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      Peritoneal dialysis outcomes in patients with nephrotic syndrome: a propensity score-matched cohort study

      research-article
      a , b , a , a , a
      Renal Failure
      Taylor & Francis
      Nephrotic syndrome, peritoneal dialysis, end-stage renal disease, outcomes

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          Abstract

          Introduction

          It is unclear whether patients with end-stage renal disease (ESRD) and nephrotic syndrome (NS) can be treated with peritoneal dialysis (PD).

          Objectives

          To investigate the outcomes of PD treatment in ESRD patients with or without NS.

          Methods

          In this retrospective cohort study, all incident patients with ESRD and NS who started PD from 1 February 2006 to 31 December 2017, were matched with patients without NS using propensity scores based on age, sex, diabetes mellitus status, and serum albumin.

          Results

          Fifty-three patients in the NS PD group and 53 matched controls were included. The median survival of the NS PD group was comparable to that of the non-NS PD group. An interaction effect was observed between survival time and baseline NS status. Thus, patients’ outcomes within and after 1.5 years were analyzed separately. Both mortality (log-rank test, p= .235) and technique failure (log-rank test, p= .543) rates within 1.5 years in patients with NS were comparable to those of the non-NS group. After 1.5 years, however, the NS status at baseline was associated with lower all-cause mortality ( p= .020) and lower technique failure ( p= .008) rates in PD patients compared with the non-NS group. The multivariable Cox regression analysis showed that compared with the patients in the non-NS PD group, PD patients with NS had both significantly lower all-cause mortality and lower technique failure rate after adjusting for other factors.

          Conclusions

          Our study indicates that PD may be considered as a long-term renal replacement therapy for patients with ESRD and baseline NS.

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          Most cited references20

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          Nephrotic syndrome in adults.

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            Determinants of modality selection among incident US dialysis patients: results from a national study.

            Few studies have comprehensively addressed the association of social factors and elements of pre-end-stage renal disease (ESRD) care with the selection of dialysis modality. This study examines the relative contribution of demographic, medical, social, pre-ESRD, and geographic factors to modality assignment among new ESRD patients. Data were collected from the Dialysis Mortality and Morbidity Wave 2 Study, a national random sample of 4025 patients in 1996 and 1997. In multivariate analyses, the selection of peritoneal dialysis (PD) over hemodialysis (HD) was significantly associated with younger age, white race, fewer comorbid conditions, and lower serum albumin. Greater use of PD was seen in patients who were employed, married, and living with someone before the start of ESRD and in those who were more autonomous and more accomplished educationally. Patients referred earlier to a nephrologist (> 4 mo versus or =2 visits versus < 2 visits) in the pre-ESRD period had greater PD use. Of the factors listed, 25% of the variability (R(2)) in PD use was explained by demographic (4.1%), comorbid (1.2%), social/pre-ESRD (14.5%), and geographic (5.2%) factors. This study identifies several clinical, social, and pre-ESRD factors with the selection of PD, and it underscores the importance of patient education, autonomy, and a strong social support system in improving rates of PD use in the United States. As pre-ESRD patient care is an important contributor to PD use in the United States, greater efforts should be expended in improving its delivery earlier in the pre-ESRD period.
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              The relationship between malnutrition and quality of life in haemodialysis and peritoneal dialysis patients

              SUMMARY BACKGROUND One of the most important factors affecting the quality of life of chronic kidney disease (CKD) patients is nutrition. Prevention of malnutrition increases patients’ quality and length of life. In this study, we aimed to determine the frequency of malnutrition, quality of life, and the relationship between them in patients with end-stage renal disease (ESRD). METHOD The study was conducted with a total of 60 CKD patients including 50 haemodialysis patients and 10 peritoneal dialysis patients. Patients’ data associated with socio-demographics, body mass index (BMI), waist circumference, triceps skin-fold thickness (TSFT), pre-dialysis systolic and diastolic blood pressure, Kt/V and urea reduction ratio (URR) values, laboratory parameters, Mini-Nutritional Assessment-Short Form (MNA-SF) and European Quality of Life 5-Dimensions (EQ5D) scale were recorded. FINDINGS Of the total 60 patients; 27 were male (45%), 33 were female (55%), 83.3% were receiving haemodialysis treatment (HD), and 16.7% were receiving peritoneal dialysis treatment (PD). The mean MNA-SF score was 10.4 ± 2.8 in the HD group and 10.5 ± 2.9 in the PD group; there was no difference between the scores of the HD and PD groups. The mean EQ5D score was 0.60 ± 0.29 in the HD group and 0.68 ± 0.33 in the PD group, no significant difference was found between the HD group and the PD group. The quality of life was found lower in malnourished group (p=0.001). CONCLUSION The quality of life needs to be increased by early diagnosis and treatment of malnutrition in patients at risk.
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                Author and article information

                Journal
                Ren Fail
                Ren Fail
                Renal Failure
                Taylor & Francis
                0886-022X
                1525-6049
                20 July 2020
                2020
                : 42
                : 1
                : 684-692
                Affiliations
                [a ]Department of Nephrology, Peking University Third Hospital , Beijing, China
                [b ]Department of Nephrology, The Forth Hospital of Daqing , Daqing, China
                Author notes
                CONTACT Wen Tang tanggwen@ 123456126.com Department of Nephrology, Peking University Third Hospital , 49 North Garden Rd, Haidian District, Beijing100191, China
                Article
                1792316
                10.1080/0886022X.2020.1792316
                7470056
                32686569
                93d5c764-1a54-468f-a449-fc0849c78fdb
                © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Figures: 5, Tables: 4, Pages: 9, Words: 4909
                Categories
                Research Article
                Clinical Study

                Nephrology
                nephrotic syndrome,peritoneal dialysis,end-stage renal disease,outcomes
                Nephrology
                nephrotic syndrome, peritoneal dialysis, end-stage renal disease, outcomes

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