2-microglobulin levels [22]. The deposit of beta-2-microglobulin is mainly in musculoskeletal system. The preferential deposition in tendons and bones can result in physical functional impairment [22–24]. Our findings elicit a hypothesized strategy to utilize large-pore hemodialyzers to remove large-size uremic toxins. The effects of improving physical functional impairment by these hemodialyzers in HD patients warrant to be investigated in the future. Our study also implied that holistic evaluation should be taken into account in making decisions for the management of impaired functional performance in patients undergoing HD. It is concerned with not only dialysis adequacy but also other potential contributors in clinical scenario.
Comparison of clinical outcome between incremental peritoneal dialysis and conventional peritoneal dialysis: a propensity score matching study
Published in Renal Failure, 2021
Su Mi Lee, Yoon Sung Min, Young Ki Son, Seong Eun Kim, Won Suk An
The primary endpoint was defined as the clinical outcomes, such as overall survival, PD survival, hospitalization, and peritonitis. Peritonitis was defined by the presence of the signs and symptoms of peritoneal inflammation and peritoneal effluent with a white blood cell count of >100 cells/mm3 and a polymorphonuclear leukocyte count of >50% [9,10]. Hospitalization was defined as an event requiring at least an admission to an in-patient unit during the investigation period. Causes of hospitalization included cardiovascular disease and cerebrovascular disease. Causes for drop-out were death, transfer to HD, or KT. Dialysis adequacy was assessed using weekly Kt/V (peritoneal + renal) and creatinine clearance. Anuria was defined as urine volume of <100 mL per day.