Year : 2020 | Volume
: 38 | Issue : 1 | Page : 39--41
|How to cite this article:|
. Literature Review.Indian J Perit Dial 2020;38:39-41
|How to cite this URL:|
. Literature Review. Indian J Perit Dial [serial online] 2020 [cited 2021 May 14 ];38:39-41
Available from: https://www.ijpd.org.in/text.asp?2020/38/1/39/305758
Title: The effect of glucose absorption from peritoneal dialysates on changes in lipid profiles in prevalent peritoneal dialysis patients
Author: Law S, Davenport A.
Journal: Perit Dial Int. 2020 Feb 10: [Epub ahead of print]
The majority of peritoneal dialysates contain glucose, which can potentially be absorbed from the peritoneal cavity. Previous studies have reported an observation between dialysate glucose exposure and increases in total cholesterol (TC), low-density lipoproteins (LDLs) and triglycerides (TGs). As most of these studies reported glucose exposure in peritoneal dialysis (PD) patients treated by continuous ambulatory peritoneal dialysis (CAPD), we wished to determine whether measured peritoneal glucose absorption resulted in an increase in lipid profile with CAPD and automated PD (APD) cycler treatments. Glucose absorption was measured in 143 patients; 89 (62.2%) males, 53 (37.1%) diabetics, mean age 61.3 ± 14.9 years, with 90 (62.1%) using a daytime icodextrin exchange; 37 (25.9%) CAPD, attending for their first assessment of peritoneal membrane function, when PD prescriptions were then individualised for peritoneal transporter status and repeated after 12 months. Median glucose absorption was 172.5 (75.5-265.5) mmol/day. Although glycated haemoglobin increased (42 ± 16 to 45.4 ± 17.7 mmol/mol, p = 0.006), there was no change in TC (4.8 ± 1.3 to 4.7 ± 1.3 mmol/L), high-density lipoproteins (1.39 ± 0.45 to 1.33 ± 0.51 mmol/L), LDL (2.48 ± 1.12 to 2.21 ± 0.87 mmol/L) or TGs (2.0 (1.3-2.6) to 2.0 (1.3-2.8) mmol/L, adjusted p > 0.05). We found no association between glucose absorption and either lipid profiles or changes in serum lipids. In the current era of APD cyclers and icodextrin, PD prescriptions can be individualised to accommodate patients with a different peritoneal transport status, so that despite daily glucose absorption from dialysates, and a minor increase in glycated haemoglobin, we were unable to demonstrate any significant increase in standard lipid profiles.
Comments: Though there was a marginal increase in HbA1C, there was not much of change in lipid profile in the peritoneal dialysis patients which is more reassuring as most believe CAPD increases the metabolic risk. Probably this can be attributed to newer fluids like icodextrin usage.
Title: Incidence and risk factors of peritoneal dialysis-related peritonitis in elderly patients: A retrospective clinical study.
Author: Wu H, Ye H, Huang R, Yi C, Wu J, Yu X, Yang X.
Journal: Perit Dial Int. 2020 Jan;40(1):26-33.
Background: This study was to analyze the incidence, risk factors, and clinical outcomes of peritonitis in elderly continuous ambulatory peritoneal dialysis (CAPD) patients.
Methods: Incident patients undergone CAPD from 1 January 2006 to 30 June 2015 in our center were enrolled and divided into aged <65 years and ≥65 years groups. Risk factors were evaluated using a logistic regression model, and outcome comparison was evaluated using a Cox proportional model.
Results: Among 1953 patients, 111(33.2%) in elderly (n=334) and 470 (29.0%) in younger (n=1619) developed at least one episode of peritonitis. Comparing with younger patients, elderly ones had a higher peritonitis rate (0.203 vs. 0.145 episodes/patient-year, p<0.05). The multivariate Cox regression showed that advanced age (hazard ratio (HR)=1.06, 95% confidence interval (CI)=1.01-1.11, p=0.015), assistant-assisted peritoneal dialysis (PD; HR=2.64, 95% CI=1.23-5.64, p=0.012), higher body mass index (BMI; HR=1.11, 95% CI=1.02-1.20, p=0.010), and low serum albumin level (HR=0.94, 95% CI=0.90-0.98, p=0.004) were associated with increased peritonitis risk in elderly patients. Compared with younger ones with peritonitis, elderly patients had an approximately fourfold increased risk of peritonitis-related mortality (odd ratio (OR)=3.57, 95% CI=1.38-9.28, p=0.009). During the cohort, peritonitis was the risk factor associated with technique failure (HR=3.19, 95% CI=2.33-4.39, p<0.001) in younger patient but not in the elderly population (HR=1.82, 95% CI=0.84-3.94, p=0.132).
Conclusions: Elderly PD patients had higher prevalence for peritonitis and peritonitis-related mortality. Advanced age, assistant-assisted PD, a higher BMI, and lower serum albumin level were independently associated with the first episode of peritonitis in elderly patients. However, peritonitis was not the predictor of death-censored technique failure in elderly ones.
Comments: Elderly CAPD patients are at higher risk of Peritonitis and related mortality. It is increase mortality rather than technique failure as compared to younger population
Title: Estimating total small solute clearance in patients treated with continuous ambulatory peritoneal dialysis without urine and dialysate collection.
Author: Fan L, Steubl D, Inker LA, Tighiouart H, Simon AL, Foster MC, Karger AB, Eckfeldt JH, Li H, Tang J, He Y, Xie M, Xiong F, Li H, Zhang H, Hu J, Liao Y, Ye X, Shafi T, Chen W1, Yu X, Levey AS.
Journal: Perit Dial Int. 2020 Jan;40(1):84-92.
Background: International Society for Peritoneal Dialysis guidelines recommend to routinely monitor the total measured clearance (mCl) of small solutes such as creatinine; however, collection of 24-h urine and peritoneal dialysis (PD) fluid is burdensome to patients and prone to errors. We hypothesized that equations could be developed to estimate mCl (estimated clearance (eCl)) using endogenous filtration markers.
Methods: In the Guangzhou PD Study (n=980), we developed eCl equations using linear regression in two-third and validated them in the remaining one-third. Reference tests were mCl for urea nitrogen (UN) (mClUN, ml/min) and average mCl for UN and creatinine (mClUN-cr, ml/min/1.73 m2). Index tests were various eCl equations using UN, creatinine, low-molecular-weight proteins (LMWPs) (beta-trace protein (BTP), beta-2 microglobulin (B2M), and cystatin C), demographic variables, and body size. After reexpression of the equations in the combined data set, we analyzed accuracy (eCl within ±2.0 units of mCl) and the predictive value of eCl to detect a weekly total standard Kt/V (weekly mClUN indexed for total body water) >1.7 using receiver operating characteristic curve.
Results: Mean age of the cohort was 50±15 years, 53% were male; mClUN was 6.9±1.8 and mClUN-cr was 7.5±2.8. Creatinine but not UN contributed to eCl for both mCl. LMWP did not improve accuracy for mClUN (range 88-89%). BTP and B2M improved the accuracy for mClUN-cr (82% vs. 80%); however, differences were small. The area under the curve for predicting a weekly Kt/V >1.7 was similar for all equations (range 0.79-0.80).
Conclusions: Total small solute clearance can be estimated moderately well in continuous ambulatory PD patients using serum creatinine and demographic variables without urine and dialysate collection.
Comments: Though this is only to reassure that clearance can be estimated with serum values of creatinine, when in doubt the gold standard of peritoneal and residual renal clearance will guide therapy. This study needs more validation especially in our patients.
Title: Cost-Utility Analysis of Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis for Thai End-Stage Renal Disease Patients.
Author: Thaweethamcharoen T1, Sritippayawan S2, Noparatayaporn P3, Aiyasanon N2.
Journal: Value Health Reg Issues. 2020 Feb 7;21:181-187. [Epub ahead of print]
Background: Continuous ambulatory peritoneal dialysis (CAPD) is the first option for patients with end-stage renal disease under the benefit package of Thailand. Nevertheless, automated peritoneal dialysis (APD) may benefit these patients in terms of both medical and quality-of-life aspects, but it is more expensive. The economic evidence for the comparison between CAPD and APD is not inconclusive. Thus, this study aims to evaluate the cost-effectiveness of CAPD compared with APD in PD patients.
Objectives: To assess the health-related quality of life and costs between patients treated with CAPD and APD.
Methods: A Markov model was developed to evaluate the cost-effectiveness of CAPD and APD from the societal perspective. Costs and outcomes were calculated over a lifetime horizon and discounted at an annual rate of 3%. The outcomes were presented as quality-adjusted life-years (QALYs) of CAPD and APD. Utility scores were calculated from the utility values of the 5-level EuroQol questionnaire. A probabilistic sensitivity analysis using 5000 Monte Carlo simulations was performed to evaluate the stability of the results.
Results: The costs of APD and CAPD were 12868080 and 11144786 Thai baht, respectively, whereas the QALYs were 24.28 and 24.72 QALYs, respectively. APD was more costly but less effective than CAPD. The most sensitive parameter was direct medical cost of outpatient visits. When the willingness-to-pay threshold was 160000 Thai baht per QALY, the probability of APD providing a cost-effective alternative to CAPD was 19%.
Conclusion: APD was not a cost-effective strategy as compared with CAPD at the current Thai threshold. These findings should encourage clinicians and policy makers to encompass the use of CAPD as a good value for money for PD treatment.
Comments: APD is an expensive proposition in our country. This study from Thailand similar to our economy also has calculated the same and confirms that whenever cost is an issue in our patients, better to consider CAPD rather than APD