Laparoscopic peritoneal dialysis catheter insertion with omentopexy-sparing the omentum in children.

INTRODUCTION: Continuous ambulatory peritoneal dialysis is an important modality of renal replacement therapy in children. Catheter dysfunction (commonly obstruction) is a major cause of morbidity and is a significant concern that hampers renal replacement therapy. As omentum is a significant cause of obstruction, some recommend routine omentectomy during insertion of the peritoneal dialysis catheter. Omentopexy rather than omentectomy has been described in adults to spare the omentum as it may be needed as a spare part in many conditions. Laparoscopic approach is commonly preferred as it provides global evaluation of the peritoneal space, proper location of the catheteral end in the pelvis and lesser morbidity due to inherent minimally invasive nature. AIM: The aim of this study is to present the technique of laparoscopic peritoneal dialysis catheter placement in children with concurrent omentopexy. METHODS: We retrospectively evaluated our patients who underwent laparoscopic placement of peritoneal dialysis catheter with concomitant omentopexy or omentectomy. RESULTS: A total of 30 patients were enrolled who received either omentectomy (n = 18) or omentopexy (n = 12). Four catheters were lost in the omentopexy group (33%) and 3 in the omentectomy group (17%), but none were related to omental obstruction. Three out of 4 patients in the omentopexy group and 2 out of 3 patients in the omentectomy group had a previous abdominal operation as a potential cause of catheter loss. Previous history of abdominal surgery was present in 6 patients (50%) in the omentopexy group and 3 patients (17%) in the omentectomy group. CONCLUSIONS: As omentum was associated with catheter failure, omentectomy is commonly recommended. Alternatively, omentopexy can be preferred in children to spare an organ that may potentially be necessary for many surgical reconstructive procedures in the future. Laparoscopic peritoneal dialysis catheter placement with concomitant omentopexy appears as a feasable and reproducible technique. Although the catheter loss seems to be higher in the omentopexy group, none was related with the omentopexy procedure and may be related to the higher rate of history of previous abdominal operations in this group.

Transitioning to peritoneal dialysis: it does not matter where you come from.

INTRODUCTION: Patients with end-stage renal disease (ESRD) frequently change renal replacement (RRT) therapy modality due to medical or social reasons. We aimed to evaluate the outcomes of patients under peritoneal dialysis (PD) according to the preceding RRT modality. METHODS: We conducted a retrospective observational single-center study in prevalent PD patients from January 1, 2010, to December 31, 2017, who were followed for 60 months or until they dropped out of PD. Patients were divided into three groups according to the preceding RRT: prior hemodialysis (HD), failed kidney transplant (KT), and PD-first. RESULTS: Among 152 patients, 115 were PD-first, 22 transitioned from HD, and 15 from a failing KT. There was a tendency for ultrafiltration failure to occur more in patients transitioning from HD (27.3% vs. 9.6% vs. 6.7%, p = 0.07). Residual renal function was better preserved in the group with no prior RRT (p < 0.001). A tendency towards a higher annual rate of peritonitis was observed in the prior KT group (0.70 peritonitis/year per patient vs. 0.10 vs. 0.21, p = 0.065). Thirteen patients (8.6%) had a major cardiovascular event, 5 of those had been transferred from a failing KT (p = 0.004). There were no differences between PD-first, prior KT, and prior HD in terms of death and technique survival (p = 0.195 and p = 0.917, respectively) and PD efficacy was adequate in all groups. CONCLUSIONS: PD is a suitable option for ESRD patients regardless of the previous RRT and should be offered to patients according to their clinical and social status and preferences.

Suture passer combined with two-hole laparoscopic peritoneal dialysis catheterization in patients undergoing peritoneal dialysis.

BACKGROUND: Laparoscopic techniques are being widely applied for peritoneal dialysis (PD) catheter (PDC) placement. The suture passer is a novel fixation tool that aims to reduce catheter migration. We compared the clinical value of the suture passer combined with two-hole laparoscopic PDC placement to open surgical placement by evaluating preoperative and postoperative conditions, as well as the onset of complications in both groups. METHODS: A retrospective study was conducted including 169 patients who underwent PDC placement surgery from January 2021 to May 2023. Based on the method employed, patients were divided into two groups: the suture passer combined with a two-hole laparoscopy group (SLG) and the open surgical group (SG). Comprehensive patient information, including general data, preoperative and postoperative indicators, peritoneal function after surgery, and the incidence rate of complications, were collected and analyzed. RESULTS: The SLG showed a statistically significant decrease in operative time, intraoperative blood loss, and 6-month postoperative drift rate compared to the SG (p < 0.05). No statistically significant differences were observed between the two groups in terms of sex, age, primary disease, hospitalization time, hospitalization costs, preoperative and postoperative examination indicators, peritonitis, and omental wrapping. CONCLUSIONS: Suture passer combined with two-hole laparoscopic PDC placement, characterized by simplicity and facilitating secure catheter fixation, was deemed safe and effective for patients undergoing PD. It reduces the catheter migration rate and improved surgical comfort. Overall, this technique demonstrates favorable outcomes in clinical practice.

The impact of icodextrin on the outcomes of incident peritoneal dialysis patients.

OBJECTIVE: The aim of the study is to investigate the effects of icodextrin on the risks of death, technique failure and the first episode of peritonitis in peritoneal dialysis (PD) patients. METHODS: From medical records of a medical center in Taiwan, a total of 725 newly diagnosed end-stage kidney disease patients receiving PD for at least 90 days from January 1, 2007 to December 31, 2018 were identified. These patients were grouped as 190 icodextrin users and 535 non-users. Users were defined as utilization of icodextrin for ≥ 50% of their PD duration. The use of icodextrin was considered a time-varying exposure in the Cox proportional hazard model. The risks of death, technique failure and the first episode of peritonitis were compared between two cohorts by the end of 2018. RESULTS: Compared to the non-users, the icodextrin users had significant lower risks of mortality (6.5 vs.7.2 per 100 person-years; adjusted HR = 0.62, 95% CI = 0.42-0.91) and technique failure (12.7 vs. 15.2 per 100 person-years; adjusted HR = 0.61, 95% CI = 0.47-0.81), and the first peritonitis episode (5.0 vs. 17.0 per 100 person-years; adjusted HR = 0.22, 95% CI = 0.14-0.35). The risk of peritonitis reduced further in icodextrin users with diabetes and with cardiovascular disease. CONCLUSION: Icodextrin was associated with lower risks of mortality, technique failure, and the first episode of peritonitis.

Psychological profile of Chinese peritoneal dialysis patients during the Omicron pandemic in 2022.

OBJECTIVE: The aim of this study was to determine the psychological status of peritoneal dialysis (PD) patients who were blocked during the 2022 Omic Pandemic in Shanghai. METHODS: This was an observational and cross-sectional study. We selected 172 PD patients from the peritoneal dialysis center of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, during the quarantine of the Omicron pandemic in Shanghai from April to May 2022. General data and biochemical indices were collected. The Kidney Disease Quality of Life (SF-36) questionnaire was used to evaluate the psychological state of the patients during the quarantine. RESULTS: According to the assessment of the SF-36 scale, the physiological and psychological health status of PD patients was better than that before quarantine (P < 0.05). According to the comparison of biochemical indices, the high-density lipoprotein, total cholesterol and body mass index (BMI) levels were lower in patients after quarantine than before quarantine, while the blood phosphorus, blood calcium and haemoglobin levels were greater after quarantine (P < 0.05). Logistic regression analysis revealed that health changes were positively correlated with age of penetration (years) (OR = 1.031, 95% CI = 1.005-1.058); however, physiological function was negatively correlated with sex (OR = 0.198, 95% CI = 0.044-0.899). Energy was significantly positively correlated with closed-loop time (OR = 1.063, 95% CI = 1.001-1.128) (P < 0.05). There were no significant differences in biochemical indices or quality of life between APD patients and non-APD patients (P > 0.05). According to the results of the abstract independent sample T test, when comparing the various dimensions of the SF-36 scale, for the dimensions of physiological function, pain and energy, the PD patients were better than the HD patients were (P < 0.05). Similarly, for the dimension of physiological function, the HD patients were better than the PD patients were (P < 0.05). During the quarantine period from April to May in Shanghai, the infection rate of PD patients was lower than usual (P < 0.05). CONCLUSIONS: During the Omicron pandemic in Shanghai in 2022, PD patients exhibited relatively stable psychological and physiological states and a low infection rate. Compared with HD patients, PD patients had better adaptability. Especially in the context of the COVID-19 pandemic, peritoneal dialysis has more advantages.

Comparison of Unplanned/Urgent-Start Versus Conventional-Start Peritoneal Dialysis: A Systematic Review and Meta-Analysis.

The timing of peritoneal dialysis (PD) initiation, whether conventional-start (planned) or urgent-start (unplanned), may impact the outcomes of PD and the rate of associated complications in individuals with chronic kidney disease (CKD). The goal of this study was to evaluate the effects of unplanned/urgent-start PD versus conventional-start PD in this cohort of patients. Electronic search of MEDLINE (via PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases was done from inception until July 2023 for studies reporting outcomes of unplanned/urgent-start and conventional-start PD in CKD patients. Outcomes of interest included mechanical complications, post-procedure infections, mortality, and transfer to hemodialysis. Heterogeneity, publication bias, and the influence of individual studies on the pooled odds ratio (OR) with 95% confidence interval (CI) were evaluated. Twenty-seven studies were finally included in the review. The overall risk of post-procedure infectious was comparable for both PD initiation methods (OR: 1.05; 95% CI: 0.83-1.34). Similarly, the risks for peritonitis and exit site infections did not differ significantly. However, urgent-start PD correlated with a significantly higher risk of overall mechanical complications (OR: 1.70; 95% CI: 1.23-2.34). Specifically, the risk for leaks was notably higher (OR: 2.47; 95% CI: 1.67-3.65) in the urgent-start group compared to the conventional-start PD group. Urgent-start PD correlated with significantly increased mortality rates (OR: 1.83; 95% CI: 1.39-2.41). There was no difference in the likelihood of technique survival and transfer to hemodialysis. Both urgent-start and conventional-start PD correlated with similar risks of overall infectious complications. Urgent-start PD resulted in significantly increased risks of mechanical complications and mortality. Our findings emphasize the need for meticulous planning and consideration when opting for PD initiation.

Peritoneal Dialysis in Italy: the 8th GPDP-SIN Census 2022 - 2nd Part: the Centers.

Objectives. The results are presented of the 8th National Census (Cs-22) of the Peritoneal Dialysis Project Group of the Italian Society of Nephrology relating to the characteristics of the Centers in Italy which used PD in 2022. Materials and methods. The 227 non-pediatric centers which used Peritoneal Dialysis (PD) in 2022 took part. The data requested were sent in aggregate form. For the first time, the resources available and training were investigated as well as home visits. The Centers have been divided into Quartiles according to the number of prevalent PD patients at 31/12/2022. Results. Centers with a smaller PD program (<9 pts) are characterized by 1. smaller overall size - 2. fewer personnel (doctors/nurses) dedicated to PD - 3. greater recourse to external personnel for training - 4. Less incremental prescription and evaluation of peritoneal permeability - 5. higher drop-out to HD in particular for choice/impossibility to continue and for adequacy/catheter-related issues. A lower peritonitis rate was recorded in Centers with a more extensive PD program (≥25 pts). Home visits are carried out regularly by a small minority of Centers. Conclusions. The analysis shows an association between size of Center PD program and available resources, PD modality and outcome.

Effect of two different peritoneal dialysis modalities on wound infection in peritoneal dialysis patients: A meta-analysis.

Peritoneal dialysis(PD) is one of the most efficient methods in end-stage kidney disease, and it is very important for PD to perform well. No research has been conducted to evaluate the effect of various types of PD catheters on the prognosis of post-operative wound complications. While recent meta-analyses are in favour of straight tubing, there is still uncertainty as to whether direct or coiled PD is beneficial. The purpose of this meta-analysis was to compare the efficacy of direct and coiled PD catheters on the incidence of post-operative wound infection, bleeding and peritonitis. A comprehensive search was carried out on three databases, including PubMed and Embase, and a manual search was carried out on the links in the paper. The results showed that the incidence rate of bleeding after operation and the degree of infection among the straight and coiled pipes were compared. The results showed that there were no statistically significant differences in the incidence of post-operative wound infection among straight PD patients with coiled PD (OR, 0.79; 95% CI, 0.58-1.08 p = 0.13). No statistical significance was found in the case of PD with coiled tubing compared with that of straight PD group in wound leakage (OR, 1.17; 95% CI, 0.71-1.93 p = 0.55). No statistically significantly different rates of post-operative peritonitis were observed for coiled tubing compared with straight ones in PD patients (OR, 1.06; 95% CI, 0.78-1.45 p = 0.7). There is no statistical significance on the rate of wound infection, wound leakage and peritonitis among coiled and straight tube in PD.

A landscape of metabolic variation among clinical outcomes of peritoneal dialysis in end-stage renal disease.

BACKGROUND: Peritoneal dialysis (PD) helps prevent lethal complications of end-stage renal disease (ESRD). However, the clinical outcomes are affected by PD-related complications. We investigated metabolic biomarkers to estimate the clinical outcomes of PD and identify patients at high risk of downstream complications and recurrent/relapsing infections. METHODS: Metabolites of normal control and ESRD patient were compared via an untargeted metabolomic analysis. Potential metabolic biomarkers were selected and quantified using a multiple reaction monitoring-based target metabolite detection method. A nomogram was built to predict the clinical outcomes of PD patients using clinical features and potential metabolic biomarkers with the least absolute shrinkage and selection operator Cox regression model. RESULTS: Twenty-five endogenous metabolites were identified and analyzed. ESRD-poor clinical outcome-related metabolic modules were constructed. Adenine, isoleucine, tyramine, xanthosine, phenylacetyl-L-glutamine, and cholic acid were investigated using the weighted gene correlation network analysis blue module. Potential metabolic biomarkers were differentially expressed between the NC and ESRD groups and the poor and good clinical outcomes of PD groups. A 3-metabolite fingerprint classifier of isoleucine, cholic acid, and adenine was included in a nomogram predicting the clinical outcomes of PD. CONCLUSION: Metabolic variations can predict the clinical outcomes of PD in ESRD patients.

Mortality of Peritoneal Dialysis versus Hemodialysis in Older Adults: An Updated Systematic Review and Meta-Analysis.

INTRODUCTION: The optimal choice of dialysis modality remains contentious in older adults threatened by advanced age and high risk of comorbidities. METHODS: We conducted a systematic review and meta-analysis of cohort and case-control studies to assess mortality risk between peritoneal dialysis (PD) and hemodialysis (HD) in older adults using PubMed, Embase, and the Cochrane Library database from inception to June 1, 2022. The outcome of interest is all-cause mortality. RESULTS: Thirty-one eligible studies with >774,000 older patients were included. Pooled analysis showed that PD had a higher mortality rate than HD in older dialysis population (HR 1.17, 95% CI: 1.10-1.25). When stratified by co-variables, our study showed an increased mortality risk of PD versus HD in older patients with diabetes mellitus or comorbidity who underwent longer dialysis duration (more than 3 years) or who started dialysis before 2010. However, definitive conclusions were constrained by significant heterogeneity. CONCLUSION: From the survival point of view, caution is needed to employ PD for long-term use in older populations with diabetes mellitus or comorbid conditions. However, a tailored treatment choice needs to take account of what matters to older adults at an individual level, especially in the context of limited survival improvements and loss of quality of life. Further research is still awaited to conclude this topic.

The relationship of platelet distribution width with all-cause and cardiovascular mortality in peritoneal dialysis patients.

BACKGROUND: Cardiovascular disease (CVD) is a major complication in peritoneal dialysis (PD) patients. Previous studies have demonstrated that platelet distribution width (PDW) is associated with cardiovascular events in hemodialysis (HD) patients. In this study, we hypothesized that elevated PDW can predict all-cause and cardiovascular mortality in PD patients. METHODS: We recruited PD patients for a single-center retrospective cohort study from 1 January 2007, to 30 June 2020. Receiver-operating characteristic (ROC) curves were made to determine the PDW cutoff value for predicting all-cause mortality. The propensity score matching (PSM) method was used to improve the equilibrium between groups. The relation of PDW with all-cause and cardiovascular mortality was analyzed by Cox proportional hazards models. Restricted cubic spline (RCS) models were used to determine whether there was a linear relationship between PDW and all-cause and cardiovascular mortality. RESULTS: A total of 720 PD patients were screened, and 426 PD patients were enrolled after PSM. After adjusting for confounders, Cox proportional hazards models showed that the PDW value was positively correlated with the risk of all-cause and cardiovascular mortality (HR = 1.162, 95% CI 1.057-1.278, p = 0.002 and HR = 1.200, 95% CI 1.041-1.382, p = 0.012). The adjusted RCS analysis further showed that the relationship of PDW with all-cause and cardiovascular mortality was linear (p for nonlinearly = 0.143 and 0.062). CONCLUSION: Elevated PDW is independently associated with all-cause and cardiovascular mortality in PD patients.

Intra-abdominal pressure and residual renal function decline in peritoneal dialysis: a threshold-based investigation.

BACKGROUND: The potential impact of elevated intra-abdominal pressure (IAP) on residual renal function (RRF) has not been determined. The objective of this study was to investigate the relationship between IAP and the rate of RRF decline in newly initiated peritoneal dialysis (PD) patients, and to identify the optimal IAP threshold value for delaying the deterioration of RRF. METHODS: A cohort of 62 newly initiated PD patients who completed both 6- and 12-month follow-up evaluations was obtained using the Durand method. A logistic regression model was used to identify variables associated with a rapid decline in RRF. Receiver operating characteristic (ROC) curves were generated to determine the optimal threshold value. Another retrospective cohort analysis was performed to validate the identified critical value. RESULTS: For each 1 cmH2O increase in IAP, the risk of a rapid decline in the RRF increased by a factor of 1.679. Subsequent analysis revealed that patients in the high IAP group had more significant decreases in residual renal estimated glomerular filtration rate (eGFR) (Z = -3.694, p < 0.001) and urine volume (Z = -3.121, p < 0.001) than did those in the non-high IAP group. Furthermore, an IAP ≥15.65 cmH2O was a robust discriminator for the prediction of the rate of RRF decline. CONCLUSION: Patients in the high IAP group experienced a more rapid decline in RRF. Additionally, an optimal critical pressure of 15.65 cmH2O was identified for predicting the rate of RRF decline. IAP, as one of the factors contributing to the rapid decline in RRF in the first year of PD, should be given due attention.

Using the concept of food as medicine to mitigate inflammation in patients undergoing peritoneal dialysis.

The most common kidney replacement therapy (KRT) worldwide is hemodialysis (HD), and only 5%-10% of patients are prescribed peritoneal dialysis (PD) as KRT. Despite PD being a different method, these patients also present particular complications, such as oxidative stress, gut dysbiosis, premature aging, and mitochondrial dysfunction, leading to an inflammation process and high cardiovascular mortality risk. Although recent studies have reported nutritional strategies in patients undergoing HD with attempts to mitigate these complications, more information must be needed for PD patients. Therefore, this review provides a comprehensive analysis of recent studies of nutritional intervention to mitigate inflammation in PD patients.

The Association of Intra-Abdominal Adhesions with Peritoneal Dialysis Catheter-Related Complications.

BACKGROUND: This study investigated the association of intra-abdominal adhesions with the risk of peritoneal dialysis (PD) catheter complications. METHODS: Individuals undergoing laparoscopic PD catheter insertion were prospectively enrolled from eight centers in Canada and the United States. Patients were grouped based on the presence of adhesions observed during catheter insertion. The primary outcome was the composite of PD never starting, termination of PD, or the need for an invasive procedure caused by flow restriction or abdominal pain. RESULTS: Seven hundred and fifty-eight individuals were enrolled, of whom 201 (27%) had adhesions during laparoscopic PD catheter insertion. The risk of the primary outcome occurred in 35 (17%) in the adhesion group compared with 58 (10%) in the no adhesion group (adjusted HR, 1.64; 95% confidence interval [CI], 1.05 to 2.55) within 6 months of insertion. Lower abdominal or pelvic adhesions had an adjusted HR of 1.80 (95% CI, 1.09 to 2.98) compared with the no adhesion group. Invasive procedures were required in 26 (13%) and 47 (8%) of the adhesion and no adhesion groups, respectively (unadjusted HR, 1.60: 95% CI, 1.04 to 2.47) within 6 months of insertion. The adjusted odds ratio for adhesions for women was 1.65 (95% CI, 1.12 to 2.41), for body mass index per 5 kg/m 2 was 1.16 (95% CI, 1.003 to 1.34), and for prior abdominal surgery was 8.34 (95% CI, 5.5 to 12.34). Common abnormalities found during invasive procedures included PD catheter tip migration, occlusion of the lumen with fibrin, omental wrapping, adherence to the bowel, and the development of new adhesions. CONCLUSIONS: People with intra-abdominal adhesions undergoing PD catheter insertion were at higher risk for abdominal pain or flow restriction preventing PD from starting, PD termination, or requiring an invasive procedure. However, most patients, with or without adhesions, did not experience complications, and most complications did not lead to the termination of PD therapy.

Resuming peritoneal dialysis after secondary embedding of the peritoneal dialysis catheter in the end-of-life period: A case report.

Secondary embedding of a peritoneal dialysis (PD) catheter has been performed for patients whose kidney function has improved enough to stop dialysis but recovery is not expected to be long term. In addition, we have also performed the procedure for patients who have poor general condition due to severe cerebrovascular and/or cardiac disease or who wish to have PD again at the end of life. Here, we report the case of the first terminal haemodialysis (HD) patient who resumed PD using a secondarily embedded catheter as an end-of-life choice. The patient had undergone secondary embedding of a PD catheter and had been transferred to HD, during which time multiple pulmonary metastases of thyroid cancer were observed. She hoped to resume PD in the end-of-life period, and the catheter was subsequently externalised. The catheter was used immediately, and the patient has continued on PD over the past 1 month without infectious or mechanical complications. For elderly end-stage kidney disease patients with progressive disease and cancer, secondary embedding of the PD catheter may be an option to permit them to live the remainder of their lives at home.

Blockade of sodium-glucose co-transporters improves peritoneal ultrafiltration in uraemic rodent models.

BACKGROUND: The most used PD fluids contain glucose as a primary osmotic agent. Glucose peritoneal absorption during dwell decreases the osmotic gradient of peritoneal fluids and causes undesirable metabolic consequences. Inhibitors of sodium-glucose co-transporter (SGLT) type 2 are wildly used for the treatment of diabetes, heart and kidney failure. Previous attempts to use SGLT2 blockers in experimental peritoneal dialysis yielded contrasting results. We studied whether peritoneal SGLTs blockade may improve ultrafiltration (UF) via partial inhibition of glucose uptake from dialysis fluids. METHODS: Kidney failure was induced in mice and rats by bilateral ureteral ligation, and dwell was performed by injection of glucose-containing dialysis fluids. The effect of SGLT inhibitors on glucose absorption during fluid dwell and UF was measured in vivo. RESULTS: Diffusion of glucose from dialysis fluid into the blood appeared to be sodium-dependent, and blockade of SGLTs by phlorizin and sotagliflozin attenuated blood glucose increment thereby decreasing fluid absorption. Specific SGLT2 inhibitors failed to reduce glucose and fluid absorption from the peritoneal cavity in a rodent kidney failure model. CONCLUSIONS: Our study suggests that peritoneal non-type 2 SGLTs facilitate glucose diffusion from dialysis solutions, and we propose that limiting glucose reabsorption by specific SGLT inhibitors may emerge as a novel strategy in PD treatment to enhance UF and mitigate the deleterious effects of hyperglycaemia.