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      Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period

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          Abstract

          Objective

          Whether automated peritoneal dialysis (APD) is a feasible strategy for urgent-start peritoneal dialysis (PD) therapy during the break-in period remains unclear. This study was conducted to compare the efficacy as well as complications among three PD modes during the break-in period.

          Methods

          Ninety-six patients treated with urgent-start PD after catheterization were retrospectively analyzed. Patients were divided into three groups, incremental continuous ambulatory PD (CAPD) group ( n = 26); APD group ( n = 42); and APD–CAPD group ( n = 28). Clinical parameters at the end of the break-in period and 1 month after the initiation of PD treatment were collected and analyzed.

          Results

          Compared with the traditional incremental CAPD, APD and APD–CAPD were superior as they could effectively remove small-molecule uremic toxins and correct electrolyte imbalance ( P < 0.05), while did not increase the incidence of early complications during the break-in period ( P > 0.05). However, APD led to a significant decline in albumin and pre-albumin, as compared with APD–CAPD and CAPD ( P < 0.05). A PD strategy consisting 6 days of APD and 3 days of CAPD showed a great advantage in preventing excessive protein loss. There were no significant differences in all tested biochemical parameters among the three groups at 1 month after treatment (all P > 0.05).

          Conclusion

          Application of APD for urgent-start PD during the break-in period is feasible. A combination of APD and CAPD regimens seems to be a more reasonable mode.

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          Most cited references 23

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          Clinical practice guidelines for peritoneal access.

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            Predictive value of malnutrition markers for mortality in peritoneal dialysis patients.

            Alterations in nutritional status have been described as important predictors of mortality in patients with chronic kidney disease (CKD). However, the association between multiple markers for nutritional status and the mortality rates of patients with CKD on peritoneal dialysis (PD) has not yet been illustrated in previously published data, particularly by using the new definition of protein energy wasting (PEW). To evaluate the predictive value of malnutrition markers for mortality rates, on the basis of the PEW definition, of PD patients. At the start of PD treatment, the nutritional status of 199 patients (mean age, 56 ± 13.3 years; 53% females) was evaluated. Body mass index (BMI), arm circumference, mid-arm muscle circumference, protein and caloric intake (by using a 3-day food record), and serum albumin were all recorded, as well as a subjective global assessment (SGA) and presence of PEW. Cut-off points were defined on the basis of the consensus of the International Society for Renal Nutrition and Metabolism (albumin, 10% in comparison with the 50th percentile for the reference population; protein intake, 65 years (P = .002), cardiovascular disease (P 65 years (P = .02), with diabetes mellitus (P = .057), cardiovascular disease (P = .005), and albumin were considered as independent factors for mortality in this study. SGA, albumin, and PEW were the only nutritional markers found to be associated with mortality in this cohort of PD patients. In the multivariate analysis, after adjusting for classic mortality risk factors, only patients with hypoalbuminemia were found to be at a high risk for mortality at follow-up. These results may be limited by the number of observations and a necessity for confirmation in larger prospective studies. Copyright © 2011 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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              Hypokalemia in Chinese peritoneal dialysis patients: prevalence and prognostic implication.

              Abnormal potassium metabolism may contribute to the increased cardiac morbidity and mortality seen in dialysis patients. We studied the pattern of serum potassium levels in a cohort of Chinese peritoneal dialysis (PD) patients. We studied serum potassium levels of 266 PD patients during 3 consecutive clinic visits. Dialysis adequacy, residual renal function, and nutritional status also were assessed. Patients were followed up for 33.7 +/- 20.7 months. Mean serum potassium level was 3.9 +/- 0.5 mEq/L (mmol/L). Five patients (1.9%) had an average serum potassium level less than 3 mEq/L (mmol/L), whereas 54 patients (20.3%) had a serum potassium level less than 3.5 mEq/L (mmol/L). Serum potassium levels correlated with overall Subjective Global Assessment score (r = 0.276; P < 0.001) and serum albumin level (r = 0.173; P = 0.005) and inversely with Charlson comorbidity score (r = -0.155; P = 0.011). There was no correlation between serum potassium level and daily PD exchange volume, total Kt/V, urine volume, or residual glomerular filtration rate. By means of multivariate analysis with Cox proportional hazard model to adjust for confounders, serum potassium level was an independent predictor of actuarial patient survival. PD patients with hypokalemia (serum potassium < 3.5 mEq/L [mmol/L]) had significantly worse actuarial survival (hazard ratio, 1.79; 95% confidence interval, 1.12 to 2.85; P = 0.015) than those without hypokalemia after adjusting for confounding factors. Hypokalemia is common in Chinese PD patients. Serum potassium level was associated with nutritional status and severity of coexisting comorbid condition. Furthermore, hypokalemia was an independent predictor of survival in PD patients. Additional studies may be needed to investigate the benefit of potassium supplementation for PD patients with hypokalemia.
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                Author and article information

                Contributors
                liushengm_cc1968@sina.com
                zhuangxiaohua0626@163.com
                1206922779@qq.com
                156011538@qq.com
                liuminwoniu@163.com
                171831006@qq.com
                lsjhylc@163.com
                miaolining55@163.com
                +8613504316157 , wenpengcui@163.com
                Journal
                Int Urol Nephrol
                Int Urol Nephrol
                International Urology and Nephrology
                Springer Netherlands (Dordrecht )
                0301-1623
                1573-2584
                16 January 2018
                16 January 2018
                2018
                : 50
                : 3
                : 541-549
                Affiliations
                ISNI 0000 0004 1760 5735, GRID grid.64924.3d, Department of Nephrology, Second Hospital, , Jilin University, ; 218 Ziqiang Street, Changchun, 130041 Jilin China
                Article
                1785
                10.1007/s11255-018-1785-1
                5845069
                29340842
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funding
                Funded by: Jilin Province Science and Technology Development Program funded project
                Award ID: 20150520034JH
                Award ID: 20150311082YY
                Award ID: 20160414014GH
                Award Recipient :
                Funded by: Jilin Province Scientific Research Program funded project
                Award ID: 2016446
                Award Recipient :
                Funded by: Jilin Province Health and Technology Innovation Development Program funded project
                Award ID: 2016J052
                Award Recipient :
                Funded by: Norman Bethune Program of Jilin University
                Award ID: 2015214
                Award Recipient :
                Categories
                Nephrology - Original Paper
                Custom metadata
                © Springer Science+Business Media B.V., part of Springer Nature 2018

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