Relationship between intraperitoneal pressure and the development of hernias in peritoneal dialysis: confirmation for the first time of a widely accepted concept.

BACKGROUND: Intraperitoneal pressure (IPP) in peritoneal dialysis (PD) is an individual characteristic that can be modified by posture and intraperitoneal volume (IPV). It is considered one of the predisposing factors for complications in the abdominal wall, such as the appearance of hernias. No studies to date have confirmed this. The main aim of this study was to assess the relationship between the development of hernia in incident PD patients and IPP measured at PD onset. METHODS: A prospective observational study of incident patients in a PD programme between 2010 and 2020. IPP was measured using the Durand's method. RESULTS: One hundred and twenty-four incident patients on PD, 68% male, mean age 62.1 ± 15.23 years, body mass index (BMI) 27.7 ± 4.82 kg/m2, 44% were diabetic. IPP in supine was 16.6 ± 4.60 cm H2O for a mean IPV of 2047.1 ± 359.19 mL. Hernias were reported in 18.5% of patients during PD follow-up: 57% were inguinal hernias, 33% umbilical, and a further 10% presented in a combined form. PD hernias correlated positively with IPP in supine position (p = 0.037), patient age (p = 0.008), BMI (p = 0.043), a history of prior hernia (0.016), laparoscopic catheter placement (p = 0.026), and technique failure (p = 0.012). In the multivariate analysis, a higher IPP was independently related to the development of hernias (p = 0.028). CONCLUSIONS: The development of hernias in PD was related to a higher IPP at PD onset, older age, higher BMI, history of prior hernia, catheter placement by laparoscopy, and technique failure.

Urinary loss of thyroid hormones: An issue to remember.

A 45-year-old woman suffering from primary hypothyroidism, previously well substituted with levothyroxine, was urgently referred from Primary Care to Endocrinology due to very elevated thyrotropin, free thyroxine at low limit of normality, very high cholesterol and generalised oedema. Hypothyroidism was suspected as the main aetiology of this clinical condition. A detailed examination showed nephrotic range proteinuria and the patient was finally diagnosed with lupus nephritis. Urinary loss of thyroid hormones, fundamentally linked to their transport proteins, in patients affected by nephrotic syndrome is sometimes a forgotten phenomenon and one which should be considered in patients with increased levothyroxine requirements. In this report, we present the details of this case and a brief review of the literature on this topic.

Prevalence of Protein-Energy Wasting in Dialysis Patients Using a Practical Online Tool to Compare with Other Nutritional Scores: Results of the Nutrendial Study.

This cross-sectional study aims to explore the prevalence of protein-energy wasting (PEW) in dialysis patients in Catalonia, Spain, using a new and practical online tool which enables rapid calculation and comparison with other nutritional scores. METHODS: A web tool (Nutrendial) was created to introduce different variables and automatically calculate PEW, Malnutrition inflammation Score (MIS) and Subjective Global Assessment (SGA) in 1389 patients (88% in haemodialysis (HD)), 12% in peritoneal dialysis (PD) from different regions of Catalonia. RESULTS: A prevalence of 23.3% (26% HD, 10.2% PD) of PEW was found, with a mean MIS score of 6 and SGA score of C in 7% of the patients. ROC analysis showed MIS as the best nutritional score to diagnose PEW (AUC 0.85). Albumin delivered lower diagnostic precision (AUC 0.77) and sensitivity (66%). A cut off point of 7 (86% sensitivity and 75% specificity) for MIS and 3.7 mg/dL for albumin were found to predict the appearance of PEW in this population. SGA B or C showed an 87% sensitivity and 55% specificity to diagnose PEW. Very low nutritional intervention (14%) was recorded with this tool in patients with PEW. CONCLUSIONS: This new online tool facilitated the calculation of PEW, enabling different professionals-including nephrologists, dieticians and nurses-to efficiently obtain insights into the nutritional status of the Catalonian dialysis population and implement the required nutritional interventions. MIS is the score with more sensitivity to diagnose PEW.